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HEMORRHAGIC  DISEASE  OF   THE   NEWBORN ( HDN ) by=  shubham   singh   dagur group -30  th

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Vitamin  K  plays  a  key  role  in  blood  clotting,   and   most   babies   are   born   with   low   stores   of   the   vitamin   in  their   system. vitamin  K  deficiency  there  is an  impaired   production  of

Hemorrhagic  disease  of  the  newborn  is  a  rare   bleeding

c o a g u la t i o n 	 f a c t o r s 	 II , 	 V II , 	 I X , 	 X 	 b y 	 t h e 	 l i v e r . 	 T he   hemorrhaging  is  a  potentially   life-threatening.

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VKDB  is  categorized  according  to  the  timing  of   first   symptoms: early  onset  (within  24  hours),  which  is  very  rare   -   Results  of  low  levels  of  prothrombin  and  other   vitamin  K  dependent  clotting  factors,  (Factors  II,   VII,  IX  and  X)  caused  by  vitamin  K   deficiency classic  onset  (two  to  seven  days),  which  is   also   very   rare late  onset  (two  weeks  to  six  months)   –  Immaturity   of   liver   affects   production   of   clotting   factors

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Newborns  have  low  vitamin  K  stores  at   birth   Vitamin  K  passes  the  placenta   poorly The  levels  of  vitamin  K  in  breast  milk  are   low The  gut  flora  as  not  yet  been  developed  (vitamin  K  is   normally  produced  by  bacteria  in  the   intestines).

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Essential  for  production  of  active  forms  of   factors II,  VII,  IX,  X  and  anticoagulants  such  as   protein  C  &   S Def   d/t Inadequate   intake Malabsorption  (  coeliac  dz,  cystic   fibrosis,   obstructive   jaundice) Vit  K  antagonists  (eg.   Warfarin)

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Billiary  obstruction  impaired  vit  K  absorption   l/t   decrease  synthesis  FII,FVII,FIX  and   X. Severe  hepatocellular  disease,  reduced  FV,   fibrinogen  &  plasminogen   activator. Dysfunctional  fibrinogen   (dysfibrinogenaemia) Low  thrombopoietin  production   l/t   thrombocytopenia Hypersplenism  associated  with  portal  HTN   l/t   thrombocytopenia

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The  diagnostic  criteria  for  vitamin  K  deficiency   bleeding   include:

Pr o lo n g e d 	 p r o t h r o m b i n 	 t i m e 	 ( P T ) /E l e v a t e d 	 i n t e r n a t i o n a l   normalized  ratio  (INR)  (gold   standard) Prolonged  activated  partial  thromboplastin  time   (aPTT) Fibrinogen  levels  and  a  platelet  count  within  in  normal  range  for   newborns

The  diagnosis  is  confirmed  if  the  INR   normalizes   after  administration  of  vitamin  K  and  the   bleeding  is   stopped.

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The  prothrombin  time  ( PT )  and  international  normalized   ratio

( INR )  are  measures  of  the  extrinsic pathway   of   coagulation (   INR  is  a  calculation  made  to  standardize  prothrombin  time.   INR  is   based   on   the   ratio   of   the   patient's   prothrombin   time   and   the  normal  mean  prothrombin   time)

PT  measures  factors  I  (fibrinogen) ,  II  (thrombin) ,  V ,  VII , and   X . Prothrombin,  or  factor  II,  made  by  the  liver.  Vitamin   K  is   needed   to   make  it   &   other   clotting   factors.

The  prothrombin  time  can  be  prolonged  as  a  result  of   deficiencies   in  vitamin  K,  warfarin   therapy,  malabsorption ,  or  lack  of   intestinal  colonization  by  bacteria  (such  as  in  newborns ).  In   addition, poor  factor  VII  synthesis  (due  to  liver  disease )  or   increased  consumption  (in  disseminated  intravascular    coagulation )  may  prolong  the   PT.

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Significant  bleeding  in  neonates  should  prompt   clinical   evaluation.

‘Initial  empirical  therapy  consists  of  platelet  and/or   factor  supplementation,  which  is  often  administered   while  diagnostic studies  are  under   way’

Laboratory  evaluation  of  the  hemorrhage  in   newborns   should   include  Sepsis   evaluation  determination   of  the  (  Blood  clotting  tests)  platelet   count,  PT,  aPTT,  TT,  and  fibrinogen   concentration.

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Vitamin  K  deficiency  causes  VKDB.  A  baby’s  risks  vary,   depending  upon  when  symptoms   occur. Early-Onset Early-onset  of  VKDB  occurs  within  the  first  24  hours   after   birth.  Risk  factors   include:

mother  taking  anti-seizure  drugs  that  interfere   with   vitamin  K  metabolism  (phenytoin, phenobarbital,   caramezepine,  or   primidone) mother  taking  blood  thinning  medication  such   as   Coumadin  or   aspirin mother  taking  antibiotics,  such  as   cephalosporins

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Late-Onset Late-onset  is  seen  in  babies  up  to  2  months  old.   Risk   factors   include:

low  levels  of  vitamin  K  in  breast   milk  biliary  atresia  (slow  bile   flow) cystic  fibrosis   celiac  disease   chronic   diarrhea   hepatitis A1-antitrypsin  deficiency  (may  cause  lung  and   liver   disease)

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The  disease  causes  an  increased  risk  of  excessive   bleeding.  The  most  common  sites  of  bleeding   are   the; umbilicus mucous  membranes gastrointestinal   tract circumcision Venipunctures  (puncture  in  the  vein   for   therapeutic  purpose  e.g   IV) Intracranial  bleeding  can  cause  brain  damage   or   death.

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Many  newborns-  deficient  in  vit.  K,  whether  measured  in  cord  blood  or   indirectly  by  measuring  the  levels  of  vitamin  K–dependent  coagulation   proteins.  Recommends  giving every  baby  a  shot  of  vitamin  K  immediately   after  birth.  This  practice  has  helped  prevent  the   condition.

The  early onset  form  of  the  disease  may  be  prevented  by  giving  vitamin  K   shots  to  pregnant  women  who  take  anti-seizure   medications.(mechanisms   by  which  anticonvulsant  drug  l/t  vit.  K  deficiency  bleeding  in   neonates :not  clearly   understood)

M o s t 	 in f a nt s 	 bo r n 	 t o 	 w e l l - n o urish e d 	 m o t h er s 	 h a v e 	 a d e q ua te   vitamin  stores  at   birth

Vitamin  K  is  naturally  produced  by  intestinal  bacteria  which newborn’s  lack   resulting  in the   deficiency Suppression  of  intestinal  bacteria  by various  antibiotics  is  responsible  for  this   deficiency Infants  receive  Vitamin  K  either  orally  or   intramuscularly

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HEMORRHAGIC DISEASE OF  THE NEWBORN
(HDN)

by= shubham singh dagur
group -30 th

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 ( INR )  are  measures  of  the  extrinsic pathway   of   coagulation (   INR  is  a  calculation  made  to  standardize  prothrombin  time.   INR  is   based   on   the   ratio   of   the   patient's   prothrombin   time   and   the  normal  mean  prothrombin   time)

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 PT  measures  factors  I  (fibrinogen) ,  II  (thrombin) ,  V ,  VII , and   X . Prothrombin,  or  factor  II,  made  by  the  liver.  Vitamin   K  is   needed   to   make  it   &   other   clotting   factors.

HEMORRHAGIC DISEASE OF THE NEWBORN (HDN) by= shubham singh dagur group -30 th

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