Anemia of Prematurity - Portal Neonatal

Hemorrhagic Disease of Newborn
Last Updated: April 29, 2005
Synonyms and related keywords: HDN, vitamin K deficiency bleeding, VKDB, coagulopathy,
intracranial hemorrhage, ICH, late-onset VKDB, early-onset VKDB, classic VKDB
AUTHOR INFORMATION Section 1 of 10
Author: Elaine B St John, MD, Associate Director of Regional Newborn Intensive Care Unit,
University of Alabama Hospital; Associate Professor of Pediatrics, Department of Pediatrics, Division
of Neonatology, University of Alabama at Birmingham
Elaine B St John, MD, is a member of the following medical societies: American Academy of
Pediatrics, Medical Association of the State of Alabama, Society for Pediatric Research, and Southern
Society for Pediatric Research
Editor(s): Oussama Itani, MD, Medical Director of Neonatology, Borgess Medical Center, Clinical
Assistant Professor, Department of Pediatrics and Human Development, Michigan State University;
Robert Konop, PharmD, Director, Clinical Account Management, Ancillary Care Management; David
A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College; Carol L
Wagner, MD, Associate Professor, Department of Pediatrics, Division of Neonatology, Medical
University of South Carolina; and Neil N Finer, MD, Director, Division of Neonatology, Professor,
Department of Pediatrics, University of California at San Diego
INTRODUCTION Section 2 of 10
Background: The more appropriate term for hemorrhagic disease of newborn is vitamin K deficiency
bleeding (VKDB). Historically, all bleeding disorders in the newborn were grouped together under the
diagnosis of hemorrhagic disease of the newborn (HDN). With methods available today for the
accurate diagnosis of other factor deficiency states and immune thrombocytopenias, VKDB can be
distinguished from other disorders by exclusion.
Pathophysiology: Newborns are relatively vitamin K deficient for a variety of reasons. Factors that
can contribute to this deficiency include low vitamin K stores at birth, poor placental transfer of vitamin
K, low levels of vitamin K in breast milk, and sterility of the gut. Because standard commercial infant
formulas contain supplemental vitamin K, VKDB is almost exclusively a problem of breastfed infants.
Infants with inadequate intake are at higher risk.
The most common sites of bleeding are the umbilicus, mucous membranes, GI tract, circumcision, and
venipunctures. Hematomas at sites of trauma, such as large cephalohematomas and bruising, are
also common findings. Intracranial bleeding can occur and is the main cause of mortality and longterm
morbidity.
Frequency:
• In the US: The frequency of VKDB is variably reported from 0.25-1.7%. The frequency in a
given US population depends upon the frequency of breastfeeding.
• Internationally: The frequency of VKDB in countries outside the United States varies with the
use of vitamin K prophylaxis, the efficacy of prophylaxis programs, frequency of breastfeeding,
and the content of locally available formulas.
Mortality/Morbidity: Intracranial hemorrhage (ICH) is uncommon in classic VKDB but can be
observed in more than 50% of infants with late-onset VKDB. ICH is responsible for nearly all mortality
and all long-term sequelae resulting from VKDB.