Innocent Blood: A History of Hemorrhagic Disease of the Newborn

Abstract

Hemorrhages occurring in the newborn without trauma have been observed by obstetricians since the 17th century, but have been considered different diseases depending on their location. Umbilical hemorrhage associated with obstructed bile canals was described by Cheyne in 1802. Grandidier in 1871 and Townsend in 1894 grouped together various forms of neonatal bleeds and associated them with disturbed coagulation. When the clotting system became better understood in the last decade of the 19th century, effective symptomatic treatment was developed: gelatin, serum injection, and the transfusion of fresh blood. In 1935, Dam detected the function of vitamin K in the coagulation system and 4 years later, Waddell introduced vitamin K administration into therapy and prevention of neonatal hemorrhagic disease. Kernicterus occurred when high doses of synthetic water-soluble vitamin K analogues were given to preterm infants, reminding physicians that progress in neonatal therapy rests on the cornerstones of controlled trials and follow-up.

Vitamin K and the Newborn Infant

“…Hemorrhagic disease of the newborn (HDN) was first described in the literature as an entity by Townsend in the late 1800s, although bleeding in the newborn had been described in detail long before that time. 1 The modern era of understanding the importance of vitamin K began with Dam and Doisy being awarded the Nobel Prize in 1943 for their work on identifying and isolating the new vitamin. 2 It was not until almost 20 years later that the American Academy of Pediatrics (AAP) published its seminal paper on vitamin K and its use in pediatrics.…”

History of the study of hemorrhagic disease of newborns

“…Клинические наблюдения, описывающие кровоте-чения у новорожденных, возникающие без видимого повреждения, известны с ХVII века [15] В 1871 году известный немецкий врач Людвиг Грандидье (Ludwig Grandidier) (1810-1878), из-учавший 40 лет своей жизни гемофилию, выпустил монографию, посвященную этому заболеванию. В ней он провел дифференциальную диагностику между пупочными кровотечениями у новорожден-ных и клиникой гемофилии [21].…”

“…5) в 1894 году [15]. Он сообщил о 50 детях, имевших схожие клинические проявления, что позволило от-нести их в одну группу [22].…”