Etiology, Clinical Features, and Management of Hemorrhagic Disease of the Newborn

Hemorrhagic disease of the newborn (HDN), also known as Vitamin K deficiency bleeding (VKDB), is a condition that affects neonates due to insufficient vitamin K, leading to impaired blood clotting and excessive bleeding.

Etiology

HDN primarily occurs due to inadequate vitamin K levels in newborns, resulting from:

• Limited placental transfer of vitamin K
• Lack of sufficient vitamin K in breast milk
• Immature hepatic function unable to synthesize clotting factors
• Underlying maternal conditions or medication use affecting vitamin K metabolism

Clinical Features

The condition is classified based on onset:

• Early HDN (within 24 hours): Common in infants exposed to maternal medications such as anticonvulsants or antibiotics
• Classic HDN (Day 2-7): Presents with bleeding from umbilical stump, gastrointestinal tract, or skin
• Late HDN (Week 2-12): Associated with intracranial hemorrhages, often in exclusively breastfed infants

Diagnostic Criteria and Laboratory Investigations

• Prolonged PT (prothrombin time) and aPTT (activated partial thromboplastin time)
• Normal fibrinogen levels and platelet count
• Improvement in coagulation parameters after vitamin K administration

Management and Prevention

Preventing HDN involves administering vitamin K prophylaxis at birth:

• Intramuscular vitamin K (0.5-1 mg) recommended for all newborns
• Oral vitamin K regimens available but less effective
• Supportive care and transfusion for severe bleeding cases

Early detection and intervention remain crucial to prevent complications, especially intracranial hemorrhages.