Intracranial Hemorrhage Due to Vitamin K Deficiency After the Newborn Period

Abstract

This study presents clinical and laboratory findings and outcome of infants with intracranial hemorrhage (ICH) due to vitamin K deficiency after the newborn period, and evaluates vitamin K prophylaxis. The hospital records of 19 infants with a diagnosis of ICH due to vitamin K deficiency after the newborn period, seen in our clinic in less than 4 years, were retrospectively evaluated. The mean age at onset of the symptoms was 49 +/- 18 days. The most frequent presenting complaints were convulsion (58%), vomiting (47%), and irritability (47%). The most frequent examination findings were coma (74%), fontanel bulging (68%), and absence of pupil reaction (42%). The localizations of the ICHs were as follows: parenchymal (47%), subarachnoid (47%), subdural (42%), and intraventricular (26%). Four patients had used antibiotics and 1 patient had suffered diarrhea before the onset of the symptoms. One patient had a mild hepatic dysfunction that resolved spontaneously in a few weeks and its cause was not found. Mortality was observed in 6 (32%) patients. Ten patients were followed up for a mean period of 26.9 +/- 22.6 months. The follow-up findings were developmental delay (40%), microcephaly (30%), epilepsy (30%), blindness (20%), strabismus (20%), spastic tetraparesis (10%), spastic hemiparesis (10%), growth retardation (10%), and hydrocephaly (10%). Three (30%) patients remained neurologically normal. Vitamin K deficiency leads to death and neurological defects. Vitamin K prophylaxis at birth is therefore a priority. In this series, hepatic dysfunction had been detected in only 1 patient. The authors speculate that additional vitamin K to breast-fed infants with liver problem, antibiotic use, diarrhea, etc., should be considered.

Intracranial Hemorrhage Caused by Vitamin K Deficiency Beyond Neonatal Period

“…Seizures were present in 62.5% of patient in this study slightly higher than earlier studies by 58% Demiroren et al and 49% by Özdemir et al 10,13 . Half of the infants had vomiting earlier studies noted vomiting in 45% patients 10,13 .…”

“…Half of the infants had vomiting earlier studies noted vomiting in 45% patients 10,13 . Nine (56.3%) children were febrile on admission.…”

“…Bulged fontanel in infants was reliable sign and present in 81.25% of ICH. Earlier studies described bulged fontanel in 60-70% of infants with ICH 10,13,14 .…”

“…Intracranial haemorrhage due to VKDB causes signifi cant mortality and morbidity 3,9,10 . Neurological defi cits including developmental delay, epilepsy, blindness, strabismus, spastic paresis, growth retardation and hydrocephaly have been described in surviving infants 10 .…”

“…In view of high burden of VKDB additional dose of vitamin K is suggested for all infants 2,9 . In breast fed infants, infants with liver disease, antibiotic uses and diarrhoea there is defi nitive role of additional doses 10 . In many developing countries vitamin K prophylaxis is not routinely administered 11 .…”