Late-Onset Vitamin K Deficiency Bleeding in Four Infants: A Forensic Pathology Case Series With Clinical-Autopsy...

Area of Science:

• Forensic Pathology
• Pediatric Medicine
• Toxicology

Background:

• Late-onset vitamin K deficiency bleeding (VKDB) causes preventable infant intracranial hemorrhage.
• Parental refusal of prophylactic vitamin K presents medicolegal challenges.
• VKDB can mimic non-accidental trauma in infant death investigations.

Purpose of the Study:

• To evaluate four infant deaths in the Turkish medico-legal system attributed to VKDB.
• To assess the role of autopsy in differentiating VKDB from other causes of intracranial hemorrhage.
• To examine the medicolegal implications of parental refusal of vitamin K prophylaxis.

Main Methods:

• Comprehensive review of clinical records.
• Full forensic autopsies, including neuropathologic examination.
• Analysis of coagulation studies (PT/INR, aPTT) when available.

Main Results:

• Autopsies revealed extensive intracranial hemorrhage consistent with VKDB in all four cases.
• No evidence of inflicted trauma, vascular malformations, or other congenital/acquired conditions was found.
• Coagulation studies supported acquired coagulopathy, and postmortem findings correlated with clinical decline.

Conclusions:

• Forensic pathology is critical in diagnosing VKDB and excluding non-accidental trauma in infant deaths.
• Accurate cause-of-death certification is essential in medicolegal evaluations of preventable infant deaths.
• These cases highlight the medicolegal responsibilities concerning caregiver decisions and vitamin K prophylaxis.