CASE HISTORY – October 2008

Late haemorrhage or late vitamin K deficiency in newborns. Literature overview and a case report


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Vitamin K is an important component in coagulation and its deficiency may cause spontaneous and life threatening haemorrhages. Vitamin K prophylaxis is recommended to prevent the hazard of haemorrhage caused by vitamin K deficiency in newborns. Depending on the time of onset of clinical symptoms, vitamin K deficiency is divided into three forms. Vitamin K deficiency may cause unexpected bleeding (incidence 0.25%–1.7%) during the first week of life in previously healthy-appearing neonates (early vitamin K deficiency bleeding of the newborn. The classical form appears in newborns at the age of 1 week and clinical symptoms are usually bleeding of the intestinal tract or brain haemorrhages. The prevalence is 0.25– 1.5% among all newborns. The late form, a syndrome defined as unexpected bleeding is attributable to severe vitamin K defi ciency in infants older than 8 days till 6 months of age. It occurs primarily in exclusively breastfed infants who have received no or inadequate neonatal vitamin K prophylaxis. In addition, infants who have intestinal malabsorption defects (cholestatic jaundice, cystic fi brosis, etc) may also have the late form of vitamin K deficiency. The rate of the late form (often manifesting as sudden central nervous system haemorrhage) ranges from 3.2 to 7.2 per 100 000 births in those who have not received vitamin K prophylaxis, according to reports from Europe and Asia. When a single dose of oral vitamin K was used for neonatal prophylaxis, the rate decreased to 1.4 to 6.4 per 100 000 births.

We describe a 1-month 5-day-old male child who was admitted to the ICU due to disturbances of consciousness and vomiting. CT scan revealed subdural, epidural and subarachnoid haemorrhages and intraparenchymal haemorrhages. Analysis indicated late vitamin K deficiency. After the administration of vitamin K and plasma, the results of analyses were normal.