Signs of the disease
For hemorrhagic disease of newborns are characterized by spontaneous bleeding of various locations - subcutaneous, with the formation of a hematoma, gastrointestinal or umbilical wound. However, bleeding can also be a consequence of external influences - for example, the wound applied to the blood test when screening newborns. Occasionally, hemorrhagic disease is detected after circumcision. The most dangerous manifestation of the disease is intracranial hemorrhage, which in approximately 30% of cases leads to death or severe brain damage leading to disability. Hemorrhagic disease is known for about 100 years, and to fight it with the appointment of vitamin K first became in the 60s of the XX century. This vitamin is present in green leafy vegetables, and is also synthesized by the normal bacterial microflora of the human intestine. It is necessary to help several factors of blood clotting, to join active platelets of blood clots resulting in the formation of a blood clot.
Insufficiency of vitamin K in newborns
In the body of the baby there is only a small amount of vitamin K inherited from the mother, and it is not yet able to synthesize its own, since the necessary bacteria are absent in the intestine. In addition, the liver of the newborn is not yet fully developed and is not able to fully synthesize vitamin-K-dependent clotting factors. All this, combined with a low content of vitamin K in human milk, increases the risk of hemorrhage. Premature babies are especially vulnerable. Some drugs taken in the last months of pregnancy can affect the metabolism of vitamin K and expose the child to the risk of bleeding in the first 24 hours of life. These include anti-tuberculosis anticoagulants and some anticonvulsants. Protecting the newborn is possible with the help of early intramuscular injections of vitamin K. There is also a rare disease, known as late hemorrhagic neonatal disease, which usually manifests itself at the age of 2-8 weeks. Most often it affects children who are breastfed, and also have metabolic disorders, such as liver disease, chronic diarrhea and developmental disorders. For all its rarity, such bleeding can be very severe and lead to death or severe disability. Hemorrhagic disease can be successfully prevented by prescribing a suitable vitamin K preparation for all babies right after birth. However, if after this there are suspicions of hemorrhagic disease, a series of blood tests are performed. Vitamin K has traditionally been used in the form of intramuscular injections. The dose of 1 mg, administered within 6 hours after birth, provides reliable protection against hemorrhagic disease. However, in 1990, a possible link between intramuscular injections of vitamin K and a slight increase in the risk of childhood cancers was identified.
Oral form of vitamin K
As an alternative to injection, vitamin K can be administered orally. However, this form of the drug is less effective in preventing late hemorrhagic disease. Therefore, if earlier more and more doctors recommended using the oral form, now most experts prefer the tested injection method of administration. This is the only proven way to prevent potentially catastrophic late bleeding.
A course of treatment
Before choosing the method of drug administration, the risks and advantages of each of them are discussed with the child's parents. The decision must be made before delivery. Thus, the first dose is administered without any delay. If parents prefer the oral route, three separate doses of 2 mg are given. Many hospitals have developed their own guidelines for the use of vitamin K. Most of them recommend intramuscular injection of the drug to infants with an assumed high risk of hemorrhagic disease. This is primarily premature babies and children born with Caesarean section. If a hemorrhagic disease is suspected, blood tests should be performed to detect anemia, liver dysfunction and coagulation ability. After the blood is taken for examination, treatment with intravenous administration of vitamin K and transfusion of blood plasma containing clotting factors can be continued. If a child suffers from a shock caused by internal bleeding, a whole blood transfusion may be required. Unfortunately, more than 50% of infants who have been diagnosed with late hemorrhagic disease experience cerebral bleeding, leading to death or causing irreversible long-term changes. This is especially tragic because the disease can be reliably prevented.
Many babies, who develop severe hemorrhage, before that had small "warning" bleeding. If you have any signs of bleeding, you should immediately report this to a midwife or general practitioner. In no case should you ignore such things. It is important that the parents tell the doctor in what form the child was receiving vitamin K because infants taking it orally may be prone to late hemorrhagic disease. Blood in the feces of an infant does not necessarily mean hemorrhagic disease, since it could enter the intestine during labor or breastfeeding if the mother has cracked nipples.