Hemorrhagic disease of the newborn (HDN)
Vitamin K deficiency bleeding (VKDB) of the newborn is a bleeding disorder in babies. It most often develops in the first days and weeks of life.
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, such as 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 system are more likely to develop this disorder:
The condition causes bleeding. The most common areas of bleeding include:
- A boy's penis, if he has been circumcised
- Belly button area
- Gastrointestinal tract (may result in blood in the baby's bowel movements)
- Mucus membranes (such as the lining of the nose and mouth)
- Places where there has been a needle stick
There may also be:
Exams and Tests
Blood clotting tests will be done.
The diagnosis is confirmed if a vitamin K shot stops the bleeding and blood clotting time (prothrombin time) quickly becomes normal. (In vitamin K deficiency, the prothrombin time is abnormal.)
Vitamin K is given if bleeding occurs. Babies with severe bleeding may need plasma or blood transfusions.
The outlook tends to be worse for babies with late-onset hemorrhagic disease than other forms. There is a higher rate of bleeding inside the skull (intracranial hemorrhage) associated with the late-onset condition.
Complications may include:
- Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
When to Contact a Medical Professional
Call your health care provider if your baby has any unexplained bleeding, seizures, or abnormal behavior. Get emergency medical care right away if the symptoms are severe.
The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medications. To prevent the classic and late-onset forms, the American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. Because of this practice, vitamin K deficiency is now rare in the US except for those babies who do not receive the vitamin K shot.
Centers for Disease Control and Prevention (CDC). Notes from the field: late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis--Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(45):901-902. PMID: 24226627 www.ncbi.nlm.nih.gov/pubmed/24226627.
Greenbaum LA. Vitamin K deficiency. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 53.
Rozance PJ. Rosenberg AA. The neonate. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 22.
Weddle M, Empey A, Crossen E, Green A, Green J, Phillipi CA. Are pediatricians complicit in vitamin K deficiency bleeding? Pediatrics. 2015;136(4):753-757. PMID: 26371205 www.ncbi.nlm.nih.gov/pubmed/26371205.