Hemorrhagic disease of newborn Hemorrhagic disease of newborn

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Hemorrhagic disease of newborn

Hemorrhagic disease of newborn

Hemorrhagic disease of newborn Definition Moderate transient deficiency of vitamin K dependent factors 2,

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

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

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 -

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

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

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

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

 Thank you

Thank you