Clinical case of late neonatal hemorrhagic disease. Hazards for the family doctor. Modern recommendations for prevention

Abstract

The article presents a clinical course and components of the treatment of a hemorrhagic syndrome caused by late vitamin K deficiency in a full-term girl of 28 days of age. The issue of early prevention of bleeding associated with late vitamin K deficiency in all newborns from 2 weeks to three months of age who are fed with breast milk is relevant without exaggeration since more than 50 % of complications of these bleeding are acute spontaneous intracranial hemorrhages with a mortality rate of over 30 %. Clinical manifestations of hemorrhagic syndrome in a girl at the end of the neonatal period, which, according to the results of clinical and laboratory examinations, was caused by a late vitamin K deficiency, were disorders of the general well-being with stable indicators of basic vital functions (body temperature, respiratory rate, heart rate, blood pressure), loss of appetite, breast refusal, the progression of the hemorrhagic syndrome: large subcutaneous hematoma on the left lateral side of the chest, palate hematoma, bleeding, scratches on the face. The child had progressive anemia, from a mild degree (hemoglobin 105 g/l, erythrocytes 3.2 x 1012/l) to severe on the second day of life, the hemoglobin level 49 g/l. The coagulogram indices, which were determined in the child, testified a late vitamin K deficiency: lengthening of blood coagulation time up to 6 min 45 seconds, lengthening of prothrombin time up to 18 seconds; APTT increased to 90 seconds; the fibrinogen level did not go beyond the normal range — 1.9 g/l. The diagnosis of late vitamin K deficiency in the infant was established after the appearance of persistent clinical and laboratory signs, in a children’s hospital. The issue of prevention of late vitamin K deficiency in a breastfed baby was not considered by a neonatologist or family doctor. It is the prevention of bleeding associated with late vitamin K deficiency that began in the second week of life with a continuation up to three months of age, according to modern scientific and practical recommendations, should be mandatory for infants who are fed exclusively with breast milk.

Keywords

• newborns
• infants
• hemorrhagic syndrome
• bleeding associated with late vitamin k deficiency