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Late-type vitamin K deficiency bleeding: experience from 120 patients
Mehmet Akif Ozdemir1, Musa Karakukcu, Huseyin Per
1Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Talas, Kayseri, Turkey.
Insights
Late vitamin K deficiency bleeding (VKDB) in infants can cause severe intracranial hemorrhages. Routine vitamin K prophylaxis at birth is crucial for preventing this serious condition and its associated mortality.
Area of Science:
- Pediatrics
- Neonatology
- Hematology
Background:
- Vitamin K deficiency bleeding (VKDB) predisposes infants to early, classic, or late forms.
- Late VKDB, occurring in exclusively breastfed infants aged 2-24 weeks, is a significant cause of intracranial bleeding, mortality, and morbidity in developing countries.
Purpose of the Study:
- To evaluate the clinical characteristics, management, and outcomes of late vitamin K deficiency bleeding (VKDB) in infants.
- To emphasize the importance of vitamin K prophylaxis in preventing severe hemorrhagic complications.
Main Methods:
- A retrospective review of 120 infants diagnosed with late VKDB between June 1990 and June 2006.
- Evaluation of clinical signs, symptoms, treatments, hemorrhage types, and mortality rates.
Main Results:
- Intracranial hemorrhage occurred in 73% of patients, with various types including subdural, intracerebral, and intraventricular.
- Common symptoms included bulging fontanels (70%), irritability (50%), and convulsions (49%).
- The mortality rate was 31%.
Conclusions:
- Late VKDB is associated with significant morbidity and mortality.
- Administration of 1 mg of vitamin K at birth can effectively prevent intracranial bleeding and other hemorrhagic manifestations, thus avoiding late VKDB.
Background:
Deficiency of vitamin K predisposes to early, classic, or late vitamin K deficiency bleeding (VKDB), of which late VKDB may be associated with serious and life-threatening intracranial bleeding. Late VKDB is characterized with intracranial bleeding in infants aged 2-24 weeks due to severe vitamin K deficiency, occurring primarily in exclusively breast-fed infants. Late VKDB is still an important cause of mortality and morbidity in developing countries.
Materials And Methods:
We presented 120 cases of late VKDB, which were evaluated at Erciyes University Medical Faculty Hospital between June 1990 and June 2006.
Results:
Signs and symptoms of the patients were bulging fontanels (70%); irritabilities (50%); convulsions (49%); bleeding and ecchymosis (47%); feeding intolerance, poor sucking, and vomiting (46%); diarrhea (34%); jaundice (11%); and pallor (9%), and among these infants, 21% received medication before the diagnosis (10%, antibiotics; 3%, simethicone; 4%, paracetamol; and 4%, phenobarbital). Intracranial hemorrhage in 88 (73%) patients has been observed. The hemorrhage was subdural in 34 (28%) cases, intracerebral in 28 (23%), subarachnoid in 17 (14%), intraventricular in 9 (8%), intracerebral and subdural in 12 (10%), subdural and subarachnoid in 6 (5%), and combination of intracerebral, subdural, and intraventricular in 14 (12%), and the mortality rate was 31%.
Conclusion:
Although late VKDB leads to significant morbidity and mortality, it can be avoided by providing vitamin K prophylaxis to all newborns. Administration of vitamin K (1 mg) at birth can prevent intracranial bleeding and other hemorrhagic manifestations.
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