What Is Hemorrhagic Disease In Newborn? Causes And Treatment

The sooner you learn the cause, the earlier and better the disorder can be treated.

Medically reviewed by Dr. Mubina Agboatwalla, MBBS, DCH Dr. Mubina Agboatwalla Dr. Mubina AgboatwallaMBBS, DCH facebook_iconlinkedin_iconyoutube_icon Specialty: PediatricsExperience: 20 years
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Hemorrhagic Disease Of Newborn Types, Causes, Symptoms And Treatment

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A hemorrhage refers to a bleeding disorder. Hemorrhage disease in newborns can happen in the initial days of a baby’s life. The condition occurs due to vitamin K deficiency and is also called vitamin K deficiency bleeding (VKDB). Reportedly, babies are born with low body reserves of vitamin K, which is essential for blood clotting; hence this condition is common in newborns.

Read this post to learn more about the types, causes, symptoms, diagnosis, complications, treatment, and long-term outcomes of hemorrhagic disease of the newborn or VKDB.

Types Of VKDB In Newborns

According to the age of onset, hemorrhagic disease of the newborns can be classified into three types(1).

  • Early VKDB occurs in-utero, during delivery, or during the first 24 hours after birth
  • Classical VKDB occurs from the second to the seventh day of neonatal life (first week of life)
  • Late VKDB occurs any time from the eighth day to six to twelve months after birth.

Causes Of Hemorrhagic Disease Of The Newborn

A deficiency of vitamin K causes the reduced activity of clotting factors, leading to bleeding. This condition is called hemorrhagic disease of the newborn or VKDB.

The causes of vitamin K deficiency could be idiopathic or secondary. The idiopathic causes are unknown causes. The secondary causes of vitamin K deficiency could include the following (2).

  • Insufficient placental transfer of vitamin K
  • Poor hepatic storage and immaturity of liver
  • Lack of vitamin K in the breastmilk
  • A sterile gut that cannot synthesize vitamin K

Adults can synthesize vitamin K in the gut with the help of gut bacteria. In comparison, the neonatal gut may lack bacteria that can make vitamin K.

Risk Factors For Hemorrhagic Disease Of The Newborn

The following factors may increase the risk of developing vitamin K deficiency in a newborn (3).

  • Mutation in genes that encode enzymes for the formation of vitamin K
  • Maternal exposure to anti-tuberculosis drugs
  • Maternal exposure to anti-epileptic drugs and broad-spectrum antibiotics
  • Maternal use of warfarin, an anti-coagulant drug and vitamin K antagonist
  • Prematurity

Some of the other risk factors for infants include being born through spontaneous vaginal delivery, breastfeeding, and male gender. It is not fully understood how these risk factors lead to vitamin K deficiency among infants.

Symptoms And Signs Of Hemorrhagic Disease

The following signs and symptoms are commonly seen in VKDB (1).

  • Intracranial bleeding (bleeding inside the skull)
  • Cephalohematoma (bleeding outside)
  • Blood streaks in mouth secretions or respiratory secretions
  • Melaena (black tarry stools) or blood streaks in stool
  • Hematemesis (vomiting blood)
  • Bleeding umbilicus
  • Petechiae or red spots on the skin
  • Bleeding from the gums
  • Nasal bleeding
  • Bleeding from the umbilical cord after cutting the cord

Respiratory symptoms indicate bleeding in the intrathoracic areas, while GI symptoms, such as black tarry stools, indicate bleeding from the GI tract. Intracranial bleeding is common in babies with VKDB, and they may have the following signs and symptoms (1). It generally occurs in the first few days of life.

  • Baby is inactive.
  • Floppiness
  • Reduced consciousness
  • Pallor (paleness of skin)
  • Feeding problems
  • Reduced respiratory rate

Seek emergency medical care if you notice any signs of bleeding in the newborn. Delay in treatment may lead to complications.

Possible Complications Of Hemorrhagic Disease

Bleeding is the most common complication in VKDB. It can lead to intracranial hemorrhage, which is often fatal among babies younger than a year. Intracranial hemorrhage and increased intracranial pressure could also lead to the following neurological conditions (4).

  • Cerebral atrophy
  • Cerebral hypoxia
  • Seizures
  • Severe developmental delay
  • Encephalopathy
  • Hydrocephalus

Complications are expected in late vitamin K deficiency bleeding. Therefore, if you notice any unusual bleeding or other signs, seek immediate pediatric care.

Diagnosis Of Hemorrhagic Disease Of The Newborn

Doctors may ask for detailed prenatal and medical history to find the cause of vitamin K deficiency. The following tests are ordered to diagnose the condition and its cause (1).

  • Partial thromboplastin time (PTT)
  • Complete blood count to analyze platelet levels
  • Prothrombin time (PT)
  • Bleeding time and clotting time
  • Liver function tests
  • International normalized ratio (INR)
  • Fibrinogen levels
  • Estimation of PIVKA, a protein induced in vitamin K absence
  • Chest X-ray and ultrasound to look for bleeding in the body
  • MRI or CT scan to visualize intracranial hemorrhage

The following diseases are differentiated before diagnosing VKDB, depending on the signs and symptoms.

  • Hemophilia or hemophilia B, a non-reversal clotting factor deficiency
  • Disseminated intravascular coagulation (DIC) due to septicemia.
  • Thrombocytopenia (low platelet count)
  • Gastrointestinal bleeding due to conditions such as intussusception

Vitamin K deficiency causes an increase in the clotting time, while the fibrinogen levels remain normal. Even if the cause of VKDB is not determined, the administration of vitamin K for five days could improve clotting time, thus letting doctors conclude the presence of VKDB.

Treatment For Hemorrhagic Disease Of The Newborn

The treatment of vitamin k deficiency is the administration of vitamin K to the newborn. Usually, the treatment begins with the investigation of the cause. Therefore, the infant is administered vitamin K even before the diagnosis of the underlying cause.

A single intramuscular dose of 1mg vitamin K can improve the condition within a week. Generally, three injections of Vitamin K are given on three consecutive days. Management may vary depending on the symptoms and severity of bleeding (5).

  • Immediate blood transfusion with fresh frozen plasma is needed for a newborn with life-threatening bleeding.
  • Intracranial shunting is done to relieve intracranial pressure.
  • Physiotherapy may be referred for neurological strengthening.
  • Nutritional assistance is provided for babies with swallowing and sucking difficulties.

Prognosis Of Hemorrhagic Disease Of The Newborn

The prognosis (outcome) of the disease is improved in babies who receive timely administration of vitamin K. It may even help reduce morbidities and mortalities due to bleeding. Neurological damage could be a long-term outcome for babies who had VKDB at an early age. However, early medical care and vitamin K injections could help prevent it.  The baby could continue to require routine follows up to reduce the risk of complications.

Frequently Asked Questions

1. Is the hemorrhagic disease of the newborn fatal?

Yes. Hemorrhagic disease in the newborn can be life-threatening if not addressed with timely treatment (1).

2. How common is the hemorrhagic disease in newborns?

According to studies, this condition affects about two percent of babies (6).

Hemorrhagic disease in newborns usually occurs due to vitamin K deficiency; hence, it is called VKDB. Based on the age of onset, it can be classified as early, classical, or late VKDB. Premature birth, malabsorption, hepatobiliary disorders, and some maternal factors increase the risk of VKDB and can lead to complications such as bleeding and intracranial hemorrhage. As a result, the American Academy of Pediatrics suggests giving newborns a vitamin K shot immediately after birth to prevent VKDB. If your baby has VKDB or is at risk of getting it, talk to your pediatrician about the available treatment options.

Key Pointers

  • Hemorrhage disease occurs as a result of vitamin K deficiency in newborns.
  • Also known as vitamin K deficiency bleeding (VKDB), this disease is seen early after birth, during the first week, or later.
  • Some of the reasons for the deficiency are insufficient vitamin K levels in the placenta or breastmilk and the inability of the infant’s liver or gut to store and synthesize vitamin K.
  • Seek medical help immediately if your newborn has symptoms such as bleeding in the umbilicus, nose, mouth.

References

1. PawaniKher and Rita P. Verma; Hemorrhagic Disease Of Newborn; US National Library Of Medicine
2. Vitamin K deficiency bleeding of the newborn; MedlinePlus; US National Library Of Medicine
3. What is Vitamin K Deficiency Bleeding?;The Centers for Disease Control and Prevention
4. Vitamin K Deficiency Bleeding in the Newborn; Lucile Packard Children’s Hospital at Stanford
5. Vitamin K Deficiency Bleeding (Hemorrhagic Disease of the Newborn); Children’s Hospital Of Philadelphia
6. Hemorrhagic Disease of the Newborn; Boston Children’s Hospital
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Dr. Mubina Agboatwalla
Dr. Mubina AgboatwallaMBBS, DCH, MCPS
Dr. Mubina Agboatwalla is a well-known pediatrician, practicing paediatrics since the last 20 years in Karachi Pakistan. She is the head of the department of Pediatrics in Karachi Liaquat Hospital, as well as her private practice in three specialist clinics in Pediatrics.

Read full bio of Dr. Mubina Agboatwalla
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