Hemorrhagic Disease In Newborn

A baby with a bleeding nose

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During pregnancy, the growing foetus needs an adequate supply of essential nutrients to develop all the organs and be healthy for delivery. Absence or shortage of essential nutrients can lead to the incomplete development of organs and birth deficiencies in the infant. In some cases, insufficient nutrition can also lead to long-term disorders or even death of the child. Therefore, it is important to ensure the proper intake of food to meet the necessary nutritional requirements.





What is Hemorrhagic Disease or VKDB?

Haemorrhagic disease in a newborn is also known as Vitamin K Deficiency Bleeding or VKDB and is a bleeding problem in a newborn baby immediately after birth. This disease is caused due to the deficiency of vitamin K. In this case, due to the absence of sufficient vitamin K, the blood doesn’t clot properly, thereby leading to severe bleeding and haemorrhaging in some cases.

The bleeding might be external or internal. Internal bleeding can occur in the brain or the intestines and can be fatal.




Types of VKDB in Newborns

Based on the timing of initial haemorrhage after the birth of the baby, this disease can be classified into the following three categories:

  • Easy Onset VKDB

This type of vitamin K deficiency bleeding can have severe haemorrhagic complications. It occurs within the first 24 hours of the baby’s birth and is mainly observed in cases where the mother has been taking anticonvulsant or anti-tuberculosis medication.





  • Classic Onset VKDB

A classic vitamin K deficiency bleeding sets in within 24 hours after birth and may be present for as late as the first week after birth. In most cases, the classic onset occurs after the first day of birth, but sometimes it can also happen anytime during the first month of birth. This condition is seen in infants who do not receive prophylactic vitamin K at birth. VKDB bleeding typically occurs in the nose, skin, gastrointestinal tract and umbilicus. Bleeding in the brain is not very common in this condition.

  • Late-Onset VKDB

The late hemorrhagic disease in a newborn occurs between the second and the twelfth week after birth. However, the bleeding can happen up to six months after birth. This condition is common in infants who do not receive vitamin K prophylaxis in sufficient quantities at birth.




Causes of Hemorrhagic Disorders in Newborns

The primary reason for the development of hemorrhagic disorder in newborn babies is the deficiency of vitamin K at birth. In the absence of sufficient vitamin K, the body loses the ability to clot blood at a faster rate. The chances of newborn babies developing this disease are high as they typically have low levels of vitamin K at birth. The causes of vitamin K deficiency in newborns are mentioned below:

  • Developing babies might not receive sufficient vitamin K as its movement through the placenta is difficult.
  • Breast milk, which is the primary source of nutrition for the child immediately after birth, does not contain enough vitamin K to suffice the child’s needs. This keeps the level of vitamin K low, allowing the disease to set in.
  • Vitamin K in a human body is also produced by good gut bacteria. However, these bacteria are not present in the body of newborns.

Risk Factors

Risk factors for VKDB are different for each type:





  • Easy Onset

The risk of developing the disease within 24 hours of birth is increased if you have taken blood thinners, anti-seizure drugs, anti-biotic or anti-tuberculosis drugs during pregnancy.

  • Classic Onset

Babies are at risk of classic onset when they have not received sufficient prophylactic vitamin K at birth. The chances of a classic onset are higher if they are only given breast milk.




  • Late Onset

Risk factors for late-onset include hepatitis, low levels of vitamin K in breast milk, chronic diarrhoea, cystic fibrosis and celiac disease.

Symptoms

Common symptoms of VKDB include:





  • Blood in stool
  • Blood in urine
  • Lumps on the head
  • Bleeding in the navel area
  • Bleeding mucus membranes
  • Bruising
  • Seizures
  • Excessive vomiting with blood in the vomit at times
  • Paleness in the skin and gums
  • Yellowish tinge in the eyes, usually after three weeks of birth
  • Bleeding in the penis if there has been a circumcision
  • Visible marks of needle stick in the body

Diagnosis

Prothrombin time is the time taken for the blood to clot and is used to determine the presence of the disease. A test conducted where the time taken for the blood to clot is measured. The baby is given a vitamin K injection, and the timing of the blood clot is taken into consideration. The existence of the disease is established if the injection shortens the blood clotting time after 30 minutes, or stops the bleeding altogether.

Ultrasound or MRI can also be used to identify a case of internal bleeding.




Treatment

Adhesive bandage on a baby’s leg to stop bleeding after shots

In case the presence of this disease is established after diagnosis, the baby will be given a vitamin K shot right away to increase the clotting ability of the blood immediately. The baby may also be provided with an oral dosage of vitamin K instead of injections. A blood transfusion may be required for babies who have experienced severe bleeding.

Possible Complications

The possible complications of a vitamin K deficiency include:





  • Damage to the brain because of bleeding inside the skull.
  • Heavy blood loss in the baby.
  • Vomiting and a feeling of discomfort.
  • Body seizures
  • Death due to an excessive loss of blood is also possible

About Vitamin K Shot

A vitamin K shot contains low quantities of benzyl alcohol which is found to be safe for infants. You can also consult a doctor to understand the risks and benefits associated with vitamin K shots.

It is difficult to supplement a vitamin K dosage with vitamin K rich food items to prevent the disease. It is important to know that the only source of nutrition for the baby during early days is the mother’s milk, which does not contain sufficient vitamin K. This makes a vitamin K shot a necessity.




Prevention

The occurrence of a hemorrhagic disease can be prevented by using the following ways:

  • A shot of vitamin K given to the baby right after birth is sufficient to prevent this condition.
  • In case you have taken anti-seizure drugs or blood thinners during pregnancy, your doctor might administer you a shot of vitamin K to protect the baby.
  • An Oral administration of vitamin K to the infant can also prevent the condition.

Hemorrhagic disease in kids can be lethal if not treated immediately. However, with certain precautionary steps, it can easily be prevented.