Overview
Previously known as haemorrhagic disease of the newborn, vitamin K deficiency bleeding (VKDB) describes easy bleeding and bruising in neonates and young infants due to low vitamin K at birth. This can range from small bruises to intracranial haemorrhage.
All neonates and infants have low stores of vitamin K and are at risk of VKDB. Breastfed babies are at an increased risk as there are low concentrations of vitamin K.
VKDB can be classified into:
- Early form – presents within 24 hours of birth
- Classic form – presents between days 1-7 of life
- Late form – presents between weeks 2-12 of life
Epidemiology
- In the UK, VKDB is rare. Most cases occur in breastfed babies whose parents have refused vitamin K prophylaxis
Risk Factors
- Early form:
- Drugs including antiepileptics, and anti-tuberculosis drugs
- Classic form:
- Idiopathic
- Breastfeeding – human breast milk has low amounts of vitamin K
- Poor oral intake
- Prematurity – due to delayed colonisation of vitamin K-producing flora of the gut, delayed feeding, and immature liver function
- Late form:
- Liver disease
- Malabsorption (e.g. coeliac disease, cystic fibrosis, diarrhoea)
Presentation
- Early VKDB – bleeding usually occurs due to trauma during birth:
- Cephalohaematoma
- Intracranial, intrathoracic, intra-abdominal bleeding
- Bleeding from scalp monitoring sites
- Classic VKDB:
- Gastrointestinal bleeding (haematemesis, haematochezia)
- Epistaxis
- Gum bleeding
- Prolonged umbilical stump bleeding
- Late VKDB usually presents with intracranial haemorrhage and has the highest risk of morbidity and mortality, and may lead to permanent disability.
Management
All newborns in the UK are offered vitamin K intramuscularly or orally.
