What is hemorrhagic disease of the newborn?
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 utero, most babies are born with low stores of this vitamin in their system.
VKDB is categorized according to the timing of first symptoms:
- early onset occurs within 24 hours of birth
- classic onset occurs within two to seven days
- late onset occurs within two weeks to six months
It’s now common practice for neonatal physicians to give babies a shot of vitamin K-1, also called phytonadione, shortly after birth. This helps protect the newborn from VKDB.
If your baby has VKDB, they may show subtle signs of “failure to thrive” before a serious bleeding event occurs. These symptoms include:
- warning bleeds, which may seem insignificant
- low weight for your baby’s age
- slow increase in weight
Bleeding can occur in one or multiple areas, including:
- their umbilical stump, the naval area where their umbilical cord was removed
- the mucous membranes of their nose and mouth
- their penis, if it’s circumcised
- areas where they’ve been stuck by a needle, for example, for vaccinations
- their gastrointestinal tract
You may notice blood in their stool or urine, bruising, or a raised lump on their head. If the raised lump appears early on, it’s probably a cephalohematoma. This is a type of hematoma that occurs when blood vessels underneath the scalp rupture during delivery. It usually resolves on its own. However, if the head lump appears later on, it can be an intracranial hemorrhage. This is bleeding inside the skull. It’s a life-threatening condition.
VKDB is caused by vitamin K deficiency. For most people, the primary dietary source of vitamin K is green leafy vegetables. Vitamin K is also a byproduct of certain types of bacteria that live in your intestines and colon (gut flora).
There are a number of reasons why newborns are prone to vitamin K deficiency. For one thing, only small amounts of vitamin K are transferred across the placenta during pregnancy. Human breast milk contains only small amounts of vitamin K too. The primary gut flora (Lactobacillus) found in breast-fed babies doesn’t synthesize vitamin K.
The risk factors for VKDB vary, depending on the type.
Early onset VKDB occurs within the first 24 hours after birth. Your baby’s risk of developing it is higher if their birth mother takes certain medications while pregnant, including:
- antiseizure drugs that interfere with vitamin K metabolism, such as phenytoin, phenobarbital, caramezepine, or primidone
- blood thinning medications, such as warfarin (Coumadin) or aspirin
- antibiotics, such as cephalosporins
- antituberculosis medications, such as rifampin and isoniazid
Classic onset VKDB occurs within the first week after birth, typically in babies who have not received prophylactic vitamin K at birth. Your baby’s risk of developing it is higher if they are exclusively breast-fed.
Late onset VKDB is seen in babies up to 6 months old. This form is also more common in babies who did not receive a vitamin K shot. Risk factors include:
- low levels of vitamin K in breast milk
- biliary atresia, which causes slow bile flow
- cystic fibrosis
- celiac disease
- chronic diarrhea
- A1-antitrypsin deficiency, which may cause lung and liver disease
If your baby’s doctor suspects they have VKDB, they will perform blood clotting tests. They will give your baby a shot of vitamin K-1. If this stops your baby’s bleeding, the doctor can confirm that the cause is VKDB.
If your baby is diagnosed with VKDB, the doctor will determine a specific treatment plan. It may include blood transfusions if your baby’s bleeding is severe.
The outlook is good for infants with early onset or classic onset disease symptoms. However, late onset VKDB can be more serious. It poses a higher risk of life-threatening intracranial bleeding. This involves bleeding in the skull, which can cause brain damage or death.
To learn more about your baby’s specific diagnosis, treatment options, and outlook, talk to your doctor.
If you breast-feed your baby, talk to your doctor about steps you can take to help them get enough vitamin K. According to the American Academy of Pediatrics, every newborn baby should receive an injection of vitamin K after delivery. This is a preventive measure to help protect your baby from VKDB.