Vitamin k deficiency of newborn

Vitamin k deficiency of newborn

1. VITAMIN K DEFICIENCY OF NEWBORN Mrs.Jagadeeswari.J M.Sc N

2. DEFINITION Hemorrhagic disease of newborn which is also known as vitamin K deficiency bleeding(VKDB) is a coagulation disturbance in newborn due to vitamin K deficiency.

3. CLASSIFICATION OF VITAMIN K DEFICIENCY (depending on onset of disease) Early onset Classic onset Late onset

4. ONSET Early onset-within first 24 hours. Classic onset-after 24 hours till 1 week Late onset-2-12 weeks

5. INCIDENCE Early onset-very rare Classic onset-2% Late onset-depending disease

6. CAUSES OF VITAMIN K DEFICIENCY OF NEWBORN A moderate decrease of factors II,VII,IX and X may cause bleeding by 48-72 hours after birth which gradual return to birth levels by 7-10 days of age.

7. CAUSES OF EARLY ONSET Maternal drugs (phenobarbitone ,phenytoin ,warfarin , rifampin, isoniazid) Inherited coagulopathy

8. CAUSES OF CLASSIC ONSET Vitamin k deficiency Breast feeding

9. CAUSES OF LATE ONSET Cholelithiasis –mal-absorption of vitamin k(biliary atresia ,cystic fibrosis ,hepatitis ) Warfarin ingestion Idiopathic in Asian breast fed infants.

10. SYMPTOMS OF VITAMIN K DEFICIENCY Early onset Cephal-hematoma Sub-galeal hematoma Intra cranial hematoma Gastro intestinal bleeding Umbilical bleeding Intra abdominal

11. SYMPTOMS OF VITAMIN K DEFICIENCY Classic onset GI bleeding ENT bleeding Intra cranial bleeding Bleeding from circumcision Cutaneous bleeding Bleeding from injection sites

12. SYMPTOMS OF VITAMIN K DEFICIENCY Late onset GI bleeding Cutaneous bleeding ENT bleeding Bleeding from injection sites Thoracic bleeding

13. DIAGNOSIS Forms of vitamin K Vitamin K1-Phylloquinone Vitamin K2-Menaquinone Vitamin K3-Menodione

14. CONT.. Coagulation profile Prothrombin time(PT) Partial thromboblastin time(PTT) Fibrinogen level Platelet count INR USG(locating bleeding) MRI(rare)

15. TREATMENT Administration of vitamin K shot at birth-IM or IV(dosage vitamin K 0.5 to 1 mcg) Subcutaneous administration of vitamin K is given in symptomatic infants than IM If the bleeding is persistent immediate blood transfusion is given –whole blood/fresh plasma until prothrombin level is increased Parenteral supplement is given in case of late onset of vitamin K deficiency

16. PREVENTIVE MEASURES Vitamin k shot at birth Vitamin k administration for pregnant women who takes anti seizure medications

17. PROGNOSIS Prognosis is very poor in case of late onset of vitamin k deficiency

18. COMPLICATIONS Intra cranial hemorrhage Retro peritoneal hemorrhage Death

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