Intra-cranial hemorrhage in infants due to vitamin K deficiency – report of 2 cases

Abstract

Objective: drive attention to the late form of the hemorrhagic disease of the newborn, secondary to vitamin K deficiency, as a cause of intracranial hemorrhage in young infants. Methods: the authors describe and analyze two cases of late hemorrhagic disease of the newborn, secondary to vitamin K deficiency, producing intracranially hemorrhage during the second month of age. The most important publications on this subject are reviewed. Results: Both infants had not received prophylaxis with vitamin K at birth. They were both being fed exclusively on breast milk. They developed intracranial hemorrhage, and the clotting defect was rapidly corrected with intramuscular vitamin K. At 3 and 4 years of age, one of them has showed normal psychomotor development, and the other has showed moderate developmental delay with microcephaly. Conclusion: late hemorrhagic disease of the newborn must be considered in young infants, between 2 and 12 weeks of age, with intracranial hemorrhage, especially those fed exclusively on breast milk who did not receive vitamin K at birth. It may produce neurodevelopmental delay. The clotting defect is rapidly corrected with intramuscular vitamin K. This condition is preventable. The prophylaxis is recommended with 1 mg of intramuscular vitamin K to all newborns, at birth, even without risk factors.

Life‐threatening retroperitoneal hemorrhage due to late vitamin K deficiency

“…Causes of VKDB are described in two forms: idiopathic and secondary. Idiopathic VKDB has several characteristic features; namely, it is more common in Asian babies and in boys, occurs in infants between 2 and 12 weeks of life, is common in exclusively breast‐fed infants, and entails a high incidence of intracranial hemorrhage 6,7 . Idiopathic VKDB is considered to result from the lower content of vitamin K in breast milk than in formula and from the inefficiency of the intestinal flora of breast‐fed infants to absorb vitamin K 6,8 .…”

“…Idiopathic VKDB is considered to result from the lower content of vitamin K in breast milk than in formula and from the inefficiency of the intestinal flora of breast‐fed infants to absorb vitamin K 6,8 . On the other hand, causes of secondary VKDB include biliary atresia, hepatitis, antibiotic therapy, chronic diarrhea, cystic fibrosis, alpha‐1‐antitrypsin deficiency, abetalipoproteinemia and celiac disease 7–9 . The most common presentation of VKDB is intracranial hemorrhage, which is found in approximately 50% of cases.…”

“…Idiopathic VKDB has several characteristic features; namely, it is more common in Asian babies and in boys, occurs in infants between 2 and 12 weeks of life, is common in exclusively breast-fed infants, and entails a high incidence of intracranial hemorrhage. 6,7 Idiopathic VKDB is considered to result from the lower content of vitamin K in breast milk than in formula and from the inefficiency of the intestinal flora of breast-fed infants to absorb vitamin K. 6,8 On the other hand, causes of secondary VKDB include biliary atresia, hepatitis, antibiotic therapy, chronic diarrhea, cystic fibrosis, alpha-1-antitrypsin deficiency, abetalipoproteinemia and celiac disease. [7][8][9] The most common presentation of VKDB is intracranial hemorrhage, which is found in approximately 50% of cases.…”

Subdural hemorrhage: A unique case involving secondary vitamin K deficiency bleeding due to biliary atresia

“…prolonged prothrombin time (PT), and rapid improvement of PT and/or cessation of bleeding after administration of vitamin K [10,11]. VKDB has been categorized into two forms: idiopathic and secondary.…”

“…ICH due to secondary VKDB sometimes occurs even when vitamin K prophylaxis is continued [12]. Other causes of secondary VKDB include neonatal hepatitis, antibiotic therapy, and chronic diarrhea [10]. Breastfeeding also increases the tendency to bleed because human milk contains low levels of vitamin K [12].…”