Hemorrhagic disease of the new born is a severe bleeding disorder that affects the newborns and neonates. It is a rare bleeding problem that usually occurs either immediately after birth or after some hours after birth.
Hemorrhaging occurs when there is severe bleeding and it is a very serious and a potentially dangerous condition for most especially the neonate. This condition is caused by the reduced intake or the lack of vitamin K.
Because of the cause, most times this disease is often referred to as vitamin K bleeding disorder or vitamin K deficiency bleeding (VKDB). Vitamin k is one of the essential vitamins in the body and it is needed by the body for blood clotting. In order words, vitamin K helps in blood clotting.
Once vitamin K is not adequately or sufficiently passed from the mother to the baby while the baby is still in the womb, the baby will be born without adequate storage or adequate levels of vitamin K in the system.
There are 3 classes of Vitamin k deficiency bleeding and they are:
1. The early stage otherwise known as the early onset: This is when the baby starts to haemorrhage within the first 24 hours after birth.
2. The classic stage or the classic onset: This occurs when the baby begins to haemorrhage within the first 2-7 days after birth.
3. The late stage or the late onset: This occurs when the baby starts to bleed severely within 2 weeks-6 months after birth.
Causes of VKDB
When there is a deficiency of vitamin K, the baby will have vitamin K deficiency Bleeding (VKDB). For most people, the major source of vitamin K is gotten from Leafy green vegetables.
One major source that most people do not know is that vitamin K is a by product gotten from some certain harmless bacteria and intestinal flora found in your gut,colon and intestines.
A number of reasons are the causes why a baby is most likely to be prone to vitamin K deficiency bleeding and these includes
1. It could occur because of the trace amounts of Vitamin K that is being transferred from the mother via the placenta and umbilical cord while the baby is still in the womb
2. Also asides this, breast milk which is given to babies also trace amounts of Vitamin K in it and this may not be sufficient for the baby and likewise the gut flora found in breast milk which is known as lactobaccillus doesn’t synthesize vitamin K unlike the intestinal flora.
If your baby has VKDB, they may begin to exhibit mild signs of “failure to thrive”. These begin to occur before the child starts to bleed profusely and continuously.
The symptoms of Vitamin K deficiency bleeding include;
- The very first thing you will notice are minor bleeding which are otherwise known as warning bleeds. You may notice this or not and they may even look insignificant to you.
- You baby may be underweight when compared to a normal neonatal weight
- Normally, within the first few hours after birth, a baby is supposed to gain a little weight. However, for a baby suffering from VKDB, the baby will slowly gain weight hence leading to the baby being underweight.
Then you may begin to notice blessing in several areas such:
- Around their umbilical stump. The baby may begin to bleed from where the umbilical cord was detached, just around the naval area.
- Bleeding may also occur from the mucous membranes found within their noses and mouths.
- If the baby is a male child and is circumcised, bleeding may at the penile region.
- Areas where they have received injections and vaccinations. Those little punctures made by needles and syringes may begin to bleed.
- They may begin to bleed from the mucous membranes of their gastrointestinal tracts.
- You may also notice bleeding found in their waste products such as their urine and stools. On their skins, you may find bruises and cuts that seem as a tear, or you may find a lump that feels raised and tender around the head region.
If the raised lump appears very early, it might possibly be a cephalohematoma. This is a kind of hematoma that occurs when blood vessels rupture and tears during birth. Normally, this kind of hematoma is not so serious and it resolves on its own within a few days or a month at most.
However, if the raised head lump appears a little bit later on, the child my have intracranial haemorrhage. This means that probably your child is bleeding inside his/her cranium and into his brain. This is a very serious, complicated and a life-threatening condition.
There are some risk factors to be considered and these risk factors is dependent on the classes of Vitamin K deficiency bleeding that occurs. They include:
1. For the early onset or early stage VKDB:
Early stage VKDB usually starts within the first 24 hours after delivery. If as the birth mother takes some certain medications during pregnancy, your baby will have an increased chance of getting this stage of VKDB. Medications that can cause this include
i. Antiseizure drugs: This is because antiseizure drugs mostly interferes with the metabolism of vitamin K. Such drugs include phenytoin, phenobarbital, caramezepine, or primidone.
ii. Blood thinning drugs: These drugs also affects the synthesis of vitamin K. Drugs as warfarin or aspirin.
iii. Medications that are used to treat or per event tuberculosis also known as antituberculosis medications. They include rifampin and isoniazid.
iv. Some antibiotics such as cephalosporins.
2. Classic onset or classic stage VKDB:
The classic onset usually starts within the first week after birth. These occurs for babies who hasn’t had the typical prophylactic vitamin K immediately after birth. If you exclusively breastfeed your baby, your baby might as well be at a greater risk of developing this stage of VKDB.
3. Late stage or late onset VKDB:
This stage is usually seen in babies who are already up to about 6months of age. For babies who didn’t receive the vitamin K shot at birth at birth, they will get this stage. However, there are other risk factors such as
- The baby receiving reduced levels of vitamin K from the breast milk he/she is taking.
- If your baby has symptoms of biliary atresia (obstructions to the flow of bile)
- If your baby has cystic fibrosis.
- If your baby has Celiac disease
- Hepatitis and
- A1 anti-trypsin deficiency which may lead to lung and liver disease if it is severe.
Diagnosis and treatment
If you suspect that your baby has VKDB, ensure you take the child immediately to the hospital where the doctor will perform blood clot tests and then give your child a shot of vitamin K to see if it stops the bleeding.
If it stops the bleeding, it you will help your doctor confirm that your baby has VKDB and he might prescribe blood infusions as part of the treatment plans if your baby’s VKDB is so severe.
Both early onset and classic onset are very easy to treat. However, for the late onset, it can become very severe and life threatening if it involves your child bleeding under his skull and into his brain. This can cause brain damage as well as brain death.