Hemorrhagic disease of the newborn (HDN) is a bleeding disorder caused by Vitamin K deficiency, a vitamin essential for blood clotting. Newborns are born with low levels of Vitamin K and have sterile guts, making them prone to HDN, especially those who are exclusively breastfed or don't receive Vitamin K prophylaxis at birth. Symptoms include bleeding from multiple sites, such as the umbilical cord, gastrointestinal tract, or even the brain (intracranial hemorrhage), and can be classified as early (within 24 hours), classical (2–7 days), or late (1–12 weeks) onset. Early HDN is particularly associated with maternal use of certain medications like antiepileptics or anti-tubercular drugs.
Causes
• Low Vitamin K stores:
Babies are born with minimal Vitamin K, which is critical for producing blood clotting factors.
• Sterile gut:
Newborns have not yet developed the gut bacteria that synthesize Vitamin K.
• Exclusive breastfeeding:
Breast milk contains low levels of Vitamin K.
• Maternal medication use:
Certain drugs, such as some anti-seizure medications, can interfere with Vitamin K transfer to the fetus.
Types of HDN (based on onset time)
• Early-onset HDN:
Occurs in the first 24 hours after birth, often in babies whose mothers took certain anti-convulsant or anti-tubercular medications.
• Classical HDN:
Typically appears between 2 and 7 days of life, particularly in babies who did not receive a preventive Vitamin K injection.
• Late-onset HDN:
Can occur later, from 2 to 12 weeks after birth, and is linked to exclusive breastfeeding or conditions that hinder Vitamin K absorption.
Symptoms
• Bleeding from the umbilical cord or circumcision site.
• Gastrointestinal bleeding (e.g., blood in stool or vomit).
• Bruising (ecchymosis).
• Bleeding from the nose (epistaxis) or urine (hematuria).
• Intracranial hemorrhage (bleeding in and around the brain), which can be severe.
Prevention and Treatment
• Vitamin K prophylaxis:
The standard prevention is an intramuscular injection of Vitamin K (phylloquinone) at birth.
• Treatment:
For diagnosed cases, treatment includes administering Vitamin K. Severe cases may require blood products like fresh frozen plasma or prothrombin complex concentrates.
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