Vitamin K Deficient Bleeding (Hemorrhagic disease of the newborn)

What this episode covers

<br /> Newborn infants need intramuscular injections of Vitamin K in order to produce critical clotting factors. If they don&#8217;t get it they can have potentially life threatening bleeding.<br /> <br /> <br /> <br /> <a href="http://www.pwmblog.com" target="_blank" rel="noreferrer noopener">PEMBlog</a><br /> <br /> <br /> <br /> <a href="http://twitter.com/PEMTweets">@PEMTweets on&#8230; sigh &#8220;X&#8221; (Twitter)</a><br /> <br /> <br /> <br /> <a href="https://www.instagram.com/bradsobolewski/" target="_blank" rel="noreferrer noopener">My Instagram</a><br /> <br /> <br /> <br /> <a rel="noreferrer noopener" href="https://med-mastodon.com/@bradsobo" target="_blank">My Mastodon account @bradsobo</a><br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> <br /> * <a href="http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/1/191">American Academy of Pediatrics, Committee on Fetus and Newborn. Controversies Concerning Vitamin K and the Newborn. Pediatrics 2003 July; 112(1):191-2.</a><br /> <br /> <br /> <br /> * Ross, JA, Davies SM. Vitamin K prophylaxis and childhood cancer. Med Pediatr Oncol. 2000 Jun;34(6):434-7.<br /> <br /> <br /> <br /> * Cornelissen, M., et al. Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K. Eur J Pediatr. 1997 Feb; 156(2):126-30.<br /> <br /> <br /> <br /> * Greer, FR, et al. Improving the vitamin K status of breastfeeding infants with maternal vitamin K supplements. Pediatr. 1997 Jan;99(1).<br /> <br /> <br /> <br /> * Kher P, Verma RP. Hemorrhagic Disease of Newborn. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558994/#<br /> <br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI<br /> <br /> <br /> <br /> Welcome to PEM Currents, the pediatric emergency medicine podcast. As always, I&#8217;m your host, Brad Sobolewski. Today, we&#8217;re gonna talk about vitamin k deficient bleeding, also known as hemorrhagic disease of the newborn. This is a bleeding disorder that manifests in the first few days to weeks of life after delivery. Under the umbrella are a whole range of hemorrhagic diseases, but the most important is vitamin k deficient bleeding.<br /> <br /> <br /> <br /> I&#8217;ll get into why in a moment. Vitamin k itself is a fat soluble vitamin mainly synthesized by gut bacteria. Newborns have minimal vitamin k reserves in a sterile gut. And there&#8217;s insufficient placental transfer and breast milk is deficient in vitamin K, so that&#8217;s why infants need vitamin K at birth. Without it, they can&#8217;t produce clotting factors 2, 7, 9, and 10.<br /> <br /> <br /> <br /> You need all those. In brand newborns, the levels are about 20 percent or less of adult values, but within a month after birth, they arise to within normal limits. Other causes of hemorrhagic disease of the newborn include hereditary clotting factor deficiencies such as hemophilia A or B. And the most common item on the differential, especially for late onset, which we&#8217;ll talk about in a moment, is trauma, non accidental or accidental trauma. So why am I covering this topic?<br /> <br /> <br /> <br /> Well, a lot of