Background The incidence of early-onset vitamin K deficiency bleeding (VKDB) in at-risk neonates who did not receive vitamin K supplementation varied from 6 to 12%. This case report aims to show that VKDB can occur abruptly after birth despite vitamin K1 1 mg IM being given immediately after birth. Case presentation A term female baby was born through vaginal delivery of a 28 years old mother, G1P0A0, 39–40 weeks gestation with normal APGAR score, and birth weight was 3445 g, birth length was 52 cm. During pregnancy, the mother did not take any drugs except vitamins. There are no abnormalities on the baby’s physical examination. The anus is patent. Immediately after birth, the baby received a vitamin K1 1 mg intramuscularly. Abruptly, 50 min after delivery, there was meconium with lots of fresh blood. Laboratory results showed hemoglobin, 19.6 g/dL; leukocytes, 25,010/uL; platelets, 390,000/uL, with increased PT and aPTT. A peripheral blood smear showed a normal blood morphology. When 7 h old, the baby had much hematochezia. Laboratory results showed decreased hemoglobin to 17.5 g/dL and increased PT, aPTT, and INR. No abnormalities were found on the babygram and abdominal ultrasound. The working diagnosis was gastrointestinal bleeding due to idiopathic early-onset VKDB. The baby received vitamin K1 2 mg IM, Fresh Frozen Plasma, and a Packed Red Cells transfusion. The patient returned home in good clinical condition. Conclusion Vitamin K1 1 mg IM prophylaxis should be given immediately after birth to prevent early-onset VKDB. In addition, pregnant women who receive drugs that interfere with vitamin K metabolism (anti-epileptic drugs, anti-tuberculosis drugs, vitamin K antagonist drugs) should be given prophylactic vitamin K1, 20 mg/d orally, for at least two weeks before the expected time of delivery.

BACKGROUND: Congenital syphilis (CS) is the second leading cause of preventable stillbirth globally. This case report shows that CS baby can be managed by amoxicillin with good results. CASE PRESENTATION: A term female baby was born through section cesarean on suspicion of syphilis of a 29-year-old mother, G4P3A0, 39 weeks gestation with normal APGAR score, and birth weight was 2330 g, birth length was 46 cm, and head circumference 32 cm. There are no abnormalities on physical examination. The baby is active and clinically sound. In history taking, the mother was diagnosed with syphilis in the first trimester of pregnancy but did not want to be treated. After birth, maternal serology showed that Treponema pallidum is reactive. Maternal VDRL was reactive at 1:1, while TPHA was reactive at 1:2560. Baby laboratory results showed Hb 18.4 g/dL, leukocytes 33,480/μL, platelets 278,000/μL, and hematocrit 54.7%. A peripheral blood smear showed neutrophilia with hypersegmentation and monocytosis due to suspected chronic inflammation. Baby VDRL was reactive at 1:16, while TPHA was reactive at 1:1280. The diagnosis was congenital syphilis with low birth weight and small for gestational age. After one month of treatment with oral amoxicillin, baby VDRL was reactive at 1:2, while TPHA was reactive at 1:320. At 1½ months, the baby’s hemoglobin is 10.1 g/dL. X-rays for chest, abdomen, and skeletal were within normal limits. The baby was given oral amoxicillin 50 mg/kg/day for a total of 3 months. When the baby was 4 months old, her growth and development were good with the VDRL reactive 1:1 and the TPHA reactive 1:160. CONCLUSION: In the unavailability of benzathine penicillin, amoxicillin may be considered an option in CS management.