Dr. Meenakshi Sharma Professor in Pediatric Medicine SMS Medical College & SPMCHI, Jaipur
Vitamin K Deficiency
Incomplete carboxylation of coagulation proteins that do not form appropriate complexes with Ca&phospholip
BLEEDING
Hemorrhagic deficiency of newborn & infants(VKDB) Chronic diarrhoeas & malabsorption Liver disorders-hepatitis Warfarin and other drugs Prolonged antibiotics
VKDB Characteristics
Type Onset Details
h/o drug intake in mother Anticonv;antiTB,coumarins, salicylates , Poor nutrition:: Scalp,GI,ICH
Usually in breast fed babies::GI,Skin,nasal Common in breast fed rare in top fed and vit K rcd at birth..50%ICH,GI
Early
Within 24 hrs
2-7 days
Classical
Late
1-6 months
3.
4.
Age 2 days to 12 months Prolonged PT(>1.5 times) & PTTK Which normalised within 24 hrs of Vit K Absence of liver disease and/or septicemia
Aetiology of Bleeding
Aetiology VKDB Hemophilia ITP DIC Chronic liver diseases Afibrinogenemia OthersALL,MDS Percentage 40 15 13 12 04 01 15
Clinical presentation
Presentation
Skin GI Bleed Epistaxis Hemarthrosis ICH
VKDB
60%
Hemo
ITP
DIC
47.5%
6.6%
15.2%
Associated conditions
Exclusive BF...76% BF and Top milk feeding.10% BF+Diarrhoea+Antibiotics..14%
Aetiology of ICH
VKD ITP Hemophilia
Mortality in VKDB
Total mortality was 30% Only in cases with ICH
Maternal:cord blood ratio30:1 Hepatic content in neonate-25% of adult Human milk content(2-15ug/l)-25% cowmilk Colostrum rich in Vit K not given Sterile gut Plasma half-life-72 hrs Liver storage one month
Pregnant mothers
Tablets of vit k 20mg/day in the last month of pregnancy--Improve blood levels of newborn Improve Vit K content of breast milk Esp. in mothers taking medications Must be given routinely
Other infants
With diarrhoea of more than 1 week Antibiotics of more than one week All other infants presenting with bleeding Dose---1-2mg IM 2-4mg PO
IM /oral
Oral does not prevent late VKDB Repeated (monthly)doses