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HEMORRHAGIC DISEASE OF NEWBORN FOLLOWUP
Category: Child Health
Abstract : hemorrhagic disease of newborn - Further Outpatient Care: Follow-up interval after discharge depends on the nature and severity of bleeding, hematocrit at discharge, and any neurologic complications. Mild VKDB that has been treated successfully can be monitored at routine newborn visits. Transfer: Infants with evidence of intracranial bleeding may require transfer to a level III nursery
hemorrhagic disease of newborn - Further Outpatient Care:
Follow-up interval after discharge depends on the nature and severity of bleeding, hematocrit at discharge, and any neurologic complications. Mild VKDB that has been treated successfully can be monitored at routine newborn visits.
Transfer: Infants with evidence of intracranial bleeding may require transfer to a level III nursery after stabilization with SC or IV vitamin K.
Deterrence/Prevention (hemorrhagic disease of newborn):
• IM vitamin K prophylaxis at birth is the standard of care in the United States.
• Commercial infant formulas in the United States contain supplemental vitamin K.
• These measures have served to make VKDB a rarity. However, parental refusal of prophylaxis and an increasing frequency of breastfeeding may cause a resurgence of VKDB in developed countries.
Complications (hemorrhagic disease of newborn):
• ICH is the primary serious complication of VKDB.
• Complications of treatment include anaphylactoid reactions to IV vitamin K, hyperbilirubinemia or hemolytic anemia after high-dose vitamin K, and hematomas at the site of injection if administered IM.
Prognosis (hemorrhagic disease of newborn):
In the absence of ICH, the prognosis for VKDB in an otherwise healthy infant is excellent. Prognosis after ICH depends on the extent and location of the hemorrhage. Long-term sequelae of ICH may include motor and intellectual deficits.
Medical/Legal Pitfalls (hemorrhagic disease of newborn):
• Most hospital nurseries include vitamin K administration in standing admission orders. A newborn's hospital chart should have a specific place for documentation of dose and administration. Failure to provide vitamin K at birth and subsequent bleeding presents a legal liability for physicians and hospitals. If parents refuse prophylaxis, document the discussion of the risks and benefits along with the parents' refusal in the chart.
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