Hemorrhagic Disease of the Newborn

Three forms of hemorrhagic disease of the newborn are recognized. The phrase is a misnomer because these can be seen during infancy after the neonatal period.

1) Early-onset: Typically presents during first 24 hours after birth and is seen in infants born to mothers who are deficient in vitamin K (those who are on seizure or tuberculosis medications). Site of bleeding is variable and can be serious (intracranial).

2) Classic: Presents between day 1 to 7 of life and is secondary to failure of administration of vitamin K at birth. Site of bleeding can be umbilicus, GI, skin, circumcision. Intracranial bleeding is less common.

3) Late:  Presents from 2 weeks up to 6 months (rarely later) and is seen in exclusively or predominantly breastfed infants who did not get vitamin K at birth. Most common presentation is intracranial hemorrhage.

Treatment: Symptomatic (transfusion, supportive care, site specific treatment), FFP for active bleeding, vitamin K administration.