Advertisement

Hemorrhagic Disease of the Newborn: A Case Series Illustrating Preventable Harm

Published:September 15, 2022DOI:https://doi.org/10.1016/j.pedhc.2022.08.004

      Abstract

      Newborns are susceptible to postnatal Vitamin K deficiencies from limited placental transfer, gastrointestinal absorption, and bioavailability in breast milk and formula preparations. For over 50 years, the American Academy of Pediatrics has recommended prophylactic vitamin K to prevent hemorrhagic disease in newborns. Yet, public skepticism contributes to increasing refusal rates. We present three cases of vitamin K-dependent bleeding following parental refusal of postnatal prophylaxis. Two patients experienced intracranial hemorrhage with resultant neurological devastation and mortality, respectively. The third child presented with symptomatic hematuria. Perinatal providers must partner with families and advocate vitamin K prophylaxis to limit unnecessary morbidity and mortality.

      KEY WORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Health Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ceratto S.
        • Savino F.
        Vitamin K deficiency bleeding in an apparently healthy newborn infant: The compelling need for evidence-based recommendation.
        Italian Journal of Pediatrics. 2019; 45: 30
        • Dituri F.
        • Buonocore G.
        • Pietravalle A.
        • Naddeo F.
        • Cortesi M.
        • Pasqualetti P.
        • Agostino R.
        Pivka-II plasma levels as markers of subclinical vitamin K deficiency in term infants.
        Journal of Maternal-Fetal and Neonatal Medicine. 2012; 25: 1660-1663
        • Gildner T.E.
        • Thayer Z.M.
        Birth plan alterations among American women in response to COVID-19.
        Health Expectations: An International Journal of Public Participation in Health Care and Health Policy. 2020; 23: 969-971
        • Hamrick H.J.
        • Gable E.K.
        • Freeman E.H.
        • Dunn L.L.
        • Zimmerman S.P.
        • Rusin M.M.
        • Skinner A.C.
        Reasons for refusal of newborn vitamin K prophylaxis: Implications for management and education.
        Hospital Pediatrics. 2016; 6: 15-21
        • Hand I.
        • Noble L.
        • Abrams S.A.
        Vitamin K and the newborn Infant.
        Pediatrics. 2022; 149e2021056036
        • Hilgartner M.W.
        Vitamin K and the newborn.
        New England Journal of Medicine. 1993; 329: 957-958
        • Jones A.H.
        • Dizon Z.B.
        • October T.W.
        Investigation of public perception of brain death using the internet.
        Chest. 2018; 154: 286-292
        • Levin R.
        • Jung J.M.
        • Forrey L.
        • Glick J.
        Refusal of vitamin K injection: Survey of the current literature and practical tips for pediatricians.
        Pediatric Annals. 2018; 47: e334-e338
        • Loyal J.
        • Shapiro E.D.
        Refusal of intramuscular vitamin K by parents of newborns: A review.
        Hospital Pediatrics. 2020; 10: 286-294
        • Loyal J.
        • Taylor J.A.
        • Phillipi C.A.
        • Goyal N.K.
        • Dhepyasuwan N.
        • Shapiro E.D.
        • Colson E.
        Refusal of vitamin K by parents of newborns: A survey of the better outcomes through research for newborns network.
        Academic Pediatrics. 2017; 17: 368-373
        • Majid A.
        • Blackwell M.
        • Broadbent R.S.
        • Barker D.P.
        • Al-Sallami H.S.
        • Edmonds L.
        • Wheeler B.J.
        Newborn vitamin K prophylaxis: A historical perspective to understand modern barriers to uptake.
        Hospital Pediatrics. 2019; 9: 55-60
        • Marcewicz L.H.
        • Clayton J.
        • Maenner M.
        • Odom E.
        • Okoroh E.
        • Christensen D.
        • Grant A.
        Parental refusal of vitamin K and neonatal preventive services: A need for surveillance.
        Maternal and Child Health Journal. 2017; 21: 1079-1084
        • Rech M.A.
        • Wittekindt L.
        • Friedman S.D.
        • Kling K.
        • Ubogy D.
        Prothrombin complex concentrate for intracerebral hemorrhage secondary to vitamin K deficiency bleeding in a 6-week-old child.
        Journal of Pediatrics. 2015; 167: 1443-1444
        • Sahni V.
        • Lai F.Y.
        • MacDonald S.E.
        Neonatal vitamin K refusal and nonimmunization.
        Pediatrics. 2014; 134: 497-503
        • Sankar M.J.
        • Chandrasekaran A.
        • Kumar P.
        • Thukral A.
        • Agarwal R.
        • Paul V.K.
        Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: A systematic review.
        Journal of Perinatology. 2016; 36: S29-S35
        • Schulte R.
        • Jordan L.C.
        • Morad A.
        • Naftel R.P.
        • Wellons J.C.
        • Sidonio R.
        Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth.
        Pediatric Neurology. 2014; 50: 564-568
        • Shah S.I.
        • Brumberg H.L.
        • La Gamma E.F.
        Applying lessons from vaccination hesitancy to address birth dose vitamin K refusal: Where has the trust gone?.
        Seminars in Perinatology. 2020; 44151242
        • Sochet A.A.
        • Nakagawa T.A.
        Trust the internet or trust your physician: Public perception of brain death isn't a no brainer.
        Chest. 2018; 154: 238-239
        • Stachowiak A.
        • Furman L.
        Vitamin K is necessary for newborns.
        Pediatrics in Review. 2020; 41: 305-306
        • Stafford D.W.
        The vitamin K cycle.
        Journal of Thrombosis and Haemostasis: JTH. 2005; 3: 1873-1878
        • Vietti T.J.
        • Murphy T.P.
        • James J.A.
        • Pritchard J.A.
        Observations on the prophylactic use of vitamin K in the newborn infant.
        Journal of Pediatrics. 1960; 56: 343-346
        • Weddle M.
        • Empey A.
        • Crossen E.
        • Green A.
        • Green J.
        • Phillipi C.A.
        Are pediatricians complicit in vitamin K deficiency bleeding?.
        Pediatrics. 2015; 136: 753-757
        • Wolpert K.
        • Szadkowski M.
        • Miescier M.
        • Hewes H.A.
        The presentation of a fussy infant with bruising: Late-onset vitamin K deficiency bleeding.
        Pediatric Emergency Care. 2019; 35: e70-e71
        • World Health Organization
        Pocket Book of Hospital Care for Children, 2nd edition: Guidelines for the Management of Common Childhood Illnesses.
        2013 (Retrieved from:)