Intracranial hemorrhage and vitamin K deficiency in early infancy

Chaou, Wun-Tsong; Chou, Min-Lang; Eitzman, Donald V.

doi:10.1016/s0022-3476(84)80070-0

Cited by 71 publications

(43 citation statements)

References 27 publications

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“…12,15 Cerebellar hemorrhage also may relate to impaired cerebral flow autoregulation 7,22 or coagulopathy. 7,9 Donat and colleagues 11 postulated that cerebellar hemorrhage in preterm infants resulted from dissection of blood from either the fourth ventricle or the subarachnoid space, secondary to a concomitant severe intraventricular hemorrhage. Yet none of the 6 infants described in this report had intraventricular blood evident on ultrasonographic examination.…”

Section: Discussionmentioning

confidence: 99%

“…P osterior fossa hemorrhage is a reported complication of a traumatic delivery, [1][2][3][4][5][6] extracorporeal membrane oxygenation (ECMO), 7,8 or coagulopathy. 2,8,9 It also has been reported in preterm infants as an extension of a severe intraventricular hemorrhage 2,10 -14 or as a result of positive pressure mask ventilation with tight binding straps across the occiput. 12,15 Previous studies have identified posterior fossa hemorrhage in infants presenting with brainstem compression symptomatology, sudden shock, and disseminated intravascular coagulation.…”

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confidence: 98%

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A New Pattern of Cerebellar Hemorrhages in Preterm Infants

et al. 1998

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ABSTRACT.Objective. Posterior fossa hemorrhages may be underdiagnosed in surviving neonates, with cerebellar hemorrhage discovered in 10% to 25% of autopsy specimens from very low birth weight infants. Posterior fossa lesions have been difficult to visualize by the traditional ultrasonography approach through the anterior fontanelle. Late in 1994, routine posterior fossa imaging through the posterolateral fontanelle was instituted to improve the ultrasonographic visualization of the posterior fossa in neonates.Methods. Infants identified with posterior fossa hemorrhage by cranial ultrasonography between 1994 and 1996 were followed prospectively through discharge and their clinical courses reviewed. Infants diagnosed with posterior fossa hemorrhage between 1991 and 1994 were identified retrospectively from a comprehensive radiology database to use in comparison. All infants surviving to discharge were entered into neurodevelopmental follow-up using standard developmental assessments.Results. Approximately 525 infants underwent cranial sonography during the study period between October 1994 and September 1996, including 250 infants weighing <1500 g. Thirteen infants were identified with posterior fossa hemorrhage using the posterolateral fontanellar approach. In contrast, only 2 infants were identified with posterior fossa hemorrhage between 1991 and 1994 using traditional anterior fontanellar views. Six very low birth weight infants were identified with cerebellar hemorrhages not associated with supratentorial, intraventricular hemorrhage. Each hemorrhage had a clinically silent presentation and, in 5 infants, was not wellappreciated by anterior fontanellar images. Magnetic resonance imaging studies were performed on 5 of the 6 infants and confirmed a cerebellar lesion in the area of previous echo density on ultrasonography. No infant is exhibiting motor abnormalities on neurologic examination, although 4 infants are demonstrating cognitive, developmental delay. Follow-up, however, is limited to a corrected age of <48 months.Discussion. Cerebellar hemorrhage is an underrecognized and poorly visualized complication in preterm infants. Consistent imaging via the posterolateral fontanelle may demonstrate cerebellar hemorrhage missed by the anterior fontanellar approach. Cerebellar hemorrhage in low birth weight infants may be clinically silent and not associated with a significant supratentorial hemorrhage. These infants may survive to discharge. Long-term neurodevelopmental follow-up is necessary to establish the ultimate outcome of these infants. Future prospective study, using posterolateral fontanellar imaging, may elucidate further the pathophysiology of cerebellar hemorrhage in low birth weight infants. Pediatrics 1998;102(6). URL: http://www.pediatrics.org/cgi/content/full/102/6/ e62; posterior fossa, cerebellar hemorrhage, neonate, ultrasound.

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A New Pattern of Cerebellar Hemorrhages in Preterm Infants

et al. 1998

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“…Delayed forms of vitamin K deficiency occur most commonly at the age of 1–2 months, and many cause intracranial hemorrhage (ICH) [1]. The incidence of ICH is reported to reach 80% [2].…”

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confidence: 99%

Intracranial Hemorrhage and Vitamin K Deficiency Associated with Biliary Atresia: Summary of 15 Cases and Review of the Literature

et al. 2006

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Biliary atresia (BA) is a rare disease, characterized by progressive and obliterative cholangiopathy, and is one of the major causes of secondary vitamin K deficiency in infancy. We describe 15 infants (10 female, 5 male) with BA, presenting with intracranial hemorrhage (ICH), including 10 subdural hemorrhages, 4 subarachnoid hemorrhages, 2 intraventricular hemorrhages, and 1 intraparenchymal hemorrhage. The age at onset of ICH ranged from 26 to 79 (mean 54.2) days. Eight patients underwent successful surgical evacuation of ICH, following administration of vitamin K. All 15 patients underwent Kasai portoenterostomy for BA 8–30 days after onset. During a mean follow-up period of 86.8 (range 2–352) months, 4 patients died of liver failure despite lack of neurological sequelae. Two patients underwent living-related donor and 1 patient living-unrelated donor liver transplantation. Only 2 patients suffered neurological signs and symptoms, including mental retardation and epilepsy, whereas 3 were noted to have temporary hemiparesis which recovered completely during the follow-up period. The possibility of BA should be considered in the treatment of ICH due to vitamin K deficiency, since it is reported to be one of the major causes of secondary vitamin K deficiency. Urgent surgical intervention for ICH can be performed successfully following sufficient administration of vitamin K or fresh frozen human plasma. Moreover, early performance of Kasai portoenterostomy is possible even for patients who have undergone craniotomy.

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“…Doença hemorrágica do recém-nascido, forma tardia, que ocorre entre a 2ª e a 12ª semana de vida, envolvendo crianças alimentadas exclusivamente ao seio e que não receberam vitamina K ao nascimento. Esta forma caracteriza-se pela complicação mais freqüente e grave da doença, manifestada pela hemorragia intracraniana, a qual é responsável pela alta mortalidade e as graves seqüelas neurológicas 2,3 . O tratamento da deficiência clínica, em qualquer das suas formas, é feito com vitamina K1 na dose de 5 mg via intramuscular ou, nos casos mais graves, via intravenosa devido ao risco de formação de hematomas no local da injeção intramuscular.…”

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Late hemorragic disease of the newborn: case report

Figueiredo¹,

Norton²,

Lamounier³

et al. 1998

J Pediatr (Rio J)

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IntroduçãoAs manifestações clínicas predominantes da carência da vitamina K são as hemorragias, decorrentes da não ativação das proteínas dependentes da vitamina. Apesar de ocorrer em qualquer faixa etária, o recém-nascido é mais susceptível à doença, por apresentar níveis mais baixos de fatores da coagulação, menores reservas de vitamina K e por ter baixo aporte da vitamina quando alimentado com o leite humano.A doença hemorrágica do recém-nascido, causada pela deficiência de vitamina K, na sua forma clássica, é bastante conhecida dos pediatras. A sua importância clí-nica deixou de ser uma preocupação em virtude do uso de vitamina K após o nascimento como uma forma efetiva de prevenir a doença. A forma tardia da doença, descrita em trabalhos publicados na década de 80, continua sendo pouco divulgada em nosso meio. Nos países de primeiro mundo, a profilaxia da forma tardia constitui, ainda, uma preocupação. O presente estudo objetiva chamar atenção para esta forma tardia de doença, muitas vezes não lembrada pelos pediatras. ResumoObjetivo: Chamar atenção para a doença hemorrágica do recém-nascido em sua forma tardia, que poderá ter graves conseqüências, incluindo o óbito e seqüelas neurológicas.Métodos: São apresentados e descritos quatro casos de recém-nascidos, com idade variando de 12 a 21 dias de vida, diagnosticados como doença hemorrágica tardia por deficiência de vitamina K.Resultados: Nos casos apresentados as manifestações hemorrágicas foram múltiplas. Os locais acometidos em nossos casos foram o aparelho digestivo, trato urinário, côto umbilical, aparelho respiratório e SNC.Conclusão: O estudo mostra a importância da forma tardia da doença hemorrágica do recém-nascido, destacando-se sua possível gravidade, risco de morte e de seqüelas neurológicas. A administração profilática de vitamina K após o nascimento, preconizada pela OMS, continua sendo a melhor forma de prevenir a doença.J. pediatr. (Rio J.). 1998; 74(1):67-70: deficiência de vitamina K, doença hemorrágica do recém-nascido, doença hemorrágica forma tardia. AbstractObjective: In this study the authors review this subject, and call attention for the late hemorrhagic disease of the newborn, due to the severity and higher risk of mortality and neurological sequelae.Methods: In this article, four cases of children, age raging from 12 to 21 days, with late hemorrhagic disease associated with vitamin K deficiency were reported.Results: All newborns had multiple hemorrhagic manifestations of the disease. The systems more affected were digestive tract, urinary system, umbilical cord, respiratory system and nervous system.Conclusion: Three forms of hemorrhagic disease of newborn have been related with vitamin K deficiency. However, late vitamin K deficiency bleeding is not common and may not be diagnosed by pediatrician. This form of disease can be prevented by vitamin K prophylaxis administration after birth.

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Intracranial hemorrhage and vitamin K deficiency in early infancy

Cited by 71 publications

References 27 publications

A New Pattern of Cerebellar Hemorrhages in Preterm Infants

A New Pattern of Cerebellar Hemorrhages in Preterm Infants

Intracranial Hemorrhage and Vitamin K Deficiency Associated with Biliary Atresia: Summary of 15 Cases and Review of the Literature

Late hemorragic disease of the newborn: case report

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