Hemorrhagic Disease of Newborn (VKDB)– Dr. Stalin Ramprakash

Hemorrhagic Disease of Newborn or VKDB is a rare and life-threatening disease that can occur for various reasons. Vitamin D deficiency is one of the common causes of this condition. VKDB manifests itself as a clotting disorder. The tricky part of this disorder is that the initial symptoms are difficult to detect. By the time the doctor can detect this clotting disorder, the condition can turn fatal.

What is Hemorrhagic Disease?

Hemorrhagic disease is a rare bleeding disorder that often develops due to a coagulation disturbance during the first few days of the life of a newborn. This disorder can be due to many causes such as Vitamin K deficiency, clotting factor deficiency, etc. The hemorrhagic disease that occurs due to a deficiency of vitamin K is called vitamin K deficiency bleeding (VKDB) and is potentially a life-threatening condition.

Types of Hemorrhagic Disease

This bleeding disorder is of three main types and the classification is based on the onset of symptoms.

1. Early-Onset

As the name suggests, an early onset hemorrhagic disease is a condition where the symptoms of VKBD are not find out during the first few hours of birth (within 24 hours) of the baby. This condition is relatively rare.

Factors responsible for the occurrence of this disorder in babies include the use of the following medications by the mother when pregnant.

Anticonvulsants drugs for seizures
Anti-coagulants for clotting disorders
Anti-Tuberculosis medications
Some broad-spectrum antibiotics

2. Classic Onset

The classic onset VKDB emerges two to seven days post-birth. This condition is also relatively rare as is the case with classic onset. This type of hemorrhagic disease can be seen in breastfed infants who did not receive a vitamin K shot within the first week after birth.

3. Late-Onset

In the case of late-onset hemorrhagic disease of the infant, the first symptoms appear when the baby is two weeks to six months old. You can see this condition in babies who did not receive a vitamin K shot at birth and were exclusively breastfed. Intracranial bleeding (bleeding inside the skull), a life-threatening condition, is common in late-onset cases.

What Causes Hemorrhagic Disease (VKDB) in Babies?

As the name indicates ( Vitamin K Deficiency Bleeding), deficiency of vitamin K (which is an important factor in blood clotting) is the main cause of hemorrhagic disease.

Why are Newborns Liable to Vitamin K Deficiency?

Newborn babies contracts vitamin K deficiency due to several reasons. Following are the top 5 reasons for newborns being more susceptible to vitamin K deficiency.

1. Impermeable Placenta

Vitamin K does not transfer easily across the placenta from the mother to the baby during pregnancy. Therefore, a newborn does not have enough vitamin K stored at birth.

2. Exclusive Breastfeeding

The level of vitamin K in breast milk is very low. Newborns depend exclusively on breast milk for nutrition. With this their blood becomes deficient in Vitamin K, as a result of which they lose their ability of blood clotting.

3. Undeveloped Gut Flora

In adults, lactobacillus, the good intestinal bacteria, is responsible for synthesizing vitamin K and making it available to the body. A newborn’s gut is relatively sterile and devoid of such bacteria. As a result, they get deficient in vitamin K. As the baby grows, their gut matures and the vitamin gets available.

4. Babies With Other Diseases

Some babies with certain digestive conditions find it difficult to absorb vitamin K from the food they eat. Such conditions include;

Diarrhea (loose motion)
Celiac disease (small intestine being hypersensitive to gluten has difficulty in digesting the food),
Cystic fibrosis (genetic disorder affects respiration and digestion)
Hepatitis often exhibit trouble absorbing the vitamin K from the food they intake

5. Babies Born With Liver Disease

Such babies often cannot use the vitamin K in their bodies to synthesize the clotting factors. This increases the risk of bleeding and leads to clotting disorders such as VKDB.

Is Vitamin K Deficiency Bleeding Dangerous For My Baby?

Yes. Vitamin K deficiency bleeding is often life-threatening for newborns. A newborn’s blood does not have enough vitamin K to form a clot. When this condition happens, bleeding can occur anywhere (external or internal) in their body.

Internal bleeding (into their intestine or brain) often goes unnoticed at an early stage and causes damage to internal organs like the brain. By the time the doctor can recognize this, the brain damage has already started and it is too late to do anything.

Studies show that one out of five babies with VKDB die making this condition extremely fatal. Unfortunately, intracranial bleeding is the most common initial symptom of late-onset VKDB.

What are the Symptoms of Hemorrhagic Disease in a Newborn?

The hemorrhagic disease can be quite tricky to identify and respond to. This is because seemingly innocuous signs which are quite normal can quickly escalate into life-threatening events, ultimately turning fatal.

Subtle Initial Signs Include

Bleeding episodes
Unusual excessive sleepiness and fuzziness
Change in behavior
Bruising more easily than normal

The classic symptom is obviously bleeding. The bleeding can occur anywhere (from single or multiple areas) in the body of the baby. The most common areas of bleeding include:

Umbilical stump
Vaccination areas and points
Boy’s penis after circumcision (surgical removal of the foreskin of the penis)
Mucous membranes of the lining of the nose and mouth
The gastrointestinal tract, resulting in blood in the stool

Dangerous Signs Where Medical Attention Should be Sought Immediately

Abnormal stiffness or rhythmic abnormal movement of the hand and feet
Unresponsive baby
Tense swelling of the soft spot on the top of the head
Excessive repeated vomiting with any of the above signs

What is This Raised Lump on My Baby’s Head?

If the lump appears within a few days of birth, it is often due to cephalohematoma (pooling of the blood from ruptured blood vessels between the skull and inner layers of the skin during delivery). Generally, this condition restricts itself to one side of the head and resolves on its own. But if the lump appears, later on, it can be due to hemorrhagic disease of the newborn and needs investigation.

How is Hemorrhagic Disease (VKDB) Diagnosed in Babies?

Once the doctor suspects VKDB in your baby post-physical examination, symptom check, and medical history study, they will prescribe blood clotting tests for the little one. The baby will fail the test if they have VKDB. In this case, the doctor will prescribe a vitamin K shot to the baby and put them on special medications.

What Signs Should I Look in My Baby When He is Diagnosed With VKDB?

Be alert if any of the following signs show up once your post VKDB diagnosis

After three weeks the white part of your baby’s eye turns yellow indicating jaundice. Jaundice is a classic sign of hepatitis. Infants with hepatitis can develop the hemorrhagic disease
Bleeding from the baby’s umbilical cord
Presence of blood in the stool
Presence of blood in the urine
Bleeding from the nose
Irritability, excessive sleepiness, seizures, or a lot of throwing up. All these symptoms can indicate intracranial hemorrhage (bleeding in the brain)

[Read : Epilepsy In Babies]

How is Hemorrhagic Disease in Babies Treated?

Your baby’s physician will chart out a treatment protocol depending on the baby’s condition. Treatment options can vary from a shot of vitamin K given whenever bleeding occurs, to a blood transfusion and some other special blood products if bleeding is severe.

What Can I do to Prevent Hemorrhagic Disease in My Baby?

If you are taking anti-seizure medications, the early onset of hemorrhagic disease in your baby can be prevented by taking vitamin K shots during pregnancy. Health organizations recommend giving every baby a shot of vitamin K immediately after birth (into the muscle in the thigh) as a preventive measure. This practice prevents the classic and late-onset of hemorrhagic disease.

Why is a Vitamin Shot Recommended For All Newborns?

Vitamin K shots are extremely safe for the newborn. In fact, newborns who fails to get a vitamin K shot are 81 times at risk of developing severe bleeding. The dose of the shot is generally very high when you compare it with the daily requirement of a baby.

But you need not worry. Babies are born without sufficient vitamin K as the vitamin K from the mother cannot cross the placenta. Not only are babies born without sufficient vitamin K, but they also will not have a good supply of vitamin K till they turn six months old and start to have foods other than breast milk. Hence, your baby must get a vitamin K shot within six hours post-birth without fail.

[Read : Vitamin K Shot for Babies- A Guide For Parents]

How do Vitamin K Shots Help the Baby?

Vitamin K shot acts in two ways. To understand this better, imagine the shot given to the newborn being divided into two parts.

The first part goes into the newborn’s circulatory system instantly and increases the level of vitamin K in the blood. This prevents the baby’s vitamin levels from dropping perilously during the first days of life. The liver stores some of this vitamin K and the blood clotting mechanism use it.

Second, whatever is left of the vitamin K gets released gradually throughout the following several weeks, providing a steady supply of vitamin K. This helps the baby until they can fortify the Vitamin K stores that they get from the diet and gut bacteria.

Having a baby with a hemorrhagic disease can be stressful for the parents and everyone else involved. Early detection and the right treatment protocols are important when your baby has clotting disorders. Vitamin K shots play a crucial role in saving a baby’s life.

Hemorrhagic Disease of Newborn (VKDB)– Causes, Symptoms and Treatment

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