Hemorrhagic disease of the newborn is caused by a disorder. Hemorrhagic disease
The birth of a child is a happy event, which is accompanied by worries from the parents. The baby was born and received 10 points on the Apgar scale, but this does not mean that the child is completely healthy. One of the common pathologies of newborns is hemorrhagic disease.
Having heard the diagnosis of the long-awaited baby, parents begin to look for ways to eliminate the problem. To find a solution, you need to know how to live with this problem, and whether it is possible to protect your child from the disease.
What is hemorrhagic disease?
Hemorrhagic disease newborns - a pathology associated with the function of blood clotting. It develops due to a deficiency of vitamin K in the body of a newborn. The incidence rate is low - 0.3-0.5% of all babies are born with the disease. Vitamin K is an important component of the blood clotting process. It is produced in a newborn 4-5 days after birth.
The lack of substance quickly makes itself felt. The quality of coagulation deteriorates significantly, and increased bleeding develops. Against this background, the child exhibits a special diathesis. Bruising and signs of bleeding are the main symptoms of hemorrhagic disease.
For what reasons does it occur in newborns?
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There are several causes of the disease: primary and secondary. Attribution of the causes of pathology to one of these types depends on at what stage of pregnancy and childbirth the problem arose.
To determine the cause of hemorrhagic disease of newborns, it is necessary to conduct a diagnosis.
Primary pathologies are easily diagnosed in the first days of life and occur during pregnancy. Secondary ones are more serious because there is a deficiency of plasma clotting factors.
Types and symptoms of pathology
The symptoms of the disease depend on the form of the disease. It is based on 2 signs: bleeding and the formation of bruises on the child’s body. Abnormalities can be noticed by an ultrasound specialist during an intrauterine examination of the fetus, when diagnosis is possible internal bleeding unborn baby.
Symptoms appear on the 7th day of the baby’s life. Symptoms are divided into early and late forms. The early form is quite rare. The clinical picture of the disease appears within 24 hours after birth.
Early, classical and late forms
Depending on the time of onset of symptoms, several subtypes of the disease are distinguished: early, classic and late forms of hemorrhagic disease. If the baby is breastfeeding, symptoms may appear a little later, since mother’s milk contains thromboplastin, which is responsible for blood clotting. Each type of pathology is characterized by its own manifestations:
| Form of the disease | Characteristic | Symptoms |
| Early |
|
|
| Classical |
|
|
| Late |
| The classic symptoms of late hemorrhagic disease of the newborn include weakness, pale skin, sharp drop blood pressure, resulting in hemorrhagic shock. |
Primary and secondary hemorrhagic disease
When classifying the disease, primary and secondary hemorrhagic disease are distinguished. They differ in the characteristics of their course and the factors of their occurrence. Primary occurs when general content There was initially little vitamin K in the baby's blood, and after birth it was not supplied to the 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 impaired liver function. Another cause of a secondary disease is the baby’s prolonged stay on parenteral nutrition. As a rule, the most severe forms of the disease are diagnosed in very premature infants and babies with serious pathologies of the liver and intestines.
At the slightest suspicion of hemorrhagic disease after discharge from the hospital, it is necessary to urgently call ambulance. Parents should be alert to unexpectedly appearing bruises on the baby’s body. Another reason to see a doctor is that when blood is taken from a finger, it does not stop for a very long time. All this is a reason for a serious examination.
Diagnostic methods
Effective treatment of hemorrhagic disease of the newborn begins with diagnosis. The sooner it is carried out, the greater the chances for a high-quality life for the child in the future. A blood test is considered the most informative; in addition to it, an ultrasound is always prescribed abdominal cavity and neurosonography:
| Diagnostics | The essence of the study |
| Complete blood count (CBC) | The level of hemoglobin and red blood cells, platelets is detected. At hemorrhagic disease the concentration of the first two factors is significantly reduced, and the platelet count does not exceed normal limits. |
| Urinalysis, stool examination | It is carried out to identify hidden bleeding and blood impurities in the biomaterial. |
| Coagulogram, or assessment of blood clotting | In the presence of pathology, the clotting time exceeds 4 minutes. |
| Ultrasound, neurosonography | Hemorrhages are detected in the periosteum of the cranial bones, in the tissue of the central nervous system and other organs and systems. |
To differentiate the disease from pathologies with similar symptoms, including “maternal blood swallowing syndrome”, hemophilia, thrombocytopenia, von Willebrand disease, an Apta test is additionally performed. Vomit and feces containing blood are diluted with water and a pink solution containing hemoglobin is obtained.
Features of treatment
Treatment methods directly depend on the severity of the pathology.
At average shape The baby will be prescribed vitamin therapy: for 3 days the baby will receive artificial synthetic vitamin K, and its deficiency will be completely replenished. For better absorption intramuscular or intravenous injections are used.
Main therapeutic methods:
- In case of vomiting with blood, gastric lavage is necessary saline solution and oral administration of aminocaproic acid;
- with internal gastrointestinal bleeding an enteral mixture with thrombin, androxon and aminocaproic acid is prescribed (we recommend reading:);
- at severe forms, accompanied hemorrhagic shock, immediate infusion of fresh frozen blood plasma is indicated;
- glucocorticosteroids that help strengthen the walls of blood vessels, vitamin A and calcium gluconate are prescribed as maintenance therapy.
Forecast
If the disease occurs in mild form and is treatable, the prognosis is good. With timely and adequate treatment later in life the child will not be in any danger, relapses and complications of the pathology with the general clinical picture are excluded.
The baby’s life is in serious danger if a severe pathology with heavy bleeding and hemorrhages. Manifestations that provoke disturbances in the functioning of the heart and disruptions in the functioning of the adrenal glands are considered mortally dangerous. Cerebral hemorrhages are especially dangerous due to their consequences.
Preventive actions
Prevention of the disease begins at the planning stage of the baby. Being pregnant, a woman needs to take care of her health. There are often cases when it becomes necessary to use antibacterial therapy. It should only be carried out 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 a doctor in a timely manner and undergo all necessary tests.
The expectant mother should include in her diet foods containing a large number of vitamin K. These are all green vegetables: green beans, cabbage, peas, spinach. Introduction of artificial vitamin is possible only by medical indications with its pronounced deficiency. At risk are premature babies, babies with birth injuries or those who are on artificial feeding.
Difficult pregnancy, taking antibiotics, vitamin deficiency and others negative factors affect not only the woman’s health, but also lead to the child developing late hemorrhagic disease of the newborn.
Abnormal changes in the blood begin when the fetus is still in the womb. The process of its coagulation and thickening is not complete without proteins, for the production of which vitamin K is responsible. This microelement retains calcium, which is actively involved in the formation of bones.
In most European countries and the United States, hemorrhagic disease of newborns is prevented. Since the main causes of the anomaly are known, children are immediately prescribed Vikasol, which compensates for the deficiency in the body natural vitamin TO.
Why does the violation occur?
Primary pathology develops in a child when he is still in the womb or immediately after birth. Provoke the appearance of the disease:
- Problems with the digestive organs in a pregnant woman.
- The presence of prolonged toxicosis.
- Uncontrolled use of sulfonamides, tetracycline antibiotics, cephalosporins, anticoagulants, carbamazepine.
- Disturbance of intestinal microflora and dysbacteriosis in a baby.
Lack of vitamins breast milk contributes to the appearance of primary pathology. Secondary disease develops with early birth if the liver and pancreas do not perform their functions. Probable Cause disturbances in the synthesis of vitamin K - fetal hypoxia. This component enters through the placenta, and in infants - with milk during feeding. With a deficiency of this substance, abnormal bleeding occurs.
Pathogenesis and forms of disorder
With insufficient production of vitamin K, passive plasma factors are formed in the liver, which are unable to retain calcium and do not participate in the synthesis of substances that promote blood clotting, as a result of which the time of thrombosis and thromboplasty increases.
Hemorrhagic syndrome in newborns has several varieties. It is believed that early form occurs when the baby is in the womb. It develops if a pregnant woman takes pharmaceuticals. A child is born with hematomas, hemorrhages on the skin, adrenal glands, spleen, liver, and intestines. The feces take on a black tint.
The baby may die if help is not provided if the bleeding continues continuously.
Most often, the classical form of the pathology is diagnosed, which occurs in infants in the first days of birth and is often accompanied by skin necrosis. The child suffers from bloody vomiting, red discharge from the navel and nose.
2–3 months after the birth of the baby, the late form of the disease makes itself felt, in which:
- Hematomas cover most of the body.
- Purulent formations appear.
- Blood volume decreases.
With such symptoms, serious complications often arise. Hypovolemic shock develops, the baby’s blood pressure drops, the filling of the heart muscle decreases, which is fraught with the appearance of multiple organ failure.
Features of symptoms
The clinical picture of the early form of the disease appears immediately after the birth of the baby. In addition to the presence of hemorrhagic spots on the buttocks and other parts of the body, a cephalohematoma forms in the periosteum area. The pathology is accompanied by hemorrhages; signs appear depending on the organ in which they appear:
- The liver increases in size, the baby has a stomach ache.
- When it enters the lungs, shortness of breath occurs, and red sputum is produced when coughing.
- The child becomes weaker and refuses to eat if hemorrhage occurs in the adrenal glands.
With this form of anomaly, anemia develops and neurological disorders are observed. The baby is suffering from bloody vomiting.
In the classic type of the disease, red spots cover the entire body, and ulcers form on the intestinal mucosa. Blood appears in the urine.
The late form is manifested by multiple hematomas on the skin and severe anemia. Hemoglobin drops sharply, thermoregulation is disrupted.
With absence urgent help at internal hemorrhages the consequences can be very sad.
Diagnostic methods
If a hemorrhagic disease is suspected, laboratory tests and examination using instrumental methods.
External examination reveals diffuse changes on the skin. A blood test determines the level of hemoglobin, the number of red cells, platelets and fibrinogen. In the presence of pathology in any form, these indicators deviate from the norm.
A coagulogram is prescribed to check clotting time. In a sick newborn it exceeds 4 minutes. The duration of bleeding is calculated.
Examination of urine and feces can detect uncharacteristic impurities. To identify internal cephalohematomas and ulcers, the baby undergoes an ultrasound of the peritoneum. Neurosonography helps to find hemorrhages in the periosteum.
Many symptoms of hemorrhagic disease are similar to thrombasthenia and some other pathologies. The study is conducted to exclude them. Red vomit and black stools may occur if the newborn ingests the woman's blood. To check this, an Apta test is prescribed.
The baby's feces are placed in water, mixed and sent to a centrifuge. Sodium hydroxide is dripped into the liquid obtained after removing the sediment. Brown color the solution indicates the presence of mother’s blood, pink confirms the abnormality in the baby.
How to treat a newborn?
Having learned that a child has a hemorrhagic disease, parents often panic and do not believe in a successful outcome, although timely therapy and mild forms of the disorder, treatment ends with recovery. It is aimed at eliminating the deficiency of vitamin K. The baby is given a subcutaneous injection or a one percent solution of Vikasol is injected into a vein. Both procedures are performed once a day for three days.
During the treatment of hemorrhagic disease, basic blood parameters and clotting time are constantly checked. It is impossible to exceed the vitamin norm, otherwise anemia develops and the amount of bilirubin increases, which is dangerous due to the appearance of jaundice.
Drugs are quickly transfused when there is a significant decrease in hemoglobin, heavy bleeding provokes the occurrence of hypovolemic shock, the consequences can result in the death of the newborn. To prevent this from happening, use prothrombin complex or fresh plasma. After the bleeding has stopped, a red blood cell transfusion is started, the baby is injected with glucocorticosteroids, and calcium gluconate is prescribed.
When treating a newborn for hemorrhagic disease, doctors give clinical recommendations. Even if the baby cannot suckle, you need to feed him expressed milk. The components that this product is rich in help normalize blood clotting.
Prognosis and prevention
A mild form of hemorrhagic disease can be cured with proper and timely therapy. The baby recovers completely, the skin is cleared of spots and purulent formations, and bruises disappear.
If the pathology is complicated and there is no urgent help, the baby dies:
- from heart failure;
- due to hemorrhage in the brain;
- in case of dysfunction of the adrenal glands.
To prevent the development of the disease, children are given an analogue of vitamin K, which is produced artificially. The drug is prescribed to premature babies, those who were injured during childbirth, and those on parenteral nutrition. The risk group includes children who were born during surgery caesarean section, suffered from asphyxia, oxygen starvation, are treated with pharmaceuticals.
In modern perinatal centers An in-depth examination of newborns is carried out. Prevention of hemorrhagic disease is necessary for babies whose mothers suffered from toxicosis, had intestinal problems, complications on latest dates pregnancy in the form of gestosis and bleeding.
Vikasol is prescribed to children if, while carrying them, the woman was treated with antibiotics, took sulfonamides, anticoagulants, and anti-tuberculosis medications.
Hemorrhagic disease, which is accompanied by heavy bleeding, leads to a significant deterioration in the baby’s health, dysfunction of the liver, kidneys, digestive organs, cardiac muscle. When the first signs of pathology appear, the newborn is prescribed replacement therapy, which allows you to stop the progression of the disease.
Hemorrhagic disease of the newborn (HDN) is a hemorrhagic diathesis resulting from the inferiority of blood clotting factors, the activity of which is determined by the concentration of vitamin K in the body.
| ICD-10 | P53 |
|---|---|
| ICD-9 | 776.0 |
| eMedicine | ped/966 |
| MeSH | D006475 |
| DiseasesDB | 29544 |
| MedlinePlus | 29544 |
Causes
Hemorrhagic disease of newborns is diagnosed with a frequency of 0.25-1.5% in post-Soviet countries. In those countries where children are given vitamin K immediately after birth for preventive purposes, the incidence rate does not exceed 0.01%.
Based on the mechanism of development, primary and secondary GRBN are distinguished. Primary hemorrhagic disease of the newborn is caused by a violation of the synthesis of blood coagulation factors due to a lack of vitamin K. The tendency to develop pathology in the first days of life is associated with a natural deficiency of vitamin K, which occurs for the following reasons:
- its synthesis occurs in the intestines, the microflora of which in the child is in the process of formation;
- vitamin K practically does not penetrate the placenta;
- Breast milk contains very little of it - 2 mcg/l.
But to start pathological process these factors are not enough. Hemorrhagic disease of newborns, as a rule, develops in the presence of certain prerequisites. Among them:
- taking during pregnancy indirect anticoagulants, anticonvulsants and broad-spectrum antibiotics;
- gestosis, toxicosis;
- liver diseases and chronic non-inflammatory intestinal pathologies in the expectant mother.
The causes of secondary hemorrhagic disease of newborns are a decrease in the production of PPPF (polypeptide precursors of plasma factors) of blood coagulation, which occurs in the liver. In addition, the pathology can be caused by the administration of coumarin and neodicoumarin (vitamin K antagonists).
The main factors on the part of the child that can provoke a decrease in the synthesis of PPPF and a lack of vitamin K:
- prematurity;
- hypoxia;
- long-term intravenous nutrition;
- late breastfeeding;
- deterioration in the absorption of microelements in the intestine due to dysbiosis or malabsorption syndrome;
- diseases of the pancreas, liver, biliary tract, intestines;
- antibiotic treatment.
Pathogenesis
Hematological functions of vitamin K:
- activation of the processes of gamma-carboxylation of excess glutamic acid in prothrombin (blood coagulation factor II), proconvertin (VII), antihemophilic globulin B (IX) and Stuart Prower factor (X);
- stimulation of plasma proteins C and S, which are involved in coagulation mechanisms.
With vitamin K deficiency, passive factors II, VII, IX and X are formed in the liver: they are not able to bind calcium and participate in blood clotting. As a result, the prothrombin and activated partial thromboplastic time is prolonged, which manifests itself in the form of an increased tendency to bleeding. This is how hemorrhagic disease of newborns develops.
Symptoms
Depending on the specifics clinical picture There are early, classic (typical) and late forms of hemorrhagic disease of newborns.
The early version of the pathology is rare and is characterized by the manifestation of symptoms during the first day of the child’s life. Main manifestations:
- hemorrhagic spots (hemorrhages) on the skin, especially in the buttocks;
- cephalohematoma - an accumulation of blood between the periosteum and the skull, on the surface of which pinpoint hemorrhages (petechiae) are visible;
- bleeding in the lungs;
- hemorrhages in the spleen, liver, adrenal glands;
- hematemesis - vomiting blood;
- intracranial hemorrhages;
- anemia.
Signs of hemorrhages in internal organs:
- brain – the appearance of neurological disorders;
- lungs – shortness of breath, blood in sputum discharged when coughing;
- liver – increase in its size, abdominal pain;
- adrenal glands – weakness, decreased activity, refusal to eat.
Classic hemorrhagic disease of newborns develops 2-4 days after birth. Its symptoms are similar to those of the early form. Added to them:
- hemorrhagic spots on the skin throughout the body;
- bleeding from the nose and navel;
- melena – intestinal bleeding, which appears due to the formation of ulcers on the intestinal mucosa and is diagnosed when blood is detected in the stool;
- hemorrhage in the kidneys, accompanied by the appearance of blood in the urine.
- uterine bleeding.
As a rule, bleeding is not profuse. But in severe cases, blood is released continuously. Without help, the child may die from shock as a result of blood loss.
Late hemorrhagic disease of newborns begins at 2-8 weeks of a child’s life. Its signs:
- bruises on the epithelial membranes and skin;
- internal hemorrhages;
- intestinal bleeding;
- blood in vomit;
- cerebral hemorrhages;
- severe anemia.
A possible consequence of hemorrhagic disease of newborns is, which occurs as a result of significant blood loss and anemia (hemoglobin level decreases by 2-3 times). It is accompanied by pallor, weakness, decreased blood pressure and impaired thermoregulation.
Diagnostics
Hemorrhagic disease of newborns is diagnosed based on clinical symptoms and laboratory tests.
Main research:
- blood test - allows you to detect a decrease in the concentration of hemoglobin and red blood cells, as well as a normal platelet count;
- urine and stool tests show blood impurities;
- checking the coagulation system (coagulogram) - demonstrates an increase in prothrombin and activated partial thromboplastic time with a normal thrombin time;
- assessment of blood clotting time – increased (more than 4 minutes);
- bleeding time calculation is normal (2-4 minutes).
Instrumental methods that make it possible to identify internal hematomas and bleeding:
- neurosonography;
- Ultrasound of the abdominal cavity and retroperitoneal zone.
Hemorrhagic disease of newborns is differentiated from hemophilia, von Willebrand disease, thrombocytopenic purpura and thrombasthenia.
In addition, bloody vomiting and melena can be the consequences of a child swallowing maternal blood. This is checked using the Apta test. Water is added to the biomaterial sample and it is centrifuged. Then a sodium alkali solution is dripped into the liquid and the color reaction is monitored: yellow-brown coloring indicates the presence of age-related hemoglobin from the mother’s blood, and pink coloring indicates the presence of fetal hemoglobin from the child’s blood.
Treatment
The basis for the treatment of hemorrhagic disease of newborns is the replenishment of vitamin K deficiency. The drug “Vikasol” in the form of a solution is most often used. It is an artificial analogue of vitamin K.
A 1% vitamin solution is administered intramuscularly or intravenously for 2-3 days. The approximate dose is 0.1-0.15 ml per 1 kg of child’s weight. Injections or infusions are carried out once a day. During therapy, hematological parameters are monitored, in particular, changes in blood clotting factors dependent on vitamin K are assessed.
During treatment, it is important to control the dosage of vitamin K. If it is in excess, complications may occur:
- anemia with intracellular inclusions;
- increased bilirubin levels, which can cause kernicterus;
- hemolytic anemia.
In case of severe bleeding, to compensate for blood loss, a bolus (rapid) intravenous transfusion of one of two drugs is performed:
- fresh frozen plasma – 15 ml/kg;
- concentrated prothrombin complex – 30 units/kg.
To eliminate the consequences of a decrease in hemoglobin, a transfusion of red blood cells (5-10 ml/kg) is performed. In addition, glucocorticoids may be prescribed to strengthen the capillary walls, vitamin A and calcium gluconate.
In case of hemorrhagic disease of newborns, breastfeeding should not be stopped. If the child is very weak or is separated from the mother, he is fed expressed milk based on age needs. Breast milk contains thrombokinase, a substance that has a hemostatic effect.
Forecast
Uncomplicated GRBN has a favorable prognosis if treated adequately. As a rule, in the future the pathology does not transform into other hemorrhagic diseases.
The risk of death occurs when:
- massive bleeding;
- disruption of the heart;
- development of adrenal insufficiency;
- hemorrhages in the brain.
Prevention
Prevention of hemorrhagic disease of newborns consists of preventive administration of vitamin K. The dosage for the “Vikasol” solution is 0.1 ml/kg. The treatment regimen is 1 time per day for 1-3 days.
Vitamin K is administered to children at risk, including:
- born significantly prematurely;
- receiving antibiotics;
- those on parenteral nutrition;
- suffered birth trauma, hypoxia or asphyxia;
- born by caesarean section.
In addition, newborns are at risk if during pregnancy a woman:
- took anticoagulants, antibiotics, antituberculosis or anticonvulsants;
- suffered from gestosis due to estrogen deficiency, enteropathy, hepatopathy or intestinal dysbiosis.
In these cases, vitamin K can be prescribed to expectant mothers shortly before and after childbirth.
In addition, early breastfeeding and natural feeding are considered preventive measures for GRBN.
vitamin K deficiency in a newborn, hemorrhagic diathesis
One of the pretty dangerous conditions in pediatrics is a hemorrhagic disease of the newborn, which is manifested by a decrease in blood clotting and the occurrence of bleeding various localizations. 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 lies in high risk complications, which can cause death. Modern methods Prevention in most cases allows you to avoid this terrible condition and its consequences.
This pathology is relatively rare - it is diagnosed in only less than 1.5% of born babies. In Western European countries and the USA, hemorrhagic disease is even less common (less than 0.1%). This is due to the mandatory use of vitamin K for its prevention in all newborns in the first day after birth.
The role of vitamin K
The main reason pathological condition- this is an insufficient supply or formation of vitamin K in the baby’s body. Therefore, in ICD-10 this disease also has the second name “vitamin K deficiency in a newborn.” In 1943, scientists who established the cause of hemorrhagic disease were awarded the Nobel Prize.
Vitamin K does important function in the human body. This substance is primarily responsible for the activation of certain components of the blood coagulation system.
Vitamin K plays a decisive role in the implementation of their blood coagulation properties; its deficiency significantly increases the risk of bleeding.
The immediate cause of increased bleeding is the lack of the following components of the coagulation system:
- antihemophilic protein B;
- prothrombin;
- Stewart factor.
In addition, with hemorrhagic disease, the process of activation of other coagulation factors is disrupted. In this case, calcium ions are not included in the process of blood clot formation, which causes bleeding.
Causes of hemorrhagic disease in newborns
Unfortunately, vitamin K does not cross the placenta well during pregnancy. In addition, breast milk contains very little of it on the first day; the concentration of the 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 may be primary or secondary. Basic primary causes hemorrhagic disease of the newborn are as follows:
- mother taking anticoagulant medications during pregnancy;
- premature birth;
- delivery by caesarean section;
- taking antibiotics or anticonvulsants by a pregnant woman;
- liver and intestinal diseases in women;
- dysbiosis in the mother;
- late toxicosis of pregnancy.
Secondary pathology is often associated with impaired liver function in the child. This can occur when it is infected (hepatitis), congenital pathologies. In this case, the factors necessary for complete blood clotting do not form sufficiently, which becomes the cause of bleeding.
How does the disease manifest itself?
Depending on the time of appearance characteristic symptoms hemorrhagic disease occurs:
- early - hemorrhagic disease of newborns manifests itself in the first 24-48 hours after birth;
- classic - symptoms appear on the third to fifth day;
- late - bleeding occurs in the first weeks or months of the child’s life.
With early or classic version The symptoms of hemorrhagic disease of newborns are as follows:
- vomiting blood;
- the presence of blood in the stool (melena);
- subcutaneous hemorrhages of various sizes (hematomas, “bruises”);
- hematomas in the head area;
- increased bleeding in the area of the umbilical wound;
- blood in the urine;
- internal bleeding (pulmonary, intracranial).
Late hemorrhagic disease of newborns in most cases is caused by insufficient intake of vitamin K in breast milk, as well as a violation of its formation in the intestines. In this case, the reasons may be reception antibacterial agents, dysbacteriosis, congenital enzymopathies. It manifests itself during the first months of the child’s life with the same symptoms as the early form of the disease.
Intracerebral hematomas
Hemorrhagic disease of newborns is especially dangerous because it can cause intracerebral hemorrhage. In some cases, this condition causes severe neurological deficits and even death.
Most often, bleeding is localized under the membranes (subarachnoid hemorrhage) or in the substance of the brain. In this case, against the background of signs of blood coagulation disorders, other symptoms appear, indicating the involvement of intracranial structures:
- impaired consciousness of varying degrees;
- frequent regurgitation, vomiting;
- constant, causeless crying of the child;
- fontanelle tension;
- divergence of the sutures of the skull;
- convulsive syndrome.
If there are signs intracranial hemorrhage necessary urgent hospitalization child in neurosurgical department and carrying out specific therapy aimed at eliminating vitamin K deficiency. Late treatment significantly worsens the prognosis for the child in relation to neurological manifestations and life.
How is it diagnosed?
You can suspect the presence of a 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 palate, increased bleeding in the area of the umbilical wound or injection. Some children also develop jaundice skin which is associated with bleeding in digestive tract, blood breakdown and increased bilirubin levels.
For additional diagnostics A number of laboratory tests are indicated:
- general clinical blood test with platelet count;
- coagulogram and determination of prothrombin index;
- determination of bleeding time;
- APTT (activated partial prothrombin time).
Hemorrhagic disease of the newborn is characterized by normal indicators bleeding time, platelet count. However, clotting time and APTT are prolonged. At prolonged bleeding a decrease in hemoglobin and red blood cell count may be detected.
Availability intracranial hematoma determined using neurosonography. If you suspect intra-abdominal bleeding shown endoscopic examination, ultrasound scanning abdominal organs.
Therapy
According to modern clinical guidelines The main method of treating hemorrhagic disease of newborns is injections of vitamin K3 (Vikasol). The medicine is administered intramuscularly, the dosage is calculated by the neonatologist individually based on the child’s weight, the maximum daily dose is no more than 4 mg. The medicine is prescribed once a day, the duration of treatment usually does not exceed three to four days.
Additionally, if necessary, the following medications and blood products are used:
- fresh frozen plasma;
- red blood cell mass;
- plasma expanders;
- prothrombin complex (“UMAN-complex D.I.”);
- drugs to maintain cardiovascular activity.
At severe course illness and the presence of complications, treatment of hemorrhagic disease of the newborn is carried out in the intensive care unit. The presence of intracranial hemorrhage with symptoms of dislocation of the midline structures of the brain requires urgent surgical intervention and removal of the hematoma.
Forecast
If the disease is detected on early stages and carried out specific therapy, then the prognosis is favorable. As a rule, relapses of hemorrhagic disease do not occur in the future.
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 indicated primarily for children at risk:
- having varying degrees prematurity;
- receiving antibiotic therapy;
- with birth injuries;
- born asphyxia or as a result of caesarean section;
- if the mother's pregnancy proceeded with complications;
- whose mothers suffered from liver diseases, dysbacteriosis, and took anticoagulants or antibacterial drugs.
In addition, prevention is also indicated for children who are bottle-fed. Although breast milk contains small amounts of vitamin K, it contains enough high level factors necessary for blood clotting. Therefore, children who do not receive mother's milk, required additional introduction artificial vitamin K.
In some European countries and the United States, prevention of hemorrhagic disease is mandatory for all newborns. In this case, vitamin K is given orally in a dose significantly higher than its content in breast milk. This introduction is repeated three times:
- in the first days after birth;
- on the fourth to seventh day;
- in the third to sixth week of life.
For newborns at risk, administration of vitamin K supplements is recommended, even in the absence of obvious signs hemorrhagic disease. "Vikasol" is administered intramuscularly for one to three days. The duration of treatment is determined individually based on laboratory data.
The consequences of hemorrhagic disease of the newborn can be quite serious and life-threatening for the child. With absence timely treatment the disease may cause severe complications with subsequent disability or even fatal. That is why it is so important to identify the pathology in a timely manner and begin treatment measures as early as possible.
In newborns, hemorrhagic disease is diagnosed more often. In the first days of life, it causes bruising in the child. More serious complication Diseases include hemorrhages in internal organs, which can be fatal. This disease is especially dangerous for premature babies.
Causes
The main reason for the development of hemorrhagic syndrome is vitamin K deficiency, under the influence of which coagulation factors II, VII, IX and X are formed. This occurs in liver tissue by y-carboxylation of glutamic acid. As a result, clotting factors are produced functionally immature, which prevents them from binding to calcium. As a result, a red blood clot does not form.
Vitamin K deficiency in newborns can be primary or secondary. In the first case, the cause is a lack of supply during pregnancy. On the mother's side, provoking factors are:
- taking indirect anticoagulants during pregnancy;
- gestosis;
- intestinal dysbiosis in a pregnant woman;
- enteropathy;
- poor nutrition;
- hypoxia and asphyxia of the fetus during childbirth;
- prematurity;
- taking anticonvulsants and antibiotics during pregnancy.
Secondary vitamin K deficiency causes a decrease in the production of PPPF by the liver tissue of the newborn. This pathology is provoked the following diseases:
- hepatitis;
- abnormalities in the structure of the biliary tract;
- malabsorption syndrome;
- not fully formed intestinal microflora in a child;
- functional immaturity of the liver parenchyma;
- lack of prophylactic administration of Vikasol after childbirth;
- long-term intravenous nutrition.
Forms
There are several forms of hemorrhagic disease. They are distinguished depending on the period of occurrence of the first symptoms of pathology in newborns:
- Early. Diagnosed when symptoms are detected in the first 12–26 hours after birth. This form is rare, more often against the background drug treatment mother.
- Classic. Symptoms manifest 2–6 days after the birth of the child. This form of the disease is more common.
- Later. The first signs appear after the first week of a newborn’s life. There are rare cases where the disease develops before the age of 4 months. Late hemorrhagic disease of newborns often occurs due to provoking diseases and the lack of prophylactic injections of Vikasol.
Symptoms
Hemorrhagic syndrome in newborns manifests itself differently depending on the form of the disease. The time of onset of symptoms also differs. The main signs of this pathology in newborns:
| Forms of hemorrhagic disease | Symptoms | When they appear |
| Most often in the first 24 hours of life. |
|
| Classical |
| More often on the 4th day. |
| Most often 7-14 days after birth. |
Diagnostics
The first stage of diagnosis is collecting anamnesis. A pediatrician or neonatologist immediately notes the factors that provoke the development of the disease: violation of the mother’s diet, taking medications, accompanying pathologies. It is important for the doctor to establish the time of onset of the first symptoms and their severity. To confirm the diagnosis, next research:
- neurosonography;
- general analysis blood;
- coagulogram;
- stool analysis occult blood;
- Analysis of urine.
Treatment
At hemorrhagic syndrome the newborn is prescribed etiotropic treatment. It is aimed at eliminating the cause of the disease - vitamin K deficiency. For this purpose, drugs containing it are prescribed. In general, they are used the following medications:
| Drugs used | Dosage | Duration of treatment |
| Fresh frozen plasma | 10–15 ml/kg intravenously. | One time. |
| Vikasol 1% |
