Fetal intracranial hemorrhage and maternal vitamin K deficiency induced by total parenteral nutrition

Abstract

Rationale: Fetal brain hemorrhage is rare. It is caused mainly by maternal trauma or fetal coagulation disorder, but in some cases, vitamin K deficiency may be the cause. Patient concerns: We describe the case of a pregnant woman with bowel obstruction who was susceptible to vitamin K deficiency due to oral diet restriction, decreased intestinal absorption, and limited intravenous vitamin K supplementation. Diagnosis: After 18 days of intermittent total parenteral nutrition, acute onset of severe fetal brain hemorrhage developed. Interventions: After acute onset of fetal brain hemorrhage, the patient underwent an emergency cesarean section at 25 + 3 weeks of gestation due to fetal non-reassuring fetal monitoring. Outcomes: The Apgar score at birth was 0/0, and despite cardiopulmonary resuscitation, neonatal death was confirmed. After the baby was delivered, we checked the maternal upper abdominal cavity and found a massive adhesion in the small bowel to the abdominal wall near the liver and stomach with an adhesion band. The adhesion band, presumably a complication of previous hepatobiliary surgery, appeared to have caused small bowel obstruction. Adhesiolysis between the small bowel and abdominal wall was performed. Lessons: This case demonstrates that even relatively short-term total parenteral nutrition can cause severe fetal brain hemorrhage. Vitamin K supplementation is required for mothers who are expected to be vitamin K deficient, especially if they are on total parenteral nutrition for more than 3 weeks.

Can small bowel obstruction during pregnancy be treated with conservative management? A review

“…After appropriate counselling, patients who require TPN during conservative management for SBIO should be referred to experienced obstetric centres where TPN and careful monitoring of the maternal and foetal conditions can be carried out. In an unfortunate case, Lee S et al reported a case where the patient presented with SBIO secondary to adhesions in the second trimester [ 33 ]. The patient was started on TPN and observed closely for 18 days.…”

Early oral feeding following intestinal anastomosis surgery in infants: a multicenter real world study

“…In our study no higher rates of hematochezia, diarrhea, and anastomotic leakage were associated with EOF, which indicated good tolerance of EOF in infants who underwent an IA. Postoperative DOF further aggravates nutrient consumption and insulin resistance, which results in impaired immune function, delayed wound healing, decreased muscle strength, and increased complications ( 16 ), and is primarily associated with delayed gut development and metabolic diseases in neonates and infants ( 21 , 22 ). EOF can stimulate the secretion of digestive juices, which may enhance the recovery of intestinal function ( 7 , 26 ).…”

“…In this study the hospital stay was shortened by EOF for infants who underwent an IA, which may be attributed to the decreased use of PN. As a result of the rapid growth and development of infants, DOF or increasing the usage of PN delays gut development, reduced the regeneration of intestinal mucosal epithelial cells, and increased apoptosis, thus leading to mucosal atrophy, barrier function impairment, and eventually intestinal bacterial translocation and sepsis ( 21 , 39 ); however, EOF has been shown to be beneficial in gut development, regeneration of the intestinal mucosal epithelium, maintenance of the integrity of the gut barrier, and prevention of bacterial translocation ( 43 , 44 ), which promotes the recovery of intestinal function. These findings indicate that EOF following an IA is effective in infants.…”

“…Due to the possibility of bowel movement dysfunction after correction of intestinal malformations, the route of early enteral feeding is usually via nasogastric or nasojejunal tubes (17,18), which are dissimilar from normal physiology and can lead to many complications, including patient discomfort, tube malpositioning, aspiration pneumonia, sinusitis, epistaxis, and tube occlusion (19,20). Because the body grows and develops more rapidly during infancy than in other periods during childhood, there are additional issues with postponing oral or enteral feeding, including cholestasis, sepsis, delayed gut development, and metabolic diseases (21)(22)(23). Unfortunately, evidence for initiating EOF after an IA procedure in infants is insufficient (24).…”