The bleeding newborn: A review of presentation, diagnosis, and management

The neonatal hemostatic system is continuously developing with rapidly changing concentrations of many coagulation proteins. Thus, determining the etiology of bleeding in a newborn has additional challenges beyond those seen in older children or adults. Bleeding can be seen in both well and sick newborns due to congenital causes, such as hemophilia or von Willebrand disease, and acquired causes, such as liver failure or disseminated intravascular coagulation. Traditional coagulation testing should be interpreted with caution and with the help of a hematologist, if possible, due to the greatly different normal ranges between neonates as compared with older children and adults. However, despite these challenges, both clinical and laboratory clues can guide physicians appropriately to diagnose and treat the bleeding newborn.