OVERVIEW
 Hemorrhagic disease is a potentially fatal condition that can occur in some newborn babies.
 It is also referred to as vitamin K deficiency bleeding (VKDB) as it results from vitamin K deficiency
 Vitamin K is necessary for efficient clotting of blood and deficiency can result in excessive hemorrhage/bleeding.
 There are two forms of vitamin K. Vitamin K1 (phylloquinone) is plant derived, especially leafy green vegetables like spinach and kale. Vitamin K2 (menaquinone) is produced naturally in the intestinal tract and has a similar mechanism of action to vitamin K1
 It usually happens during the first few days after birth
 Giving prophylactic vitamin K (phytonadione) injection to newborn babies can prevent VKDB. It is recommended to be given as a single intramuscular dose.

ETIOLOGY
Vitamin K is not transferred efficiently from mother to baby in utero. As a result babies are usually born with low vitamin K stores in their body

TYPES OF VKDB
Vitamin K deficiency bleeding is classified into three types based on time of onset
 Early onset type - within 24 hours of delivery
 Classic onset type – 2 to 7 days after birth
 Late onset type - two weeks to six months

RISK FACTORS FOR VKDB
 Early onset type
• Medications taken by mother during pregnancy (cephalosporins, anti-tuberculous treatment, anticoagulants, anticonvulsants)
 Classic onset type
• Typically occurs in exclusively breastfed babies who have not received vitamin K prophylaxis
 Late onset type
• Babies born with certain conditions such as biliary atresia, cystic fibrosis
• Chronic diarrhea
• Liver disease
• Exclusively breast fed babies

CLINICAL FEATURES OF VITAMIN K DEFICIENCY BLEEDING
 Blood in baby's stool
 Oozing of blood around baby’s umbilical cord
 Blood in baby's urine (haematuria)
 Bleeding from nose and mouth
 Easy bruising more especially over baby's head and face and vaccination sites
 Excessive drowsiness and lethargy (due to intracranial bleeding in severe cases)

DIAGNOSIS OF VKDB
 In suspected cases, clotting tests (bleeding and clotting times) are performed on baby’s blood
 Giving vitamin K injection stops bleeding

TREATMENT OF VKDB
 Vitamin K injection
 Blood transfusion in severe cases

PROGNOSIS
The prognosis is better for infants having early onset or classic onset disease . However, late onset VKDB carries a higher risk of life-threatening intracranial bleeding which can be potentially fatal