Original Article

Intracerebral Hemorrhage due to Hemorrhagic Disease of the Newborn and Failure to Administer Vitamin K at Birth

Authors: Dena Hubbard, MD, Joseph D. Tobias, MD

Abstract

In infants, intracerebral hemorrhage (ICH) is most likely the result of trauma or disturbances of coagulation function. Routine and standard care of the newborn includes the administration of vitamin K to prevent hemorrhagic disease of the newborn. We present two infants, the products of home deliveries, who did not receive vitamin K at birth. Both infants developed ICH at 5 weeks of age and presented with signs and symptoms of increased IC pressure. In both cases, recombinant factor VIIa was administered to correct coagulation function and allow immediate surgical intervention which included craniotomy and hematoma evacuation in one patient and placement of a ventriculostomy in the other to treat increased IC pressure. Despite this therapy, both infants were left with severe neurologic sequelae. These two cases illustrate that hemorrhagic disease of the newborn can occur when prophylactic vitamin K is not administered and that it can have devastating consequences. Given these issues, the routine administration of vitamin K to all infants is mandatory and should not be considered optional.


Key Points


* Hemorrhagic disease of the newborn can occur when prophylactic vitamin K is not administered.


* The consequences of hemorrhagic disease in the newborn can lead to devastating consequences.


* The routine administration of vitamin K to all infants should be mandatory and is currently recommended by the American Academy of Pediatrics.


* Intracerebral hemorrhage (ICH) in adults is primarily related to prolonged hypertension, amyloid angiopathy, or arteriovenous malformations, whereas ICH in infants is more likely to be the result of trauma or disturbances in coagulation function.

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