Hemorrhagic disease of the newborn
Hemorrhagic disease of the newborn (HDN) is a bleeding disorder in babies. It most often develops shortly after a baby is born.
Vitamin K deficiency bleeding; VKDB
A lack of vitamin K causes hemorrhagic disease of the newborn. Vitamin K plays an important role in blood clotting.
Babies often have low levels of vitamin K for a variety of reasons. Vitamin K does not move easily across the placenta from the mother to the baby. As a result, a newborn does not have much vitamin K stored-up at birth. Also, there is not much vitamin K in breast milk.
Your baby may develop this condition if:
- A preventive vitamin K shot is not given at birth (if vitamin K is given by mouth instead of as a shot, it must be given more than once, and it may not be as effective)
- You take certain anti-seizure or blood thinning drugs
The condition is grouped into three categories:
- Early onset hemorrhagic disease of the newborn is very rare. It occurs during the first hours after birth and within 24 hours. Use of anti-seizure drugs or a blood thinner called coumadin during pregnancy is a common cause.
- Classic onset disease occurs between 24 hours and 7 days after birth. It may be seen in breast-fed infants who did not receive a vitamin K shot within the first week after birth. It is also rare.
- Late onset HDN is seen in infants between 2 weeks and 2 months old. It is more common in children who did not receive a vitamin K shot.
Newborns and infants with the following problems involving the gastrointestinal tract are more likely to develop this disorder:
- Alpha1-antitrypsin deficiency
- Biliary atresia
- Celiac disease
- Cystic fibrosis
The condition causes bleeding. The most common areas of bleeding include:
- A boy's penis, if he has been circumcised
- Belly button area
- Gastrointestinal tract (may result in blood in the baby's bowel movements)
- Mucus membranes (such as the lining of the nose and mouth)
- Places where there has been a needle stick
There may also be:
- Blood in the urine
- Raised lump on the baby's head (suggesting bleeding underneath one of the skull bones)
Exams and Tests
Blood clotting tests will be done.
The diagnosis is confirmed if a vitamin K shot stops the bleeding and blood clotting time (prothrombin time) is within normal limits.
Vitamin K is given if bleeding occurs. Patients with severe bleeding may need blood transfusions.
The outlook tends to be worse for babies with late onset hemorrhagic disease than other forms. There is a higher rate of bleeding inside the skull (intracranial hemorrhage) associated with the late onset condition.
- Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
- Severe bleeding
When to Contact a Medical Professional
Call your doctor if your baby has any unexplained bleeding.
The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medications.
The American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. This practice has helped prevent the classic and late-onset forms of the condition, which is now rare in the U.S.
Blood Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011.
American Academy of Pediatrics Committee on Fetus and Newborn. Policy statement: controversies concerning vitamin K and the newborn. Pediatrics. 2003;112:191-192.
Warren M et al. Notes from the field: late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis--Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013 Nov 15;62(45):901-2.
Reviewed By:Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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