Hemorrhagic disease of the newborn is a rare bleeding problem that can occur after birth. Hemorrhaging (excessive bleeding) is a potentially life-threatening condition.
Vitamin K plays a key role in blood clotting, and most babies are born with low stores of the vitamin in their system. For this reason, the condition is often called vitamin K deficiency bleeding, or VKDB.
VKDB is categorized according to the timing of first symptoms:
- early onset (within 24 hours), which is very rare
- classic onset (two to seven days), which is also very rare
- late onset (two weeks to six months) – according to the National Institutes of Health (NIH), is more common in children who did not receive a vitamin K shot, and in females and babies of Asian descent (NIH, 2012)
It is now common practice for neonatal physicians to give babies a shot of vitamin K1 (phytonadione) at birth. This will protect your newborn in case he or she has low vitamin K levels.
The primary dietary source of vitamin K is green leafy vegetables. Vitamin K is also a byproduct of certain types of bacteria (flora) in the intestines and colon (gut).
There are a number of reasons why newborns are prone to have vitamin K deficiency. For example, vitamin K does not transfer across the placenta during pregnancy. Additionally, human breast milk contains only small amounts of vitamin K. The primary gut flora (Lactobacillus) found in breastfed babies does not synthesize vitamin K.
There may be subtle signs of “failure to thrive” before a serious bleeding event occurs. These symptoms include:
- warning bleeds (seemingly insignificant)
- low weight for the infant’s age
- slow increase in weight
Bleeding can occur in one or multiple areas, including:
- umbilical stump (the naval area where the umbilical cord was removed)
- mucous membrane of the nose and mouth
- circumcised penis
- areas where there has been a needle stick (such as for vaccinations)
- gastrointestinal tract (blood in bowel movements)
There may also be blood in the stool or urine, bruising, or a raised lump on the baby’s head. If a raised lump appears early on, it is often cephalohematoma, which occurs when blood vessels rupture during delivery. This usually resolves on its own.
However, if a head lump appears later, it can be an intracranial hemorrhage (bleeding inside the skull), which is a life-threatening condition.
Vitamin K deficiency causes VKDB. A baby’s risks vary, depending upon when symptoms occur.
Early-onset of VKDB occurs within the first 24 hours after birth. Risk factors include:
- mother taking anti-seizure drugs that interfere with vitamin K metabolism (phenytoin, phenobarbital, caramezepine, or primidone)
- mother taking blood thinning medication such as Coumadin or aspirin
- mother taking antibiotics, such as cephalosporins
Classic onset occurs within the first week after birth. The primary risk is exclusively breastfeeding.
Late-onset is seen in babies up to 2 months old. Risk factors include:
- low levels of vitamin K in breast milk
- biliary atresia (slow bile flow)
- cystic fibrosis
- celiac disease
- chronic diarrhea
- A1-antitrypsin deficiency (may cause lung and liver disease)
The baby will undergo blood clotting tests. If a shot of vitamin K1 stops the bleeding, the cause of VKDB is confirmed.
Specific treatment for VKDB will be determined by your baby’s physician. It may include blood transfusion if bleeding is severe.
The outlook is good for infants with early-onset or classic disease symptoms. However, late-onset can be more serious. There is a higher rate of life-threatening intracranial bleeding in late-onset cases.
Intracranial bleeding can cause brain damage or death.
If you breastfeed your baby, talk to the pediatrician about risks and treatments that can help your baby get adequate amounts of vitamin K.
According to the American Academy of Pediatrics (AAP), every newborn baby should receive an injection of vitamin K after delivery. This is a preventative measure to protect the baby from VKDB, the potentially life-threatening disease. (AAFP, 2003)