Late vitamin K deficiency bleeding in infants: five-year prospective study

Abstract Objective: To study the presenting clinical and demographic features, risk factors, and outcome of infants with late vitamin K deficiency bleeding. Methods: Over a 5-year study period, the presenting clinical features and outcome of all 47 infants observed aged less than 6 months, who were diagnosed with late-onset primary and secondary VKDB by detailed history, physical examination, and laboratory findings were evaluated. Confirmed primary late VKDB was diagnosed when no cause other than breastfeeding could be found, while in the secondary subtype additional risk factors compromising the vitamin K effect were diagnosed. Results: Secondary late VKDB (83%, 39 patients) was more common than the primary subtype. The mean age of patients was 10.50 ± 5.75 and 9.74 ± 6.04 weeks in primary and secondary VKDB subtypes, respectively, and the age of infants did not have a significant difference (> 0.05). The male to female ratio was 2.13:1. The residency, place and mode of delivery, gestational age, and types of feeding of patients did not have a significant difference between VKDB subtypes. The skin and gastrointestinal tract (GIT) (40.4%) followed by intracranial hemorrhage (ICH) (32%), were common sites of bleeding. Neurological complications were seen in 21% of patients; however, lethality was 23%, and the outcome of patients did not have a significant difference (p > 0.05) between VKDB subtypes. Conclusion: Secondary late VKDB is more common than the primary subtypes, and late VKDB is still a serious disease in developing countries, including Iraq, when vitamin K prophylaxis isn't routinely used at birth.

Hemorragia intraventricular en el recién nacido prematuro / Intraventricular hemorrage in preterm neonates

El presente trabajo es producto de una revisión de la patogénesis, incidencia, tratamiento y pronóstico de la hemorragia intraventricular en el recién nacido prematuro. En las publicaciones revisadas, que incluyen series importantes de seguimiento, esta patología se presenta en 25% de los infantes menores de 1500 gramos de peso, en los que tanto la morbilidad como la mortalidad es mayor que los recién nacidos normales, ya que el desarrollo de la hemorragia intraventricular, puede producir alteraciones de flujo sanguíneo cerebral en la inmadura matriz germinal y en la red microvascular. En consecuencia la prevención de la hemorragia intraventricular está directamente relacionada con su patogénesis. Se pregona que el uso de esteroides tipo dexametazona en dosis bajas en el período prenatal y bajas dosis de endometacina en el período postnatal, pueden dar mejor neuroprotección. El tratamiento quirúrgico es excepcional y tiene indicaciones bien precisas, cuando se demuestra certeramente una hidrocefalia progresiva tardía. Por lo tanto en los neonatos prematuros con hemorragia intraventricular el mejor tratamiento actual, es el usar un sistema de seguimiento médico y farmacológico...

Intracranial hemorrhage in late hemorrhagic disease of the newborn.

This study was conducted to evaluate the clinical profile and outcome in late hemorrhagic disease of the newborn (HDN) with particular reference to intracranial hemorrhage. Infants (n = 42) presenting with late HDN from January 1998 to December 2001 were studied. Majority (76%) were in the age group of 1-3 months. All were term babies on exclusive breast-feeding and none received vitamin K at birth. 71% patients presented with intracranial hemorrhage, commonest site being intracerebral and multiple ICH. Visible external bleeding was noted in 1/3rd of patients only. Three patients expired. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Isolated intracranial hemorrhage is a common mode of presentation.