Hemorrhagic disease of newborn Hemorrhagic disease of newborn

Hemorrhagic disease of newborn

Hemorrhagic disease of newborn Definition Moderate transient deficiency of vitamin K dependent factors 2, 7, 9 and 10 Contributing factors • 1 - Reduced body store of vitamin k of newborn due to lack of vitamin k intake by mother • 2 - Negligible vitamin k Intake after birth • 3 - Liver immaturity • 4 -Malabsorption disease (biliary atresia) • 5 - Absence of the bacterial intestinal flora normally responsible for the synthesis of vitamin K

Hemorrhagic disease of newborn 6 - Breast milk is a poor source of vitamin K, and thus hemorrhagic complications are more common in breast-fed than formula-fed infants 7 - Maternal medication that interfere with vitamin k formation as phenytoin , phenobarbital and salicylates

EARLY-ONSET DISEASE Age Site of hemorrhage CLASSIC DISEASE 0 -24 hr 2 -7 days 1 -6 mo Cephalohematoma Gastrointestinal Intracranial Subgaleal Ear-nose-throat-mucosal Gastrointestinal Intracranial Cutaneous Gastrointestinal Circumcision Ear-nose-throat-mucosal Umbilicus Cutaneous Injection sites Intra-abdominal Gastrointestinal Thoracic Injection sites Maternal drugs (phenobarbital, phenytoin, Vitamin K deficiency Breast-feeding Etiology/risks warfarin, rifampin, isoniazid) that interfere with vitamin K Prevention Incidence LATE-ONSET DISEASE Cholestasis—malabsorption of vitamin K (biliary atresia, cystic fibrosis, hepatitis) Abetalipoprotein deficiency Prevented by parenteral and high. Possibly, administrations of dose oral vitamin K during periods vitamin K to infant at birth Prevented by parenteral vitamin K at birth of malabsorption or cholestasis or to mother (20 mg) before Oral vitamin K regimens require repeated birth dosing over time Avoid high-risk medications Very rare ≈2% if infant not given vitamin K Dependent on primary disease

Laboratory data 1 - PT, PTT and clotting time --- are prolonged 2 - Levels of factors 2, 7, 9 and 10 - are decreased. 3 - Bleeding time and platelets--- are normal 4 - PIVKA (protein induced in vitamin K absence), which is a sensitive marker for vitamin K deficiency

Treatment of Hemorrhagic disease of newborn 1 -Viamin K---- slow IV or IM of 1 -5 mg -- cessation of bleeding noted within a few hours. 2 - Fresh frozen plasma -- in cases of Serious bleeding, particularly in premature infants 3 - Whole blood transfusion – in cases of marked hemorrhage

swallowed blood syndrome in which blood or bloody stools are passed, usually on the 2 nd or 3 rd day of life, may be confused with hemorrhage from the gastrointestinal tract. The blood may be swallowed during delivery or from a fissure in the mother's nipple.

the Apt test ---- is used for Differentiation from gastrointestinal hemorrhage is based on the fact that the infant's blood contains mostly fetal hemoglobin, which is alkali-resistant, whereas swallowed blood from a maternal source contains adult hemoglobin, which is promptly changed to alkaline hematin after the addition of alkali

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