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Causes of hemorrhagic disease of the newborn, treatment and consequences

One of the rather dangerous conditions in pediatrics is hemorrhagic disease of the newborn, which is manifested by a decrease in blood clotting and the occurrence of bleeding of various localization. The reason for this is a decrease in the synthesis of some factors of the coagulation system, which is largely due to a lack of vitamin K in the child’s body. The danger of the disease is a high risk of complications, which can cause a fatal outcome. Modern methods of prevention in most cases allow to avoid this terrible condition and its consequences.

This pathology is relatively rare - it is diagnosed only in less than 1.5% of babies born. In Western European countries and the United States, hemorrhagic disease occurs even less frequently (less than 0.1%). This is due to the mandatory use of vitamin K for its prevention in all newborns on the first day after birth.

The role of vitamin K

The main cause of the pathological condition is insufficient intake or the formation of vitamin K in the body of a baby. Therefore, in ICD-10, the disease also has the second name “vitamin K deficiency in the newborn”. In 1943, scientists who established the cause of hemorrhagic disease, were awarded the Nobel Prize.

Vitamin K has an important function in the human body. This substance is primarily responsible for the activation of some components of the blood coagulation system.
Vitamin K plays a crucial role in the implementation of their coagulation properties of blood, with its lack of significantly increases the risk of bleeding.

The immediate cause of increased bleeding in this case is the lack of the following components of the coagulation system:

  • antihemophilic protein B
  • prothrombin,
  • Stuart factor.

Causes of hemorrhagic disease in newborns

Unfortunately, vitamin K does not penetrate the placenta during pregnancy. In addition, breast milk on the first day contains very little of it, the concentration of vitamin gradually increases only in the next day. That is why small children in the first days after birth, especially those who are breastfed, are extremely sensitive to its deficiency.

Depending on the root cause, this pathology can be primary or secondary. The main primary causes of hemorrhagic disease of the newborn are as follows:

  • mother's use of anticoagulant drugs during pregnancy
  • preterm labor,
  • Caesarean delivery,
  • taking pregnant antibiotics or anticonvulsants,
  • liver disease, female intestine,
  • mother's dysbacteriosis
  • late toxicosis of pregnant women.

How is the disease manifested

Depending on the time of occurrence of characteristic symptoms, hemorrhagic disease is:

  • early - hemorrhagic disease of the newborn manifests itself in the first 24-48 hours after birth,
  • classical - symptoms appear on the third or fifth day,
  • late - bleeding occurs in the first weeks or months of a child’s life.

In the early or classic variant of the course, the symptoms of hemorrhagic disease of the newborn are as follows:

  • vomiting blood
  • the presence of blood in the stool (melena),
  • subcutaneous hemorrhages of various sizes (hematomas, bruises),
  • hematomas in the head,
  • increased bleeding in the area of ​​the umbilical wound,
  • blood in the urine,
  • internal bleeding (pulmonary, intracranial).

Intracerebral hematomas

Hemorrhagic disease of newborns is especially dangerous because intracerebral hemorrhage may occur on its background. In some cases, this condition is the cause of gross neurological deficit and even death.

Most often, the bleeding is localized under the membranes (subarachnoid hemorrhage) or in the substance of the brain. In this case, other symptoms that indicate the involvement of intracranial structures appear on the background of signs of coagulation disorder:

  • impairment of consciousness of varying degrees,
  • frequent regurgitation, vomiting,
  • constant unreasonable cry of a child
  • spring of spring,
  • the divergence of the seams of the skull
  • convulsive syndrome.

How to diagnose

You can suspect the presence of hemorrhagic disease in a child by the presence of characteristic external signs: the appearance of "bruises" on the skin even with slight pressure, petechial rash on the sky, increased bleeding in the umbilical wound or injection. Some children also have yellowness of the skin, which is associated with bleeding in the digestive tract, blood breakdown and increased levels of bilirubin.

For additional diagnostics, a series of laboratory tests are shown:

  • clinical blood count with platelet count,
  • coagulogram and determination of prothrombin index,
  • determination of bleeding time,
  • APTTV (activated partial prothrombin time).

Hemorrhagic disease of the newborn is characterized by normal indicators of bleeding time and platelet numbers. However, the coagulation time and the APTT are lengthened. With prolonged bleeding, a decrease in hemoglobin and red blood cell count may be detected.

According to current clinical guidelines, the main method of treating hemorrhagic disease of the newborn is injections of vitamin K3 (“Vikasol”). The drug is administered intramuscularly, the dosage is calculated individually by a neonatologist based on the weight of the child, the maximum daily dose is no more than 4 mg. Prescribed medication once a day, the duration of treatment usually does not exceed three to four days.

Additionally, if necessary, use the following medicines and blood products:

  • fresh frozen plasma
  • erythrocyte mass
  • plasma substitutes
  • prothrombin complex ("UMAN-complex D.I."),
  • drugs to support cardiovascular activity.

If the disease is detected in the early stages and specific therapy is carried out, then the prognosis is favorable. As a rule, recurrences of hemorrhagic disease subsequently do not occur.

Late stages of hemorrhagic disease of the newborn can cause complications in some children in the form of damage to the central nervous system. Less commonly, the disease ends in death.

Prevention

Preventive measures are shown, above all, to children at risk:

  • having a different degree of prematurity,
  • receiving antibiotic treatment
  • with birth injuries,
  • born asphyxia or as a result of cesarean section,
  • if the mother’s pregnancy was complicated,
  • mothers who suffered from liver diseases, dysbacteriosis, took anticoagulants or antibacterial drugs.

In addition, prophylaxis is indicated for artificially fed babies. Despite the fact that breast milk contains a small amount of vitamin K, there is a rather high level of factors necessary for blood clotting. Therefore, children who do not receive breast milk require additional administration of artificial vitamin K.

In some European countries and the United States, the prevention of hemorrhagic disease is mandatory for all newborns. In this case, vitamin K is given orally at a dose that significantly exceeds its content in breast milk. This introduction is repeated three times:

  • on the first day after birth,
  • on the fourth or seventh day,
  • in the third to sixth week of life.

The consequences of hemorrhagic disease of the newborn can be quite serious and dangerous for the life of the child. In the absence of timely treatment, the disease can cause serious complications, followed by disability or even death. That is why it is so important to identify the pathology in a timely manner and to start medical measures as soon as possible.

What is hemorrhagic disease and why does it occur in newborns?

The first days after birth, the child's body adapts to new conditions. Vital systems and organs are rebuilt, the small circle of blood circulation is switched on, the lungs begin to work, and the intestines are gradually colonized by microorganisms.

Vitamin K is one of the main components of the normalization process of blood coagulation. He is involved in the synthesis of proteins and is used by the liver to make prothrombin, which thickens the blood. Bacterial flora in the body of an adult produces a sufficient amount of this vitamin, they are rich in dark green leafy vegetables. In infants, the intestinal microflora has not yet been formed, therefore, hemorrhagic disease of the newborn occurs.

Most acutely, the deficiency of K-vitamin-dependent factors is felt on the 2-4th day of life. The situation is normalized after a few days, when more mature liver cells are involved in the synthesis process.

The causes of K-hypovitaminosis can be several:

  • intestinal dysbiosis - the production of bacterial intestinal flora begins only 3 days after birth,
  • lack of vitamins in the fetal period - vitamin K is difficult to penetrate the histohematogenous barrier, therefore in adults its amount is 2 times higher than that of the newborn,
  • low vitaminization of breast milk - daily intake of vitamins is not always covered by mother's milk, then a diet adjustment is needed,
  • taking pregnant anticoagulants and aspirin,
  • congenital abnormalities in the bowels or the liver,
  • toxicosis pregnant,
  • drugs for the treatment of tuberculosis in the mother,
  • reduced levels of estrogen in the infant,
  • obstruction of the biliary tract.

The occurrence of hemorrhagic disease contributes to the prematurity of the child. In such a situation, the liver produces an insufficient amount of polypeptide precursors of plasma factors involved in blood clotting.

Late hemorrhagic disease of the newborn causes a lack of vitamin K production due to:

  • late application to the maternal breast and intravenous nutrition,
  • malabsorption - nutrients are poorly absorbed by the intestines,
  • antibiotics such as 3rd generation cephalosporins,
  • lack of oxygen by the fetus,
  • birth injuries
  • artificial delivery,
  • impaired respiratory function at birth.

The first colostrum, obtained by the baby from the mother's breast 15-30 minutes after birth, contains many vitamins and trace elements. It colonizes the intestines microflora and helps further the production of bacteria in the body. The mechanism of coagulopathy in the newborn is rarely triggered. A small dose of vitamin K is enough to maintain a healthy child’s blood circulation. As a rule, the onset of pathology at an early stage is triggered by the diseases of a woman during pregnancy.

Classification and symptoms of the disease

Parents do not always correctly evaluate the symptoms and are in no hurry to seek medical help. The recovery of the baby is possible only with the treatment of the initial stage and the mild form of hemorrhagic disease. Serious blood loss, malfunction of the heart, lungs, and cerebral hemorrhage often lead to fatal consequences.

Early and late forms

Depending on the duration of the disease, physicians distinguish the following forms:

  • early - develops 1-2 days after birth, is characterized by a strong bleeding of tissues,
  • classical - occurs on the 3-5th day of life,
  • late - the most dangerous form, manifests itself only at 2-8 weeks of life and can provoke hemorrhage in the internal organs and brain.
In the presence of hemorrhagic disease in the newborn, an increased bilirubin is observed.

The disease is easily diagnosed because its symptoms are difficult to confuse with other diseases. At the baby are observed:

  • bruises, ecchymosis and petechiae,
  • nose bleed,
  • weakness, lethargy, decrease in motor activity,
  • umbilical bleeding,
  • blood in the feces or urine
  • bloody vomiting, cough (we recommend to read: how is cough and vomiting treated in a child?),
  • bilirubin increase,
  • neurological symptoms of intracranial hemorrhage,
  • "Sharp" belly.

The presence of blood in the baby’s feces does not always indicate internal bleeding. It may also be the blood of the mother that entered his body during childbirth. In order to determine the nature of the melena, conduct an Apt's test:

  • feces are mixed with water until it turns pink,
  • the supernatant is released from the solution,
  • add sodium hydroxide in a ratio of 5: 1,
  • After 2-3 minutes, analyze the color of the solution.
Sample Apta will accurately determine the nature of melena

Yellowish brown color indicates the presence of hemoglobin of an adult, that is maternal. If the color has not changed - it is the blood of the newborn.

Primary and secondary forms

Depending on the factor that provoked a lack of vitamin K in the body, hemorrhagic disease in newborns is classified into:

  • primary - vitamin K deficiency is initially observed,
  • secondary - its main causes - liver pathology and impaired synthesis of dna in the infant.

The intrauterine development of the disease leads to the fact that at birth on the head of an infant, cephalohematomas are visible - tumors with visible dot hemorrhages. Hemorrhagic disease in late-born infants sometimes appears even in the third month of a baby’s life. It develops reactively, after the appearance of numerous bruises, intracranial hemorrhage occurs, so it is important to pay attention to early symptoms in time and seek medical help. A child is at risk if:

  • there are a lot of bruises on the body - in the first few months the movement of the baby is limited, therefore he is not able to hit himself,
  • injection site and blood sampling for analysis for a long time bleeding,
  • pale skin.

Features of treatment

Treatment of hemorrhagic disease of the newborn must begin at the first signs. Efficiency of diagnosis and therapy is the key to the successful recovery of the child. The main task that faces parents and doctors is to replenish vitamin K deficiency, and it is important to observe the dosage and use a set of procedures:

  • breastfeeding - the baby is fed with breast milk every 3 hours, the portion depends on the age, with thrombocytopenic purpura the feeding lasts at least 4 weeks,
  • the introduction of 1% solution of vitamin K - drugs are administered intravenously, but in mild cases, intramuscular injection is possible 1 time per day, the dosage is calculated depending on the baby’s body weight (0.1-0.15 ml per 1 kg),
  • Vikasol solution - an artificial analogue of vitamin K, which stops bleeding, but is less effective, is applied every 12 hours, the dose is 2-4 mg,
  • plasma bolus transfusion - carried out with the recurrent nature of bleeding (dosage - 15 ml / kg),
  • solutions of thrombin, sodium bicarbonate, aminocaproic acid with adroxone (we recommend to read: how is aminocaproic acid used in adenoids in the nose for children?),
  • preparations based on ascorbic acid, rutin, calcium gluconate or calcium chloride,
  • glucocorticosteroids or specific antibiotics,
  • red blood cell transfusion (5-10 ml / kg) - the doctor prescribes a procedure if the disease is complicated by hypovolemic shock.
During the treatment of the disease is very important to adhere to breastfeeding.

Excess vitamins can lead to complications such as:

  • hemolytic anemia,
  • nuclear jaundice is associated with an increased level of bilirubin,
  • anemia.

Acceptance of too much hemostatic drugs can cause the development of hyperbilirubinemia and activation of Heinz Taurus. In this regard, treatment is carried out exclusively in stationary conditions, and the appointment and use of drugs is controlled by a neonatologist.

Consequences of hemorrhagic disease of the newborn

Professional and timely medical care allows you to quickly eliminate mild forms of the disease. The risk of fatal outcome is great for children who have experienced:

  • more blood loss
  • impaired cardiac activity
  • malfunctions in the development of the adrenal glands,
  • cerebral hemorrhage.

To prevent the development of pathology, children from the risk group are recommended to inject vitamin K immediately after birth (0.5 mg premature babies, and for full-term babies with normal body weight, the dose is increased to 1 mg). Also an excellent precautionary measure is an early attachment to the chest. The pathology does not transform into other diseases, at the end of the treatment the symptoms disappear, and the organism of the little man continues to develop without any violations.

The content of the article

  • Hemorrhagic disease of the newborn: causes, forms, effects
  • Cefalohematoma in the newborn on the head: causes and treatment
  • Galactosemia in newborns

Causes of pathology can be classified into primary and secondary. Primary effects on the body in the prenatal period or on the 1st day after birth. They are caused by a lack of vitamin K. These reasons include:

  • placental impermeability of vitamin K,
  • lack of substance of mother's milk,
  • toxicosis, preeclampsia,
  • taking drugs prohibited during pregnancy,
  • failures in the liver, gastrointestinal tract in a pregnant woman,
  • violation of intestinal microflora in the newborn.

Secondary causes are associated with clotting factors. In addition, a woman can take drugs that cause a lack of vitamin K. The secondary causes of the disease include:

  • fetal hypoxia,
  • premature pregnancy (up to 37 weeks),
  • dysbacteriosis,
  • dysfunction of the pancreas, intestines, liver, biliary tract,
  • long-term use of antibiotic drugs.

Pathology is rarely diagnosed, less than 1.5% of children.

There are 2 forms of hemorrhage: primary and secondary. In the first case, the fetus is deficient in vitamin K, and the newborn child receives less of this substance from the mother's milk. On the 5th day, vitamin K begins to be synthesized in the intestines of the baby.

The secondary form of hemorrhage is manifested in lesions of the liver. In a child, the formation of PPPP (polypeptide precursors of plasma factors) is disturbed.

The disease is also classified by the time of appearance:

  1. Early form. Manifested in 1-2 days. after birth.
  2. Classic form. Develops for 3-5 days.
  3. Late form. Manifested in the first 8 weeks. of life.

Effects

If hemorrhagic disease is detected quickly, and timely treatment was carried out, recovery occurs without any consequences. In the future, there is no recurrence of pathology.

But the late form of hemorrhage can lead to terrible consequences in the form of complications in the central nervous system. Some babies develop hypovolemic shock. Sometimes as a result of hemorrhagic disease, death occurs.

Adequate therapy allows you to avoid serious consequences. It includes injections of "Vikasola" (a synthetic analogue of vitamin K). The duration of the substitution treatment course is 2-4 days. You need to do control tests on the level of vitamin K in the body of the newborn.

In case of bloody vomiting, gastric lavage is performed with saline, additionally aminocaproic acid is introduced through the probe. If there are signs of bleeding in the gastrointestinal tract, an enteral mixture is prescribed with aminocaproic acid, Adroxone and Thrombin preparations. For the prevention of the disease, all newborns are recommended to inject vitamin K analogs.

Factors contributing to the appearance of the disease

Hemorrhagic disease of the newborn can be prevented if you know the risk factors. And some of them related to external exposure can be minimized or eliminated altogether.

First, it is the reception of a woman during pregnancy, anticoagulants, antibiotics, anticonvulsant drugs, sulfa drugs.

Secondly, it is preeclampsia, enteropathy and intestinal dysbiosis in a pregnant woman.

Thirdly, the development of pathology can be triggered by chronic hypoxia and fetal asphyxia during childbirth and prematurity.

There are also cases of acquired hypovitaminosis K, the formation of which in a child is a consequence of antibacterial therapy, hepatitis, biliary tract atresia, malabsorption syndrome, α1-antitrypsin deficiency and celiac disease.

Vitamin K in the body is involved in the process of blood coagulation, activating plasma factors, antiprotease C and S plasma.

Hemorrhagic disease of the newborn: symptoms

As a rule, the first manifestations fall on the interval between the 1st and 3rd day of the child's life. They are characterized by increased bleeding of the umbilical wound, intestine and stomach, the appearance of characteristic spots on the skin.

Similar conditions occur in approximately 0.2–0.5% of newborns. If the baby eats breast milk, the symptoms may appear later (in the third week of life). This is because mother's milk contains thromboplastin, which is a blood coagulation factor.

Diagnostics

Risk factors, specific symptoms and indicators of laboratory research methods allow to establish a reliable diagnosis. In particular, the KLA is characterized by an increase in the time of blood clotting, while the bleeding time and the number of platelets remain normal. In cases of severe blood loss, a decrease in hemoglobin level is observed.

Also, when diagnosing, they resort to neurosonography and ultrasound of the internal organs.

Differential diagnosis

Melena (black feces with bloody inclusions) is the most typical symptom for this pathology. But its appearance does not always indicate that hemorrhagic disease of the newborn occurs. The reasons may be different. For example, the so-called false melena occurs when maternal blood enters the child’s digestive system through nipple cracks.

It is also necessary to distinguish other pathologies of newborns, which may be accompanied by hemorrhagic symptoms. This can occur if coagulation, vascular or platelet hemostasis is impaired, including disseminated intravascular coagulation (DIC).

Also the cause of hemorrhagic syndrome can be hyperbilirubinemia, hemophilia, thrombocytopenic purpura, which can manifest in the neonatal period.

The essence of the treatment is the introduction of drugs aimed at stopping bleeding. First of all, fresh frozen plasma of 10–15 ml / kg or a concentrated solution of the prothrombin complex 15–30 U / kg by the intravenous route and a 1% solution of Vikasola are introduced by the intramuscular method.

Vitamin K ("Vikasol") is used as an antihemorrhagic agent. And "Octaplex" and "Protrompleks" (concentrates of the prothrombin complex) are hemostatic.

If this pathology proceeds without complications, then the prognosis is quite favorable. Subsequently, there is no further transformation into other hemorrhagic diseases.

Hemorrhagic disease of the newborn: forms

Three forms are known: early, classical and late.

The emergence of the early form, as a rule, is associated with the reception by the mother during pregnancy of drugs, including aspirin (acetylsalicylic acid). The development of hemorrhagic syndrome may begin in the womb. And at birth, the child already has many cephalhematomas, skin hemorrhages and bleeding from the navel. Speaking of skin manifestations, doctors often use the term "purpura."

Often are cases of hemorrhage in the adrenal glands, liver, spleen. Also characterized by the occurrence of bloody vomiting, pulmonary and intestinal bleeding. The latter are diagnosed by the black color of feces and the presence of bloody inclusions in the feces.

Most often, intestinal bleeding are one-time and non-abundant. But if the bleeding from the anus is continuous, then it is a "severe" hemorrhagic disease of the newborn. The consequences in this case, unfortunately, in the absence or with the late provision of qualified medical care, can be fatal - the child dies from shock.

The classic form is manifested during the first five days of life of a baby who is breastfed. The newborn has bloody stools and bloody vomiting. Also characterized by the occurrence of ecchymosis, petechiae, bleeding from the umbilical wound and nose. Similar cases of the disease are complicated by ischemic skin necrosis.

Late hemorrhagic disease of the newborn can develop in a child under the age of 12 weeks and is one of the manifestations of the disease with which the baby is currently suffering. Symptomatology is similar to the classical form, but is more ambitious. Often there are complications in the form of hypovolemic post-hemorrhagic shock.

Summarizing, we can say that the main factor in the treatment of this pathology is the timely provision of qualified medical care to the newborn.

What causes hemorrhagic disease of the newborn?

The biological role of vitamin K is to activate the process of gamma-carboxylation of glutamic acid residues in blood coagulation factors: prothrombin (factor II), proconvertine (factor VII), antihemophilic globulin B (factor IX) and Stuart-Prouer factor (factor X), also in proteins C and S plasma involved in anticoagulant mechanisms, osteocalcin and some other proteins. With a lack of vitamin K in the liver, inactive acarboxy-factors II, VII, IX, and X (Protein induced by vitamin K-absence - PIVKA) are formed, which are unable to bind calcium and fully participate in blood coagulation.

Vitamin K is very weak penetrates through the placenta. Primary hemorrhagic disease is due to the fact that the content of vitamin K in the fetus is small (does not exceed 50% of the level of an adult). After the birth of vitamin K with breast milk comes a little, and its active production of intestinal microflora begins with the 3-5th day of life of the child.

Factors contributing to the primary K-hypovitaminosis in the newborn: prematurity, the appointment of a pregnant indirect anticoagulants, anticonvulsants, broad-spectrum antibiotics, gestosis, hepato-and enteropathy, intestinal dysbiosis.

In case of prematurity, synthesis of polypeptide precursors of plasma factors (PPPF) of blood coagulation in the child's liver is reduced.

In secondary hemorrhagic disease, impaired PPPF synthesis of blood coagulation occurs in liver diseases (hepatitis, biliary atresia, etc.). There is a second variant of the development of secondary hemorrhagic disease - a violation of the synthesis of vitamin K, due to prolonged parenteral nutrition, malabsorption syndrome or the appointment of vitamin K antagonists - coumarin and neodicoumarin.

At the same time, children with very low levels of vitamin K in the blood and children with elevated levels of PIVKA are detected.

Impaired PPPP synthesis and / or carboxylation of glutamic acid PPPF coagulation leads to impaired production of factors II, VII, IX and X. This is manifested by prolongation of the prothrombin time (PT) and activated partial thromboplastin time (APTT).

Symptoms of hemorrhagic disease of the newborn

The early form of hemorrhagic disease of the newborn is characterized by the appearance in the first days of life of bloody vomiting (hematemesis), pulmonary hemorrhage, hemorrhages in the abdominal organs and retroperitoneal space, especially often in the adrenal glands, liver, spleen. Hemorrhagic disease of the newborn may begin in utero, and the child already at birth will have intracranial hemorrhages (with neurosonography), skin hemorrhages.

The classic form of hemorrhagic disease is typical for a breastfed child and manifests itself on the 3-5th day of life with bloody vomiting, melena (intestinal bleeding), skin hemorrhages (ecchymosis, petechiae), bleeding during the fall of the umbilical cord, kefalogomatoma can occur. In children with severe hypoxia, birth trauma, vitamin K deficiency can manifest itself in the form of intracranial hemorrhage, hemorrhage under the aponeurosis, as well as internal hematomas and bleeding.

Children with melena may have hyperbilirubinemia due to increased erythrocyte breakdown in the intestine. The reason for melena is the formation of small ulcers on the mucous membrane of the stomach and duodenum, in the genesis of which the leading role is played by an excess of glucocorticoids in the newborn (due to birth stress), ischemia of the stomach and intestines. Gastroesophageal reflux and peptic esophagitis play a definite role in the origin of melena and hematemesis.

The clinical symptoms of late hemorrhagic disease of the newborn can be: intracranial hemorrhages (more than 50%), extensive skin ecchymosis, melena, hemetemesis, umbilical wound hemorrhage, hematuria, cefalohetoma.

Complications of hemorrhagic disease of newborns include hypovolemic shock, which is manifested by weakness, pallor, often a decrease in body temperature to subnormal numbers, a drop in blood pressure.

Differential diagnostics

Hematemesis and melena in children of the first days of life must be differentiated from the “swallowed maternal blood syndrome”, which occurs in one of three children who have blood in the vomit or feces on the first day of life. To do this, use the Apta test: bloody vomit or feces diluted with water and get a pink solution with hemoglobin. After centrifuging, 4 ml of the supernatant is mixed with 1 ml of 1% sodium hydroxide solution. A change in the color of the liquid (assessed after 2 min) on brown indicates the presence of hemoglobin A (maternal blood) in it, and the preservation of pink color indicates fetal (alkali-resistant) hemoglobin D, i.e. blood of the child.

Differential diagnostics is also performed with other coagulopathies (hereditary), thrombocytopenic purpura of the newborn, and disseminated intravascular coagulation syndrome (DIC). For this purpose, a coagulogram is developed and, if necessary, a thromboelastogram.

Laboratory data for the most common hemorrhagic syndromes in newborns

What is hemorrhagic disease?

Hemorrhagic disease of the newborn - a pathology associated with the function of blood clotting. It develops due to a deficiency in the body of a newborn vitamin K. The incidence rate is low - 0.3-0.5% of all babies are born with ailment. Vitamin K is an important component of blood clotting. It is produced in a newborn at 4-5 days after birth.

Lack of substance quickly makes itself felt. The quality of coagulability deteriorates significantly, and increased bleeding develops. Against this background, the child has a special diathesis. Bruising and signs of bleeding are the main symptoms of a hemorrhagic disease.

What are the reasons for newborns?

There are several causes of the disease: primary and secondary. The attribution of the causes of pathology to one of these types depends on at what stage of pregnancy and childbirth the problem occurred.

  • taking illicit drugs during pregnancy,
  • disruption of the liver and gastrointestinal tract,
  • in the period of gestation, toxicosis was diagnosed, and in the later periods - gestosis of pregnant women,
  • the immaturity of the child's digestive system,
  • obstruction of vitamin K through the placenta,
  • lack of vitamin K in breast milk of a nursing mother.
  • preterm labor,
  • oxygen starvation of the child in the womb,
  • long take antibiotics.

To determine the cause of hemorrhagic disease of newborns, it is necessary to diagnose.

Varieties and symptoms of pathology

Symptoms of the disease depends on the form of the disease. It is based on 2 signs: bleeding and the formation of bruises on the child’s body. Violations can be seen by an ultrasound specialist even during intrauterine examination of the fetus, when it is possible to diagnose internal bleeding of an unborn baby.

Symptoms appear on the 7th day of the baby's life. Symptomatology is divided into early and late forms. Early form is quite rare. The clinical picture of the disease appears within 24 hours after birth.

Early, classic and late forms

Depending on the time of onset of symptoms, several subtypes of the ailment are distinguished: early, classical, and late forms of hemorrhagic disease. If the infant is breastfed, symptoms may appear somewhat later, since mother's milk contains thromboplastin, which is responsible for blood clotting. Each type of pathology is characterized by its manifestations:

  • The first symptoms appear 12-36 hours after delivery. One of the rarest forms of the disease.
  • The consequence of the mother taking prohibited during pregnancy drugs.
  • vomiting with blood ("coffee grounds"),
  • nose bleed,
  • internal bleeding in the parenchyma of the liver, spleen and adrenal glands,
  • in the prenatal period - hemorrhages in the brain.
  • The clinical picture becomes apparent at 2-6 days after birth. The most common type of disease.
  • bloody vomiting
  • bloody black stools,
  • scattered throughout the body dark spots like blood clots under the skin,
  • umbilical wound bleeding,
  • cephalohematomas (we recommend reading: what are the effects of cefalohematoma on the head of a newborn?),
  • elevated blood bilirubin as a result of gastrointestinal bleeding,
  • jaundice of newborns.
  • Late hemorrhagic disease of the newborn appears on the 7th day after birth.
  • Develops against the background of systemic diseases and the lack of prophylactic injections of vitamin K.

Primary and secondary hemorrhagic disease

When classifying a disease, primary and secondary hemorrhagic disease is isolated. They differ in features of the course and factors of occurrence. Primary occurs when the total content of vitamin K in the baby’s blood was initially low, and after birth it did not come from mother’s milk. Active production of intestinal microflora begins on the 5th day.

The secondary type implies a pathology associated with impaired synthesis of blood clotting due to disruption of the liver. Another cause of secondary disease is the long-term crumbs on parenteral nutrition. Как правило, самые тяжелые формы заболевания диагностируются у глубоко недоношенных детей и малышей с серьезными патологиями печени и кишечника.

At the slightest suspicion of hemorrhagic disease after discharge from the maternity hospital, it is necessary to urgently call an ambulance. Parents should be alerted by unexpected bruises on the body of a baby. Another reason to go to a doctor is that she doesn’t stop for a very long time when taking blood from a finger. All this is a reason for a serious examination.

Diagnostic methods

Effective treatment of hemorrhagic disease of the newborn begins with a diagnosis. The earlier it is carried out, the greater the chances for a child’s quality life in the future. The blood test is considered the most informative, in addition to it, abdominal ultrasound and neurosonography are always assigned:

In order to differentiate the disease from symptomatic pathologies, among which are “mother's blood swallowing syndrome”, hemophilia, thrombocytopenia, von Willebrand disease, the Apt test is additionally performed. Vomit and feces with blood impurities diluted with water and get a pink solution containing hemoglobin.

Preventive actions

Prevention of the disease begins at the planning stage of the baby. Being pregnant, a woman needs to look after her health. There are often cases when it is necessary to use antibacterial therapy. It should be carried out only under the supervision of a gynecologist, provided that the benefits of such treatment are higher than the risks to the fetus. It is necessary to visit the doctor in time and undergo all the necessary research.

The future mother should include in the diet foods that contain large amounts of vitamin K. These are all green vegetables: green beans, cabbage, peas, spinach. The introduction of an artificial vitamin is possible only for medical reasons with a pronounced deficiency. At risk are premature babies, babies with birth injuries or being artificially fed.

Features of the disease and causes

Hemorrhagic disease is a pathological change in the blood, during which there is a violation of blood clotting. Because of this, people often have diathesis, which is caused by a violation of the synthesis of blood clotting and a lack of vitamin K. As a rule, this pathological condition is more commonly diagnosed in newborns. Bruising and signs of bleeding are the main symptoms of the disease in the first days of life.

Among all the diseases of newborns in our country, hemorrhagic disease is given 1.5%. In European countries, this pathological condition is diagnosed in 0.01% of cases of the total number of postpartum diseases. This is due to the fact that in many European countries, prophylactic administration of vitamin K to infants is practiced.

According to experts, this pathology can be classified into primary and secondary disease. Primary disorders, as a rule, occur during fetal development or in the first days after birth. Most commonly, this is due to the natural lack of vitamin K. Hemorrhagic disease in newborns has various causes.

Primary causes of disease

  • The use of prohibited drugs during pregnancy,
  • violation of the liver and intestines in a pregnant woman,
  • gestosis and toxicosis during pregnancy,
  • disturbed and immature intestinal microflora of the infant,
  • placental impermeability of vitamin K,
  • minimum vitamin content in breast milk.

At the heart of the development of the secondary causes of the disease, there are impaired plasma clotting factors occurring in the liver, more often they are of a late form. In addition, an important reason for a lack of vitamin can be the use of mother antagonistic drugs vitamin K.

Secondary causes of the disease

  • Preterm labor for up to 37 weeks
  • hypoxia,
  • intestinal dysbiosis,
  • disruption of the liver, intestinal pancreas and biliary tract,
  • long use of antibiotics.

The causes of disease are many. In order to correctly determine what exactly caused the development of a pathological condition, it is necessary to carry out an appropriate diagnosis. Since the method and method of treating a disease will depend on what exactly underlies the onset of a hemorrhagic disease.

Features of vitamin K and its importance in the body

Up to ten proteins are involved in the blood coagulation process, 5 of which are synthesized using vitamin K. In addition, it is of no small importance in the process of thickening the blood flowing in the liver. With the help of this vitamin, the human body retains such trace elements as calcium, which plays an important role in the work of the skeletal system.

A lack of vitamin K causes damaging damage to the body. Therefore, in case of its deficiency, it is necessary to immediately begin to eliminate this pathology. In adults, the lack of this vitamin is much less common than in children. Since the body of an adult can compensate for its lack, the use of vegetables and other products.

Symptoms of the disease

The first and most important symptom of the disease is bleeding and bruising. Often, such a violation occurs in the prenatal period, when the doctor diagnoses the bleeding of the internal organs of the baby. The presence of bleeding after emptying the bowel or after regurgitation is also an important symptom of the disease.

As a rule, this symptom appears on the 7th day of the child's life. Hemorrhagic disease of the newborn has symptoms of early and late, which differ in the time of appearance and forms of manifestation.

Early symptoms of the disease:

  1. bruises on the baby’s body, identified after childbirth,
  2. nose bleed,
  3. the presence of blood in the child’s stool or after regurgitation,
  4. constant bleeding of wounds after injections,
  5. signs of anemia.

Late symptoms of the disease:

  1. frequent gagging with blood,
  2. intracranial hemorrhage,
  3. self-induced bruising of the skin,
  4. the presence of blood in the urine
  5. obvious symptoms of gastrointestinal disorders,
  6. constant and long bleeding of the umbilical wound.

In most cases, the late form of the symptoms is the basis of hepatic impairment. In case of acute illness, the child has symptoms of hypovolemic shock. Due to the frequent vomiting and impaired stool, the child’s body suffers a lack of fluid, which causes a decrease in circulating blood volume. This pathological condition is very dangerous for the life and health of the child.

In order to prevent the development of serious complications, it is necessary to promptly seek medical help, as it is better to treat the disease at the initial stage of its occurrence.

Treatment methods

The method of treatment of the disease depends on the severity of the pathology. If the child has an average form of the disease, with no obvious signs of complication, then vitamin therapy will be applied. For three days, the child will be injected with synthetic vitamin K, which compensates for its lack. According to experts, the vitamin is better absorbed if it is administered intravenously or intramuscularly. Oral vitamin administration is considered to be ineffective.

In the case of a severe form of the disease, measures will be applied in the first place to eliminate the pathological conditions and their causes. If hemorrhage is dangerous to the child's life, fresh frozen plasma is injected. After its introduction stabilizes the condition of the child.

Prognosis of the disease

The prognosis of the disease will be positive, in the case of a mild form of the disease, when nothing threatens the life of the child. Timely diagnosis in combination with modern methods of treatment, can easily cope with the existing pathology.

In the event of serious changes, and in particular with a large number of internal hemorrhages, the child’s life may be at risk.

Preventive measures

To reduce the risk of developing pathology, the prevention of hemorrhagic disease of the newborn plays an important role. During pregnancy, young moms should be attentive to their health.

Preventive measures for pregnant women:

  1. use of antibacterial drugs is possible if the risk of developing complications in the mother is much higher than in the child,
  2. exclude the use of drugs displacing vitamin K.

In our country, the use of vitamin K for preventive measures of newborns does not have a constant practice. Despite this, having special indications, some experts may recommend the administration of a vitamin preparation. This is done in the case of a clear lack of vitamin, without the absence of complications.

Indications for the introduction of vitamin

  • intrauterine hypoxia,
  • prematurity
  • postpartum complications
  • the use of antagonistic drugs during pregnancy,
  • obvious signs of vitamin K deficiency in the woman in labor.

Some perinatal centers practice additional diagnostics of a child’s health. By agreement with the doctor, babies can be given in-depth postnatal health diagnostics. Actually this will be the case if during the pregnancy the mother has endured conditions that affect the content of vitamin K in the body. With a pronounced deficiency of the content of this vitamin, young parents may be recommended to conduct a course of vitamin therapy for their baby.

Frequently asked Questions

After the diagnosis, early hemorrhagic disease of the newborn, the parents have a lot of questions. In this section, we collected the most relevant of them. Thanks to the answers of a specialist, you can get useful information on this topic.

My baby is three months old, he is on artificial feeding. After regurgitation, an admixture of blood is present in the mixture. Is this symptom a symptom of the disease?

Answer: “Late hemorrhagic disease of the newborn, may be caused by disorders of the digestive system. Frequent gagging, mixed with blood and a violation of the chair, can be a symptom of deviation. Of course, the presence of blood in the regurgitated mixture, a sign of disruption of the digestive system. But this does not mean that it is hemorrhagic disease that causes the development of this deviation. In this situation, it is necessary to diagnose the state of health of the child in order to identify the cause of the pathological change. ”

The child was diagnosed with hemorrhagic disease. The condition of the baby is stable, but in the maternity hospital we were recommended to refuse vaccinations for a period of 6 months. During the scheduled medical examination, the pediatrician spoke of the need for vaccination, although we are only 4 months old. How to be in this situation? Conversation with the doctor did not give a specific answer.

Answer: “According to the protocol, this pathological condition has an obvious medical withdrawal from vaccinations. The duration of the allotment depends on the stage, degree and form of the disease. If we are talking about a mild form of pathology, which is characteristic only of a clear lack of vitamin K, then the period of medical allotment is minimal. In the case of severe forms of disruption of the body, with multiple hematomas and hemorrhages, it will be significantly increased, until the full recovery of the body. Before you decide on the need to start a vaccination, it is worth at least a blood test for clotting. ”

After giving birth, the child was sent to the neonatal intensive care unit. The doctor diagnosed an acute form of hemorrhagic disease. Multiple cephalohematomas, jaundice and hypoxia are the main reasons for transferring a child. Very worried about the baby. Why was it decided to transfer, when his life is not in danger?

Answer: “The decision to transfer to the intensive care unit for infants is taken by a neonatologist, after assessing his health condition. To exclude the development of serious pathologies, it is necessary to conduct an in-depth diagnosis of the health of the baby. After all, the latent forms of violation of the work of organs can lead to irreversible consequences. The early form of diagnosis and features of nursing care will help your baby get stronger. Since the observation of the injured children takes place under the strict guidance of a neonatologist during the entire period of stay in the maternity hospital, the recovery of infants is much faster. ”

In a month during a routine examination, the doctor said he suspected hemorrhagic disease. We received a referral to the analysis of the prothrombin complex. Do I have to do it?

Answer: “Prothrombin analysis is a screening test that plays an important role in the diagnosis of this disease. When using the analysis, the doctor will be able to assess the deficiency of the prothrombin complex factors and the external coagulation pathway. If a specialist has appointed this study, then it is necessary. All methods of diagnosing the disease are selected at the discretion of the attending physician, based on the characteristics of the pathology. "

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