Vitamin K deficiency hemorrhagic syndrome in newborns and children in the first months of life. Vaccination of vitamin K in the maternity hospital for newborns

Vitamin K is a valuable food component, and is also a key link in the blood coagulation system. The body's needs for this component, as a rule, are compensated by those food products that a person consumes daily. In addition, the synthesis of vitamin K occurs inside the body, which is a kind of insurance against its deficiency.

During the newborn period, the level of this biologically active substance in the baby’s body is reduced compared to adults. When the baby is born, his immature body is not yet able to produce the required amount of this component. To avoid shortages of this element, medical workers running injection a drug that contains natural vitamin TO.

Vitamin K deficiency in the newborn's body

Often parents do not realize the importance of the presence of vitamin K in the child’s body. When a newborn baby is faced with a deficiency of this element, its blood coagulation system ceases to function properly. This condition is fraught with internal bleeding.

The most serious complication of vitamin deficiency is hemorrhagic disease of the newborn, which is characterized by regular internal bleeding. At severe course the disease risks turning into a hemorrhage in the infant’s brain.

To the main factors of occurrence hemorrhagic disease newborns can be classified as:

• Birth of a baby through surgery caesarean section. In this case, children are born with sterile intestinal microflora, therefore, vitamin K is synthesized in insufficient quantities;
• Low birth weight, as well as premature birth;
• Delivery that was performed using obstetric forceps;
• Pathologies of the hepatobiliary system, as well as increased load on the liver after ;
• Situations in which a pregnant woman was forced to take anticoagulants antibacterial agents and anticonvulsants. This is especially true for pregnant women in the first trimester of pregnancy;
• Prolonged labor, especially at the stage of expulsion of the fetus.

Either one of the mentioned points or their combination can serve as a factor for the occurrence of hemorrhagic disease of newborns. Having analyzed this information, parents should not have any questions about the need to inject this substance within the walls of the maternity hospital.

How and when injections are performed

A simple way to deliver vitamin K is by intramuscular injection of the appropriate drug. A vitamin K injection is given to the front of the thigh. Injection of the drug is carried out over several weeks or until the newborn baby’s body is mature enough to independently produce the biologically active component.

If some parents do not want to burden their child with injections, then they are offered to administer the drug orally. In terms of efficiency, this method is not preferred. In addition, in clinical practice There have been cases in which oral use vitamin K caused vomiting in a newborn. The standard injection plan for this substance is as follows:

• The first injection is performed immediately after birth;
• The second injection is given one week later;
• The 3rd injection is performed 1 month after the birth of the baby.

Important! Both parents and doctors should not forget that the oral use of vitamin K preparations is strictly contraindicated in children born before the expected term. A similar ban applies to children who have congenital diseases.

For injection administration to a newborn baby, analogs of vitamin K are used - Vikasol and Kanavit. The few side effects that occur in newborns when these medications are administered are associated with the preservatives used in the manufacture of medications.

Experts have named 6 symptoms of vitamin D deficiency in infants. Timely diagnosis This disorder will help protect the child’s health from numerous troubles.

If your baby is under one year old, he or she needs at least 5 micrograms of vitamin D every day. Otherwise, in a rapidly growing children's body may arise serious violations, primarily affecting bone development. In recent times, a deficiency of this vitamin has caused entire epidemics of rickets in children. Here are 6 signs that your baby may be experiencing some vitamin D deficiency.

Bone deformation. Infants with vitamin D deficiency usually have slightly bowed legs. They may have a curvature of the spine, which is reflected in appearance. All this is observed if the child does not receive the amount of vitamin D necessary for normal bone development.

Dents or dimples on the head. The process of final formation of the skull is completed during the first 19 months after birth. Vitamin D deficiency can significantly slow it down. If you touch your baby's skull, you will notice that it is still very soft. Also in this case, dents or dimples on the head are noted.

Pain and muscle weakness. If you notice that it is quite difficult for your baby to crawl or sit for a certain period of time, then this may be caused by pain or muscle weakness due to rickets. These children are also more irritable.

Recurrent infections. Numerous studies have linked repeated infections in babies to vitamin D deficiency. If your baby gets colds and flu too often, ask your pediatrician for a x-rays to determine the amount of vitamin D in the body.

Rachitic “rosary” or “bracelets”. As noted in the first point, bone deformities are the most common symptom of vitamin D deficiency. Have you noticed that your baby's chest is sticking out too much? Osteomalacia chest, lower limbs, excessive osteogenesis is the same rachitic “rosary” caused by calcium deficiency in the body.

Developmental delays. In more severe cases of vitamin D deficiency or rickets, babies experience delays in normal development. Not only are they unable to walk or support their weight, but they also suffer from swelling of the limbs.

A newborn baby can receive vitamin K in the first days after birth. And the purpose of this injection is good - to prevent a hemorrhagic disease, which is very dangerous for the child’s life. Why does an American doctor, in whose country these injections have been performed for more than half a century, oppose this?

Source: Fotolia

Vitamin K injection to a newborn is done based on the following considerations:

• During pregnancy, vitamin K is retained by the placenta, as a result of which its amount in the newborn’s body is often deficient;
• Vitamin K in the adult body is synthesized by the forces of colonizing gastrointestinal tract microorganisms. The gastrointestinal tract of a newborn baby is sterile - it will take time to populate it with both beneficial and harmful (alas, this is inevitable, bacteria);
• in colostrum and even in breast milk mothers, vitamin K is present in very limited quantities;
• injections of vitamin K are necessary for the newborn’s body, because his liver is unable to synthesize proteins into required quantity, and this, in turn, affects the level of vitamin K in the newborn’s body;
• and the last fact: vitamin K deficiency, depending on the severity, can lead to poor healing umbilical cord, the occurrence of bleeding before the age of three months, and in especially severe cases - cerebral hemorrhage, extremely difficult treatment, disability of the child and even death.

So does a newborn need vitamin K?

Opponents of administering vitamin K to a newborn have their own arguments. And one of the most important is written down in the instructions for Vikasol; this is the name of vitamin K in the language of pharmacists, in the “Side Effects” section:

Allergic reactions: facial hyperemia, skin rash(including erythematous, urticaria), skin itching, bronchospasm.

From the blood system : hemolytic anemia, hemolysis in newborns with congenital deficiency of glucose-6-phosphate dehydrogenase.

Local reactions: pain and swelling at the injection site, skin lesions in the form of spots with repeated injections into the same place.

Others: hyperbilirubinemia, jaundice (incl. kernicterus at infants); rarely - dizziness, transient decrease in blood pressure, profuse sweat, tachycardia, weak pulse filling, changes in taste sensations.

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As we see, possible side effects administration of vitamin K to a newborn is no less terrible than the diseases that may arise as a result of its action. By the way, according to statistics, hemorrhagic disease occurs in 0.25% - 1.7% of newborns (data from American statistics. Not enough? What if your child falls into this 0.25%?

On the Internet, on “mom’s” forums, you can find a lot of personal stories about what mothers had to go through as a result of vitamin K deficiency in their newborn. And at the end of almost every post - “If vitamin K had been introduced, this would not have happened!” It is difficult, however, to say whether it would have happened or not - history, as we know, does not have a subjunctive mood. And this aphorism has the most direct relation to pediatrics.

Source: Burda Media

Except side effects administration of vitamin K to a newborn, there is also a simple logic. Namely: the placenta does not allow vitamin K to pass through? Is nature wrong? Maybe if it doesn’t let you through, it means it’s not really needed? After all, babies take millions of years to be born, but research on the role of vitamin K in the newborn is only a few decades old. The same can be said in contrast to the statement that colostrum and breast milk are poor in vitamin K.

However, in many countries around the world there is a practice of universally administering vitamin K to a newborn. American doctor Joseph Mercol talks about why you should refuse an injection and what to replace it with in the article “ Dark Side a routine vitamin K injection.”

Since 1944 in the USA, as well as in most Western countries, there is a standard practice of greeting newborn babies with a row of medical interventions, one of which is a painful prick from a syringe needle, complete vitamin K: This injection is routinely given to almost all newborns unless you as a parent opt ​​out.

Is this injection really in the best interests of the child? Is vitamin K really needed immediately after birth? And is there a more humane alternative?

Source: Fotolia

Why is this injection given immediately?

Vitamin K (from English - koagulation - coagulation) — fat-soluble vitamin, which is involved in blood clotting. It is administered to newborns to prevent hemorrhagic disease (vitamin K deficiency). This disease causes the baby's blood to stop clotting, umbilical wound bleeding and does not heal, possible stomach bleeding and hemorrhages in internal organs. This disease is especially dangerous due to hemorrhages in the brain, which can be fatal.

Although this is rare disease(0.25% to 1.7%), standard practice is to inject vitamin K as a preventative measure, regardless of whether risk factors are present.

Injection dangers they don't warn you about

There are three main areas of risk associated with this injection:

1. Probably the most significant is the infliction of pain immediately after birth, leading to possible psychoemotional disorder and neonatal trauma.
2. The amount of vitamin K given to newborns is 20,000 times greater required dose. In addition, in injection solution may contain preservatives that are toxic to a weak and immature immune system.
3. At the moment when immune system the child is still immature, the injection creates additional risk introducing infection from environment, in which they are located dangerous pathogens infections.

Vitamin K by mouth is a safe and effective alternative

Fortunately, a recent study has shown that there are safer and more best practices, which may just as well protect your child from TTH, the alternative to this blatantly unnecessary injection is surprisingly simple: give the vitamin orally. It is safe and equally effective, and free of the previously mentioned worrying side effects.

Orally administered vitamin K is absorbed less efficiently than parenterally administered vitamin K. However, this can be easily corrected by adjusting the dose. And since vitamin K is non-toxic, there are dangers of overdose and adverse reactions No.

What do you need to do before the baby is born?

1. Whether or not to agree to a vitamin K injection for your child is ultimately a personal choice. At least now you have information with which you can make an informed decision.
2. During childbirth, anxiety makes it very difficult to keep in mind that your baby should not get an injection. So it might be helpful to have someone at the birth, such as your spouse, to remind the staff that your baby shouldn't have the shot.
3. Remember that you must be proactive. Typically, nurses never ask permission to give a vaccine or vitamin K injection, as this is standard practice and does not require separate consent. Therefore, you must be very careful and persistent in your demands.
4. Please remember - you must show maximum perseverance and perseverance in order to force your desires to be taken into account. The system will fight you tooth and nail, because its representatives are sincerely convinced that they know better. It's worth the extra protection for your newborn.

Some children develop pathological conditions between 24 and 72 hours - increased bleeding from the umbilical wound, intestines, and stomach. Group similar conditions, occurring in 0.2-0.5% of babies, is called hemorrhagic disease of the newborn. Often this disease is the result of a lack of vitamin K in the baby’s body. In newborns breastfeeding this disease can appear in the third week of life. This is due to the presence of thromboplastin in milk, a blood clotting factor. Hemorrhagic disease of newborns that appears at this stage is considered late.

There are two forms of this disease: primary coagulopathy in newborns, developing with a lack of vitamin K, and secondary, which affects premature and weakened children with weak functional liver activity. About 5% of newborns suffer from reduced levels of vitamin K-dependent clotting factors if the mother took antibiotics, aspirin, phenobarbital or anticonvulsants, affecting liver function. Children whose mothers are also at risk are also at risk. later suffered from toxicosis, enterocolitis and dysbacteriosis.

With primary hemorrhagic diathesis in children, nasal, gastrointestinal intestinal bleeding, bruises on the skin, hematomas. Such skin manifestations are called purpura in medicine. Diagnosis of intestinal bleeding is carried out by stool - the stool on the diaper is black with a bloody rim. This is often accompanied by bloody vomiting. Often, intestinal bleeding is one-time and light. The severe form is accompanied by continuous bleeding from anus, bloody persistent vomiting. Sometimes it may even occur uterine bleeding. Unfortunately, the consequences of severe hemorrhagic disease of newborns in the absence of timely medical care are fatal - the child dies from shock. The secondary form of the disease is characterized by the presence of infection and. In addition, hemorrhage in the brain, lungs, and ventricles of the brain can be diagnosed.

Diagnosis of hemorrhagic disease of newborns is based on clinical data and the results of subsequent studies (blood smear, thrombotest, platelet count, determination of the activity of clotting factors and hemoglobin). At the same time, the newborn is checked for the presence of other hemorrhagic diathesis: hemophilia, von Willebrandt disease, thrombasthenia.

If the course of this disease is uncomplicated, then the prognosis is generally favorable. Subsequent transformation into other types hemorrhagic diseases doesn't happen.

Treatment of any bleeding in babies in the first days of life begins with intramuscular injection vitamin K, which the body lacks. Thrombotest monitoring is required to monitor the alignment of K-vitamin-dependent blood coagulation factors. For three to four days, the child is administered Vicasol, and in severe cases, an immediate infusion of plasma (fresh frozen) with simultaneous administration of vitamin K is necessary. Plasma is administered at the rate of 10 milliliters per kilogram of the baby’s weight. Symptomatic therapy carried out only in specialized departments.

Prevention of this disease consists of a single administration of Vikasol to babies who were born from a history of diarrhea. Newborns in a state of asphyxia as a result of childbirth also need similar prevention. intracranial injury or intrauterine infection.

Women who have had a history of various diseases, which are associated with increased or pathological bleeding, should be carried out under medical supervision throughout pregnancy.

Hemorrhagic disease in newborns is a common disease that many parents have to deal with. Having encountered this diagnosis, many parents begin to grab their heads and look for all sorts of ways to eliminate the pathology. To accept the right decision to eliminate the disease, let's find out what its features are and how to protect the child from this disease.

Features of the disease and causes

Hemorrhagic disease is a pathological change in the blood, during which a violation of its coagulation occurs. Because of this, people often experience 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 It is more often diagnosed in newborns. Bruising and signs of bleeding are the main symptoms of the disease in the first days of life.

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

According to experts, this pathology can be classified into primary and secondary disease. Primary disorders usually occur during intrauterine development or in the first days after birth. More often than usual, this is due to a natural lack of vitamin K. Hemorrhagic disease in newborns has various causes.

Primary causes of the disease

• Use of prohibited medications during pregnancy;
• disruption of the liver and intestines in a pregnant woman;
• gestosis and toxicosis during pregnancy;
• disturbed and immature intestinal microflora of the infant;
• placental vitamin K impermeability;
• minimum vitamin content in breast milk.

At the heart of development secondary causes diseases, there are disturbances in the functioning of plasma blood clotting factors occurring in the liver; more often than usual they have a late form. In addition, an important cause of vitamin deficiency may be the use of vitamin K antagonist drugs by the mother.

Secondary causes of the disease

• Premature birth before 37 weeks;
• fetal hypoxia;
• intestinal dysbiosis;
• dysfunction of the liver, intestines, pancreas and bile ducts;
• long-term use of antibiotics.

There are many reasons for the occurrence of diseases. In order to correctly determine what exactly triggered the development of the pathological condition, it is necessary to carry out appropriate diagnostics. Since the method and method of treating the disease will depend on what exactly underlies the occurrence of hemorrhagic disease.

Features of vitamin K and its importance in the functioning of the body

Up to ten proteins are involved in the process of blood clotting, 5 of which are synthesized with the help of vitamin K. In addition, it is of no small importance in the process of blood thickening that occurs in the liver. With the help of this vitamin, the human body retains such released trace elements as calcium, which plays important role in the functioning of the skeletal system.

A lack of vitamin K causes detrimental harm to the body. Therefore, if its deficiency occurs, it is necessary to immediately begin to eliminate this pathology. In adults, deficiency of this vitamin is much less common than in children. Since the body of an adult can compensate for its deficiency by consuming vegetables and other foods.

Symptoms of the disease

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

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

Early symptoms of the disease:

1. bruises on the baby’s body detected after childbirth;
2. nosebleeds;
3. the presence of blood in the baby's stool or after regurgitation;
4. constant bleeding of wounds after injections;
5. signs of anemia.

Late symptoms of the disease:

1. frequent vomiting mixed with blood;
2. intracranial hemorrhages;
3. spontaneously occurring bruises of the skin;
4. the presence of blood in the urine;
5. obvious symptoms of gastrointestinal dysfunction;
6. constant and prolonged bleeding of the umbilical wound.

In most cases, the late form of symptoms underlies liver disorders. In case acute illness, the child exhibits symptoms of hypovolemic shock. Due to frequent vomiting and broken stools, the child’s body experiences a lack of fluid, which provokes a decrease in the volume of circulating blood. This pathological condition is very dangerous for the life and health of the child.

In order to prevent the development serious complications, you must promptly apply for medical assistance, since it is better to treat the disease with initial stage occurrence.

Diagnosis of the disease

Treatment of hemorrhagic disease of the newborn is important for normal life child. Timely diagnosis is the key speedy recovery baby. In case early symptoms, the doctor will inform the mother about the need for an examination. As a rule, the most informative method diagnostics is a blood test. In addition, the specialist can offer additional methods studies that will help assess the condition of the newborn. When conducting diagnostic studies children do not experience heavy loads, diagnosis is carried out quickly and painlessly.

Research methods

1. general blood test;
2. blood clotting test;
3. fecal occult blood test;
4. ultrasound examination internal organs.

An in-depth diagnosis of the child’s condition is carried out if the doctor is not clear about the causes of the deviation. If the parents of a newborn have a tendency to form data pathological changes, the specialist may also suggest diagnosing the baby’s health. Typically this is classical analysis blood and ultrasound examination of the child’s organs. Conducted this procedure, to prevent the development of internal bleeding.

Treatment options

The method of treating the disease depends on the severity of the pathology. If the child has average shape diseases, without obvious signs complications, then vitamin therapy will be used. Over the course of three days, the child will be given synthetic vitamin K, which compensates for its lack. According to experts, the vitamin is better absorbed if it is administered intravenously or intramuscularly. Oral administration vitamin is considered ineffective.

In the case of a severe form of the disease, measures will be taken first to eliminate pathological conditions and the causes of their occurrence. If hemorrhage poses a danger to the child's life, fresh frozen blood plasma is administered. After its administration, the child’s condition stabilizes.

Disease prognosis

The prognosis of the disease will be positive, in mild case forms of the disease when the child’s life is not in danger. Timely diagnosis combined with modern methods treatment, are able to easily cope with the existing pathology.

In case of major changes, and in particular with a large number internal hemorrhages, the child's life may be at risk.

Preventive measures

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

Preventive measures for pregnant women:

1. application antibacterial drugs possible if the risk of complications in the mother is much higher than in the child;
2. Avoid the use of drugs that displace vitamin K.

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

Indications for vitamin administration

• intrauterine hypoxia;
• prematurity;
• postpartum complications;
• use of antagonistic drugs during pregnancy;
• clear signs of vitamin K deficiency in a woman in labor.

Some perinatal centers practice additional diagnostics child's health. By agreement with the doctor, children can undergo in-depth postpartum diagnostics health. This will be relevant if during pregnancy the mother suffered from conditions that affect the content of vitamin K in the body. If there is a pronounced deficiency of this vitamin, young parents may be advised to conduct a course of vitamin therapy for their baby.

Frequently Asked Questions

After diagnosis, early hemorrhagic disease of newborns, parents experience large number questions. In this section we have collected the most relevant ones. Thanks to the specialist's answers, you can get useful information on this topic.

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

Answer: “Late hemorrhagic disease of the newborn may be caused by dysfunction digestive system. Frequent vomiting, mixed with blood and stool disturbances, may be a symptom of the development of a deviation. Of course, the presence of blood in the regurgitated mixture is a sign of disruption of the digestive system. But this does not mean that it is hemorrhagic disease that is the cause of the development of this deviation. In this situation, it is necessary to diagnose the child’s health condition in order to identify the cause of the pathological change.”

The child was diagnosed with hemorrhagic disease. The baby’s condition is stable, but the maternity hospital recommended that we refuse vaccinations for 6 months. During a routine medical examination, the pediatrician started talking about the need for vaccination, although we are only 4 months old. What to do in this situation? A conversation with the doctor did not give a concrete answer.

Answer: “According to the protocol, this pathological condition has a clear medical exemption from vaccinations. The duration of withdrawal directly depends on the stage, degree and form of the disease. If we're talking about O mild form pathology, which is characterized only by a clear lack of vitamin K, then the period of medical withdrawal is minimal. In case severe forms disruption of the body, with multiple hematomas and hemorrhages, it will be significantly increased, up to full recovery body. Before deciding whether to start vaccination, you should at least take a blood clotting test.”

After birth, the child was sent to the department intensive care newborns. The doctor diagnosed acute form hemorrhagic disease. Multiple cephalohematomas, jaundice and hypoxia are the main reasons for transferring a child. I'm very worried about the baby. Why was the decision made to transfer when his life is not in danger?

Answer: “The decision to transfer infants to the intensive care unit is made by a neonatologist, after assessing the state of his health. To exclude development serious pathologies, it is necessary to conduct an in-depth diagnosis of the baby’s health. After all hidden forms organ dysfunction may lead to irreversible consequences. Early form diagnostics and features nursing care, will help the baby get stronger. Since traumatized children are monitored under the strict guidance of a neonatologist throughout their stay in the maternity hospital, the babies’ recovery is much faster.”

One month during a routine examination, the doctor said that he suspected the development of a hemorrhagic disease. We received a referral for testing for prothrombin complex. Is it necessary to do it?

Answer: " Prothrombin analysis– 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 prothrombin complex factors and external path coagulation. If a specialist has ordered this study, then it is necessary. All methods for diagnosing the disease are selected at the discretion of the attending physician, based on the characteristics of the pathology.”