What is Hemorrhagic Disease of the Newborn?
During the first 4-7 days after birth, there is a decrease in the concentration of coagulation factors in the plasma.
Early colostrum feeding can significantly alleviate this depression of K-vitamin-dependent factors. One of the most important roles in the elimination of the violation in question is played by the colonization of the child’s gut with normal microflora producing vitamin K. Due to this, by the end of the 2nd week of life, the deficiency of K-vitamin-dependent factors is completely eliminated in most children.
More often, deficiency of K-vitamin-dependent factors in newborns does not lead to bleeding.
Forms of the disease that have a pronounced clinical picture are more often observed with prematurity.
Diseases of the mother and her reception during pregnancy of drugs that promote K-hypovitaminosis, as well as obstetric pathology (fetal asphyxia, traumatic labor) contribute to the development of hemorrhagic disease of the newborn. It is also aggravated by the enteropathy of the newborn, the prescription of antibiotics for pneumonia, sepsis and other diseases.
Symptoms of Hemorrhagic Disease of the Newborn
A typical manifestation of the disease is bleeding that occurs between the 2nd and 5th days of life and then disappears within 2-3 days. Gastrointestinal bleeding is most common. Often there are also umbilical and nasal bleeding, multiple hemorrhages in the skin and subcutaneous tissue. In case of untimely or insufficient treatment, the number of lethal outcomes reaches 30%, with almost all patients dying within the first 2-3 days after the onset of hemorrhagic events, and some within a few hours.
Death is more often associated with large acute hemorrhage or with hemorrhages in the brain, less often with bleeding into the internal organs (kidneys, liver, heart muscle).
A comatose state can also be caused by hemorrhages in the adrenal glands with the development of acute adrenal insufficiency.
The prognosis is difficult because of the possibility of rapid transformation of the lungs of the initial hemorrhages into extremely heavy ones, and also because of the sudden onset of hemorrhages in the brain and other vital organs.
Diagnosis of Neonatal Hemorrhagic Disease
The characteristic periods of development of the pathological process, its frequent connection with prematurity, the presence of bleeding in the mother of the child indirectly indicate the possibility of the development of hemorrhagic disease of the newborn.
The diagnosis is confirmed by the identification of violations in the indications of prothrombin and autocoagulation tests or other common coagulation samples (activated partial thromboplastin time).
To establish the correct diagnosis, it is necessary to exclude other types of bleeding characteristic of the neonatal period. These include: disseminated intravascular coagulation syndrome, hereditary deficiency of certain coagulation factors (especially factors V, VII and XIII, which are pronounced bleeding in the newborn), thrombocytopenia of the newborn.
Treatment of Hemorrhagic Neonatal Disease
Due to the fact that this pathology often has a rapid progression of the disease, therapy should have an immediate effect. This is achieved by donor plasma transfusion (about 50 ml). Intravenous injections of K-vitamin-dependent factors (PPSB) should be used only for specific reasons, since these drugs easily provoke life-threatening, disseminated intravascular coagulation and thrombosis in newborns.
At the same time, 3-5 mg of Vicasol is administered intravenously. Treatment with Vicasol alone is not sufficiently reliable, since the effect occurs at best after 6 hours. In this situation, transfusion therapy becomes the only method of emergency treatment.
Large doses of vitamin K should not be prescribed for hemolytic disease of newborns, as this may increase the destruction of red blood cells.