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.
* 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.
1. Qureshi AI, Tuhrim S, Borderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med2001;344:1450–1460.
2. Mayer SA. Ultra-early hemostatic therapy for intracerebral hemorrhage. Stroke 2003;34:224–229.
3. Chen ST, Chen SD, Hsu CY, et al. Progression of hypertensive intracerebral hemorrhage. Neurology1989;39:1509–1514.
4. Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn: breast feeding as a necessary factor in pathogenesis. Am J Dis Child 1967;113:524–533.
5. Aballi AJ, de Lamercus S. Coagulation changes in the neonatal period and in early infancy. Pediatr Clin North Am 1962;9:785–812.
6. Haroon Y, Shearer MJ, Rahim S, et al. The content of phylloquinone (vitamin K1) in human milk, cow’s milk and infant formula foods determined by high-performance liquid chromatography. J Nutr1982;112:1105–1117.
7. Townsend CW. The haemorrhagic disease of the newborn. Arch Paediatr 1894;11:559–562.
8. Dam CPH. Cholesterinstoffwechsel in Huhnereierin und Huhnchen. Biochem Zeitschr 1929;215:475–478.
9. Waddell WW, Guerry D. The role of vitamin K in the etiology, prevention, and treatment of hemorrhage in the newborn infant: part II J Pediatr 1939;15:802–811.
10. American Academy of Pediatrics Committee on Nutrition. Vitamin K compounds and the water-soluble analogues: use in therapy and prophylaxis in pediatrics. Pediatrics 1961;28:501–507.
11. Kugelmass IN. The management of hemorrhagic problems in infant and childhood. JAMA1932;99:895–897.
12. Clifford SH. Hemorrhagic disease of the newborn: a critical consideration. J Pediatr 1941;18:333–335.
13. Lucey JF, Dolan RG. Hyperbilirubinemia of newborn infants associated with the parenteral administration of a vitamin K analogue to the mothers. Pediatrics 1959;23:553–560.
14. Golding J, Paterson M, Kinlen LJ. Factors associated with childhood cancer in a national cohort study. Br J Cancer 1990;62:304–308.
15. Golding J, Greenwood R, Birmingham K, et al. Childhood cancer, intramuscular vitamin K, and pethidine given during labour. BMJ 1992;305:341–346.
16. Ross JA, Davies SM. Vitamin K prophylaxis and childhood cancer. Med Pediatr Oncol 2000;34:434–437.
17. Draper GJ, Stiller CA. Intramuscular vitamin K and childhood cancer. BMJ 1992;305:709–711.
18. American Academy of Pediatrics, Vitamin K Ad Hoc Task Force. Controversies concerning vitamin K and the newborn (revised). Pediatrics 2003;112:191–192.
19. Cornelissen EA, Kollee LA, De Abreau RA, et al. Effects of oral and intramuscular vitamin K prophylaxis on vitamin K1, PIVKA-II, and clotting factors in breast fed infants. Arch Dis Child1992;67:1250–1254.
20. Cornelissen M, Von Kries R, Loughnan P, et al. Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K. Eur J Pediatr 1997;156:126–130.
21. Greer FR, Marshall SP, Severson RR, et al. A new mixed micellar preparation for oral vitamin K prophylaxis: randomized controlled comparison with an intramuscular formulation in breastfed infants.Arch Dis Child 1998;79:300–305.
22. Cote CJ, Drop LJ, Hoaglin DC, et al. Ionized hypocalcemia after fresh frozen plasma administration to thermally injured children: effects of infusion rate, duration, and treatment with calcium chloride.Anesth Analg 1988;67:152–160.
23. Tobias JD, Groeper K, Berkenbosch JW. Preliminary experience with the use of recombinant factor VIIa to treat coagulation disturbances in pediatric patients. South Med J 2003;96:12–16.
24. Tobias JD. Recombinant factor VIIa in pediatric patients. TATM 2003;5:40–44.
25. Mayer SA, Brun NC, Begtrup K, et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005;352:777–785.