Introduction
Vitamin K deficiency bleeding or VKDB, occurs when babies cannot stop bleeding because their blood does not have enough Vitamin K to form a clot.
The bleeding can occur anywhere on the inside or outside of the body.
It is formerly known as the Haemorrhagic Disease of the Newborn.
It is due to the deficiency of the clotting factors II, VII, IX and X.
In the newborn, the levels of the clotting
factors are naturally low and coupled with low Vitamin K production, the newborn infant has a natural tendency for haemorrhage.
Both term and preterm infants are affected but the risk is higher among preterm infants.
Infants of mothers on anti-convulsant or anti coagulant therapies and infants on prolonged exclusive breastfeeding are also at higher risk of the disease.
Clinical Presentation of Vitamin K Deficiency Bleeding in Children
This disease in the classical type, it presents between the second and fourth days of life.
The early type presents within the first 24 hours of life while the late type occurs as late as three to six weeks of life.
Classical features include oozing from
puncture sites or circumcision sites, umbilical stump haemorrhage, haematemesis and or melaena, ecchymoses, epistaxis or scalp haemorrhage, intra-viscera haemorrhage (kidney, brain) may also occur in severe cases.
Investigations
- Prothrombin time – very prolonged
- Activated partial thromboplastin time – prolonged
- Thrombin time – normal.
- Fibrin degradation products – normal
- Platelet count – normal
Treatment for Vitamin K Deficiency Bleeding in Children
Once haemorrhage occurs, intramuscular injections should be avoided to prevent haematoma formation.
Intravenous Vitamin K, (1-3mg) should be administered daily for up to 3 days.
Fresh Frozen Plasma should be
administered along with therapeutic
doses of Vitamin K, because the corrective action of Vitamin K, is usually delayed.
If bleeding is severe and baby is shocked,
immediate replacement transfusion with O Rhesus-negative whole blood (20ml/kg) is indicated.
This is preferably done through a central vein (umbilical vein) over 20-30 minutes.
Important supportive care includes oxygen therapy and frequent monitoring of oxygen saturation and central venous pressure.
In the absence of shock, gradual correction using single-volume exchange
blood transfusion (80ml/kg) is important.
This may be followed up with top-up transfusion (10ml/kg of packed cells or 15ml/kg of partially packed cells) in case the haematocrit remains low.