Vitamin K deficiency bleeding in infants and children

Area of Science:

• Pediatrics
• Hematology
• Biochemistry

Background:

• Vitamin K deficiency bleeding (VKDB) is a bleeding disorder in infants caused by reduced activity of vitamin K-dependent coagulation factors.
• The historical term "hemorrhagic disease of the newborn" is inaccurate as neonatal bleeding isn't always VK-deficient, and VKDB can occur post-neonatally.

Purpose of the Study:

• To clarify the definition, diagnosis, classification, and prevention of VKDB.
• To evaluate the efficacy and safety of different vitamin K (VK) prophylaxis methods.

Main Methods:

• Diagnosis relies on prolonged prothrombin time, normal fibrinogen and platelet counts, and response to VK administration.
• Classification is based on age of onset: early, classic, and late forms, with the latter extending up to 6 months.
• Evaluation of oral versus parenteral VK prophylaxis, considering factors like absorption, dosage, and potential risks.

Main Results:

• VKDB is characterized by low VK-dependent coagulation factors and the presence of acarboxy proteins.
• Postnatal VK administration effectively prevents classic and late VKDB, with parenteral prophylaxis potentially more effective for late forms and in hepatobiliary disease.
• Oral prophylaxis, especially repeated doses, offers a safer alternative to parenteral administration, avoiding excessively high VK levels and injection risks.

Conclusions:

• VKDB diagnosis and management require careful consideration of coagulation factor activity and response to VK.
• VK prophylaxis is crucial for preventing VKDB and intracranial hemorrhages, with oral administration being a preferred method for healthy neonates.
• Further research into improved oral VK formulations may enhance prophylaxis efficacy and reliability.