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

Introduction

Hemorrhagic disease of the newborn (HDN) is a bleeding disorder caused by vitamin K deficiency. It presents with spontaneous bleeding in various sites within the first few days of life.

Etiology and Pathophysiology

Newborns are born with low vitamin K levels due to inadequate placental transfer and immature hepatic function, leading to impaired synthesis of clotting factors II, VII, IX, and X.

Types of HDN

• Early-onset HDN: Occurs within the first 24 hours, often linked to maternal medications like anticonvulsants or antibiotics.
• Classical HDN: Manifests between days 2-7, with bleeding at sites such as the gastrointestinal tract and umbilical stump.
• Late-onset HDN: Occurs between weeks 2-12, primarily in exclusively breastfed infants, presenting with intracranial hemorrhage.

Clinical Features

Common signs include prolonged bleeding from circumcision, umbilical cord stump, or injection sites. Severe cases may present with intracranial or gastrointestinal hemorrhage.

Diagnosis

Diagnosis is based on prolonged prothrombin time (PT) and low vitamin K-dependent clotting factors. A rapid response to vitamin K administration confirms the condition.

Management

Prevention

• Routine vitamin K prophylaxis via intramuscular injection at birth.
• Consider oral supplementation for high-risk infants.

Treatment

• Administer vitamin K (1 mg IM or IV).
• Supportive care for significant bleeding episodes, including blood transfusions.

Conclusion

HDN is a preventable condition with proper vitamin K prophylaxis. Early identification and intervention are crucial in managing this neonatal disorder.