1. NICKSON MAZUBA @ NWUCHAS OCTOBER
2022
UNIT 8: HAEMORRHAGIC
CONDITIONS OF THE
NEWBORN.

2. TOPICS
 Vitamin K deficiency
 Thrombocytopenia

3. HEMORRHAGIC DISEASE OF THE NEWBORN
 Hemorrhagic disease of the newborn occurs
in I of every 200 - 400 neonates not given
vitamin K prophylaxis.

4. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
 A moderate decrease in factors II, VII, IX and
X normally occurs in all newborn infants by
48-72 hour after birth, with a gradual return to
birth levels by 7-10 days of age.

5. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
 This transient deficiency (classic form) of vitamin K-
dependent factors is due to lack of free vitamin K
from the mother and absence of the bacterial
intestinal flora normally responsible for the synthesis
of vitamin K.
 Accentuation and prolongation of this deficiency
between the 2nd and 7th days of life result in
spontaneous and prolonged bleeding.
 Hemorrhagic complications are more frequent in
breast-fed (poor source of vitamin K) than in formula-
fed infants.

6. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
 Early-onset (0-24 hour) life-threatening
vitamin K deficiency induced bleeding occurs
if the mother has been treated with
phenytoin, primidone, methsuximide, or
phenobarbital.

7. HEMORRHAGIC DISEASE OF THE NEWBORN
CLASSIFICATION
 Late onset (>2 week) is often associated
with vitamin K malabsorption (neonatal
hepatitis, biliary atresia, cystic fibrosis).

8. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
 The most common form of bleeding is
melena (melena neonatorum); frank blood
may be passed per rectum in severe cases.

9. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
 Hematemesis;
 Hematuria;
 Nasal, subgaleal, intracranial, post
circumcision, or vaginal bleeding; and
 Hemorrhage from the umbilicus or into the
skin may also occur.

10. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
 The prothrombin time (PT), clotting time, and
partial thromboplastin time are prolonged.

11. HEMORRHAGIC DISEASE OF THE NEWBORN
CLINICAL FEATURES
 The levels of vitamin K dependent
coagulation factors II, VII, IX, and X
(Thrombotest) are significantly reduced.

12. HEMORRHAGIC DISEASE OF THE NEWBORN
 Vitamin K facilitates post-transcriptional
carboxylation of factors II, VII, IX, and X. In
the absence of carboxylation, such factors
form PIVKA (protein induced in vitamin K
absence), which is a sensitive marker for
vitamin K status.
 The platelet level is normal.

13. HEMORRHAGIC DISEASE OF THE NEWBORN
DIFFERENTIATE DIAGNOSIS
 Factor VII and IX deficiency (only 5-35%
cases become clinically apparent in the
newborn period), DIC,
 The swallowed blood syndrome (blood from
maternal source, contains adult hemoglobin,
promptly change to alkaline hematin with
alkali, Apt test-yellow-brown).

14. HEMORRHAGIC DISEASE OF THE NEWBORN
TREATMENT
 1. Vitamin K, (phytomenadione) 1-5 mg, IM or
IV in a single dose.
 2. If there is active bleeding or PT is greatly
prolonged, 10 ml/kg fresh frozen plasma with an
IV dose of 1 mg of vitamin K is given.
 3. In cases where blood loss is severe and
sudden, transfusion of fresh blood (20 ml/kg) is
life-saving.
 4. Vitamin K,, I mg/wk for the first 3 months of
life, may prevent late hemorrhagic disease of
newborn.

15. QUESTIONS