Vitamin K Deficiency Bleeding (VKDB) in Infancy

Anton H. Sutor; Rüdiger von Kries; Marlies E. A. Cornelissen; Andrew W. McNinch; Maureen Andrew

doi:10.1055/s-0037-1614494

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1999; 81(03): 456-461
DOI: 10.1055/s-0037-1614494

Scientific and Standardization Committee Communications

Schattauer GmbH

Vitamin K Deficiency Bleeding (VKDB) in Infancy^[*]

On behalf of the ISTH Pediatric/Perinatal Subcommittee

Authors

Anton H. Sutor

¹From the Universitäts-Kinderklinik, Freiburg, Germany
Rüdiger von Kries

²Institut für Soziale Pädiatrie und Jugendmedizin, München, Germany
Marlies E. A. Cornelissen

³University Children’s Hospital, Nijmegen, The Netherlands
Andrew W. McNinch

⁴Department of Child Health, Royal Devon and Exeter Hospital, Exeter, United Kingdom
Maureen Andrew

⁵Hamilton Civic Hospital Research Centre, Henderson General Division, Hamilton, Ontario, Canada

Abstract

Summary

Terminology. Replace the term “Hemorrhagic Disease of the Newborn” (HDN) by “Vitamin K Deficiency Bleeding” (VKDB), as neonatal bleeding is often not due to VK-deficiency and VKDB may occur after the 4-week neonatal period. Definition. VKDB is bleeding due to inadequate activity of VK-dependent coagulation factors (II, VII, IX, X), correctable by VK replacement. Diagnosis. In a bleeding infant a prolonged PT together with a normal fibrinogen level and platelet count is almost diagnostic of VKDB; rapid correction of the PT and/or cessation of bleeding after VK administration are confirmative. Warning signs. The incidence of intracranial VKDB can be reduced by early recognition of the signs of predisposing conditions (prolonged jaundice, failure to thrive) and by prompt investigation of “warning bleeds”. Classification. VKDB can be classified by age of onset into early (<24 h), classical (days 1-7) and late (>1 week <6 months), and by etiology into idiopathic and secondary. In secondary VKDB, in addition to breast feeding, other predisposing factors are apparent, such as poor in-take or absorption of VK. VK-Prophylaxis: Benefits. Oral and intramuscular VK (one dose of 1 mg) protect equally well against classical VKDB but intramuscular VK is more effective in preventing late VKDB. The efficacy of oral prophylaxis is increased with a triple rather than single dose and by using doses of 2 mg vitamin K rather than 1 mg. Protection from oral doses repeated daily or weekly may be as high as from i.m. VK. VK-Prophylaxis: Risks. VK is involved in carboxylation of both the coagulation proteins and a variety of other proteins. Because of potential risks associated with extremely high levels of VK and the possibility of injection injury, intramuscular VK has been questioned as the routine prophylaxis of choice. Protection against bleeding should be achievable with lower peak VK levels by using repeated (daily or weekly) small oral doses rather than by using one i.m. dose. Breast feeding mothers taking coumarins. Breast feeding should not be denied. Supervision by pediatrician is prudent. Weekly oral supplement of 1 mg VK to the infant and occasional monitoring of PT are advisable. Conclusion. VKDB as defined is a rare but serious bleeding disorder (high incidence of intracranial bleeding) which can be prevented by either one i.m. or multiple oral VK doses.

Full Text

References

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Vitamin K Deficiency Bleeding (VKDB) in Infancy[*]

Authors

Vitamin K Deficiency Bleeding (VKDB) in Infancy^[*]