Hemorrhagic disease of the newborn babies
Hemorrhagic disease of the newborn is a rare bleeding problem that can occur after birth. Hemorrhaging is excessive bleeding. It’s a potentially life-threatening condition.
The condition is caused by vitamin K deficiency. As a result, it’s often called vitamin K deficiency bleeding, or VKDB. Vitamin K plays a key role in blood clotting. Because vitamin K is not efficiently passed on from mother to baby in uterus, most babies are born with low stores of this vitamin in their system.
Forms of vitamin K
Vitamin K is known as the “blood-clotting vitamin” for its important role in healing wounds. The "K" is derived from the German word koagulation.
The following 3 forms of vitamin K are known:
• K 1: Phylloquinone is predominantly found in green leafy vegetables, vegetable oils, and dairy products. Vitamin K given to neonates as a prophylactic agent is an aqueous, colloidal solution of vitamin K 1.
• K 2: Menaquinone is synthesized by gut flora.
• K 3: Menadione is a synthetic, water soluble form that is no longer used medically because of its ability to produce hemolytic anemia.
Vitamin K is an essential cofactor for γ-glutamyl carboxylase enzymatic activity that catalyses the γ-carboxylation of specific glutamic acid residues in a subclass of proteins. These vitamin K–dependent proteins are known as Gla-proteins. The image below outlines the vitamin K cycle.
Sources
Bacteria in the gastrointestinal tract naturally make vitamin K. Dietary sources of vitamin K include green leafy vegetables — collards, green leaf lettuce, kale, mustard greens, parsley, romaine lettuce, spinach, Swiss chard and turnip greens — as well as vegetables such as broccoli, Brussels sprouts, cauliflower and cabbage. Other sources that are less rich in vitamin K include meats, fish, liver, eggs and cereals.
Causes
A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting.
Babies often have a low level of vitamin K for a variety of reasons. Vitamin K does not move easily across the placenta from the mother to the baby. As a result, a newborn does not have much vitamin K stored up at birth. Also, the bacteria that help make vitamin K are not yet present in a newborn's gastrointestinal tract. Finally, there is not much vitamin K in mother's milk.
Your baby may develop this condition if:
• A preventive vitamin K shot is not given at birth (if vitamin K is given by mouth instead of as a shot, it must be given more than once, and it does not appear to be as effective as the shot).
• You take certain anti-seizure or blood thinning drugs
The condition is grouped into three categories:
• Early onset VKDB is very rare. It occurs during the first hours after birth and within 24 hours. Use of anti-seizure medicines or some other medicines, including a blood thinner called Coumadin, during pregnancy is a common cause.
• Classic onset disease occurs between 24 hours and 7 days after birth. It may be seen in breastfed infants who did not receive a vitamin K shot within the first week after birth, especially those for whom feedings were delayed initially. It is also rare.
• Late onset VKDB is seen in infants between 2 weeks and 2 months old. It is more common in children who did not receive a vitamin K shot.
Newborns and infants with the following problems involving the gastrointestinal tract are more likely to develop this disorder:
• Alpha1-antitrypsin deficiency
• Biliary atresia
• celiac disease
• cystic fibrosis
• Diarrhea
• Hepatitis
•
Symptoms of hemorrhagic disease of the newborn
If your baby has VKDB, they may show subtle signs of “failure to thrive” before a serious bleeding event occurs. These symptoms include:
1) Warning bleeds, which may seem insignificant
2) Low weight for your baby’s age
3) Slow increase in weight
4) Bleeding can occur in one or multiple areas, including:
a )their umbilical stump, the naval area where their umbilical cord was removed
the mucous membranes of their nose and mouth
b) their penis,it is circumcised
c) areas where they’ve been stuck by a needle, for example, for vaccinations
d) their gastrointestinal tract
The second nation-wide survey in Japan of vitamin K deficiency in infancy:
In 1980, the first nationwide survey on late vitamin K deficiency bleeding (VKDB) in infants was conducted in Japan, and it was followed by the second, third and fourth nationwide surveys in 1985, 1988 and 1991, respectively. The fifth nationwide survey was designed to ascertain the epidemiology of late VKDB between January 1999 and December 2004.
PATIENTS AND METHODS:
Questionnaires were sent to 2161 hospitals in Japan that employed members of the Japan Pediatric Society in March 2005. Responses were received from 1373 hospitals, for a response rate of 63.5%.
RESULTS:
The total number of reported cases was 71, including 21 idiopathic type and 16 secondary type. The incidence of late VKDB was estimated to be 1.9 cases per 100,000 births (95% confidence interval: 1.2-3.0) during this survey period. In 34 cases, the presence or absence of any underlying disease was not clarified. A total of 67/71 infants were entirely breast-fed. Intracranial hemorrhaging was observed in 26 (63.4%) out of 41 infants whose bleeding sites were described in the questionnaires. In 63 cases (88.7%) of late VKDB found in the present survey, however, vitamin K had been given at least once either during or after the neonatal period.
CONCLUSIONS:
A reevaluation of the current prophylaxis strategy for late VKDB in infants is necessary.
The condition is caused by vitamin K deficiency. As a result, it’s often called vitamin K deficiency bleeding, or VKDB. Vitamin K plays a key role in blood clotting. Because vitamin K is not efficiently passed on from mother to baby in uterus, most babies are born with low stores of this vitamin in their system.
Forms of vitamin K
Vitamin K is known as the “blood-clotting vitamin” for its important role in healing wounds. The "K" is derived from the German word koagulation.
The following 3 forms of vitamin K are known:
• K 1: Phylloquinone is predominantly found in green leafy vegetables, vegetable oils, and dairy products. Vitamin K given to neonates as a prophylactic agent is an aqueous, colloidal solution of vitamin K 1.
• K 2: Menaquinone is synthesized by gut flora.
• K 3: Menadione is a synthetic, water soluble form that is no longer used medically because of its ability to produce hemolytic anemia.
Vitamin K is an essential cofactor for γ-glutamyl carboxylase enzymatic activity that catalyses the γ-carboxylation of specific glutamic acid residues in a subclass of proteins. These vitamin K–dependent proteins are known as Gla-proteins. The image below outlines the vitamin K cycle.
Sources
Bacteria in the gastrointestinal tract naturally make vitamin K. Dietary sources of vitamin K include green leafy vegetables — collards, green leaf lettuce, kale, mustard greens, parsley, romaine lettuce, spinach, Swiss chard and turnip greens — as well as vegetables such as broccoli, Brussels sprouts, cauliflower and cabbage. Other sources that are less rich in vitamin K include meats, fish, liver, eggs and cereals.
Causes
A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting.
Babies often have a low level of vitamin K for a variety of reasons. Vitamin K does not move easily across the placenta from the mother to the baby. As a result, a newborn does not have much vitamin K stored up at birth. Also, the bacteria that help make vitamin K are not yet present in a newborn's gastrointestinal tract. Finally, there is not much vitamin K in mother's milk.
Your baby may develop this condition if:
• A preventive vitamin K shot is not given at birth (if vitamin K is given by mouth instead of as a shot, it must be given more than once, and it does not appear to be as effective as the shot).
• You take certain anti-seizure or blood thinning drugs
The condition is grouped into three categories:
• Early onset VKDB is very rare. It occurs during the first hours after birth and within 24 hours. Use of anti-seizure medicines or some other medicines, including a blood thinner called Coumadin, during pregnancy is a common cause.
• Classic onset disease occurs between 24 hours and 7 days after birth. It may be seen in breastfed infants who did not receive a vitamin K shot within the first week after birth, especially those for whom feedings were delayed initially. It is also rare.
• Late onset VKDB is seen in infants between 2 weeks and 2 months old. It is more common in children who did not receive a vitamin K shot.
Newborns and infants with the following problems involving the gastrointestinal tract are more likely to develop this disorder:
• Alpha1-antitrypsin deficiency
• Biliary atresia
• celiac disease
• cystic fibrosis
• Diarrhea
• Hepatitis
•
Symptoms of hemorrhagic disease of the newborn
If your baby has VKDB, they may show subtle signs of “failure to thrive” before a serious bleeding event occurs. These symptoms include:
1) Warning bleeds, which may seem insignificant
2) Low weight for your baby’s age
3) Slow increase in weight
4) Bleeding can occur in one or multiple areas, including:
a )their umbilical stump, the naval area where their umbilical cord was removed
the mucous membranes of their nose and mouth
b) their penis,it is circumcised
c) areas where they’ve been stuck by a needle, for example, for vaccinations
d) their gastrointestinal tract
The second nation-wide survey in Japan of vitamin K deficiency in infancy:
In 1980, the first nationwide survey on late vitamin K deficiency bleeding (VKDB) in infants was conducted in Japan, and it was followed by the second, third and fourth nationwide surveys in 1985, 1988 and 1991, respectively. The fifth nationwide survey was designed to ascertain the epidemiology of late VKDB between January 1999 and December 2004.
PATIENTS AND METHODS:
Questionnaires were sent to 2161 hospitals in Japan that employed members of the Japan Pediatric Society in March 2005. Responses were received from 1373 hospitals, for a response rate of 63.5%.
RESULTS:
The total number of reported cases was 71, including 21 idiopathic type and 16 secondary type. The incidence of late VKDB was estimated to be 1.9 cases per 100,000 births (95% confidence interval: 1.2-3.0) during this survey period. In 34 cases, the presence or absence of any underlying disease was not clarified. A total of 67/71 infants were entirely breast-fed. Intracranial hemorrhaging was observed in 26 (63.4%) out of 41 infants whose bleeding sites were described in the questionnaires. In 63 cases (88.7%) of late VKDB found in the present survey, however, vitamin K had been given at least once either during or after the neonatal period.
CONCLUSIONS:
A reevaluation of the current prophylaxis strategy for late VKDB in infants is necessary.
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