Vitamin K Deficiency

Vitamin K

On several occasions we have discussed significant gastrointestinal conditions that may present in the young child (Intussusception, Malrotation, Necrotizing Enterocolitis, and even Crohn’s Disease).  These conditions may present with blood being noticed in the stool (Meckel’s Diverticulum would also come to mind).  Distinguishing between these conditions and others that lead to bleeding can be difficult; however, there is one question that you should add to your list that may help pick up on a condition that is often forgotten about nowadays:

“Has your child received Vitamin K?”

 

Hemorrhagic Disease of the Newborn

  • Obviously, low Vitamin K levels will place the child at risk for bleeding.
  • Infants usually have low levels of Vitamin K.
    • Vitamin K does not cross the placenta well, so they don’t have stores of it at birth.
    • Vitamin K is not passed through breast milk well either, so they can’t get it readily after birth.
  • Generally divided into 3 categories:
    • Early onset – within first few hours of birth. Often due to maternal medications.
    • Classic onset – within first few days to week.
    • Late onset – 2 weeks to 2 months. More common in kids who did not get the IM Vitamin K.
      • Oral Vitamin K seems to work well for the early and classic, but not the Late onset.
  • Traditionally, we give a Vitamin K shot at birth to prevent hemorrhagic disease of the newborn.
    • Some patients will still be at risk – those who have absorption problems like:
      • Biliary Atresia
      • Celiac Disease
      • Cystic Fibrosis
    • Some mothers may be taking medications that interfere with Vitamin K stores or function:
      • Anti-seizure medications
      • Warfarin
      • Rifampin
      • Isoniazid
      • Barbiturates
    • Some parents have been electing to not give the Vitamin K
      • There was a report, that has since been debunked, that associated IM Vitamin K with childhood Leukemia.
      • Unfortunately, this has lead to kids being placed at risk of hemorrhagic disease (see article).

Is this a Big Deal?

  • In the USA, vitamin K deficiency bleeding varies from 0.25-1.7% in the first week of life in infants not receiving vitamin K prophylaxis.
  • The sites of bleeding are most commonly:
    • Umbilicus
    • Mucous membranes
    • GI tract
    • Circumcision
    • IV sites
  • Several bleeding may also occur:
    • Intracranial hemorrhage is uncommon in classic onset of vitamin K deficiency
    • Intracranial bleeding can be observed in more than 50% of infants with late-onset vitamin K deficiency bleeding.
    • This is responsible for nearly all mortality and long-term sequelae.

 

So, the next time you are evaluating an infant for bleeding at the umbilicus or blood in the stool… or blood from anywhere, ask the simple question of whether the child got his/her Vitamin K shot.  The answer may change your management and evaluation drastically.

References

American Academy of Pediatrics Committee on Fetus and Newborn. Controversies concerning vitamin K and the newborn. American Academy of Pediatrics Committee on Fetus and Newborn. Pediatrics. 2003 Jul;112(1 Pt 1):191-2. PMID: 12837888. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

You may also like...

Leave a Reply