Hemorrhagic Disease of Newborn (HDN) ; #Topic_of_the_Day ; 28.07.2020

🔰 Hemorrhagic Disease of Newborn (HDN) 🔰

📌 Hemorrhagic manifestations in a newborn baby due to Vitamin K Deficiency.

💉 Pathogenesis -

💉 Types -

💠 Classical HDN -

📌 Most common type of HDN

📌 Occurs due to physiological Vitamin K deficiency

📌 Aggravated by exclusive breast feeding

📌 Presentation -

👉 Commonly during 2nd or 3rd day of life (upto 1-7 cays)

👉 Umbilical stump bleeding, Nasal bleeding, GI bleeding (Not life threatening)

💠 Early HDN -

📌 Risk Factors - 

👉 Maternal Drug Intake (Warfarin, Anticonvulsants, INH, Rifampicin etc).

📌 Presentation - 

👉 Life-threatening hemorrhagic manifestations are seen in-utero or within 24 hours of life. 

👉 Concealed hemorrhages inside cranium, thorax or abdomen. 

 

💠 Late HDN -

📌 Risk factors -

👉 Cholestasis

👉 Malabsorption

👉 Chronic diarrhoea

👉 Prolonged administration of broad-spectrum antibiotics

📌 Presentation -

👉 Presents after 1st week of life (2-16 weeks)

👉 Life-threatening bleeding manifestations (intracranial bleed), but bleeding may occur from any site (skin, GIT etc.) 

💉 Diagnosis -

📌 Infants do not appear clinically ill or toxic

📌 Coagulation Profile -

👉 Bleeding Time — Normal

👉 Clotting Time — Prolonged

👉 Prothrombin Time — Prolonged

👉 aPTT = Prolonged 

👉 aPTT may be normal initially, as Factor Vii has the lowest half life and it is the earliest clotting factor to decline resulting in increased PT and normal aPTT

📌 PIVKA (Protein Induced in vit. K absence) is Elevated

💉 Prophylaxis -

📌 All newborns born in hospital settings should be given 0.5-1 mg of vitamin K intramuscularly at birth or within 24 hours of life (0.5 mg for newborns < 1000 gms)

💊 Treatment - 

📌 Vitamin K has 3 forms according to the source - 

👉 K1 (plant source) and K2 (animal source) are safe in newborns, but K3 (synthetic) is potentially toxic. 

📌 Classical HDN -

👉 Vitamin K1 - 1 to 2 mg i.v or i.m. causes dramatic response

📌 Early HDN - 

👉 Predisposed infants should receive vitamin K1 (2 mg) at birth

👉 Delivery preferably by LUCS

📌 Late HDN -

👉 Predisposed infants should receive vitamin K1 (1 mg) i.m. monthly, till underlying disorder is controlled

📌 Life-threatening hemorrhage —

👉 FFP transfusion along with vitamin K injection

👉 Whole Blood/PRBC Transfusion for large amount of bleeding (> 20% blood loss)

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