HEMORRHAGIC DISEASE IN A NEW BORN

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cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04a00840erlcjm.gif"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>pediatryPART I</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="pediatryPART I"><U><B>home</B></U></A></div> <div> <A HREF="id31.htm" TARGET="_top" TITLE="PEDIATRIC PEARLS FOR THE USMLE"><U>PEDIATRIC PEARLS FOR THE USMLE</U></A>   |   <A HREF="id48.htm" TARGET="_top" TITLE="pearls pediatry 2"><U>pearls pediatry 2</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="general"><U>general</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="appendiceal colic"><U>appendiceal colic</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="ATOPIC DERMATITIS"><U>ATOPIC DERMATITIS</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Stuttering"><U>Stuttering</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="enuresis"><U>enuresis</U></A>   |   <A HREF="id21.htm" 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Problems</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Chronic Abdominal Pain in Childhood: Dia"><U><B>Chronic Abdominal Pain in Childhood: Diagnosis and Management </B></U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="child devlpt"><U><B>child devlpt</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="ACETAMINOPHEN OVERDOSE"><U><B>ACETAMINOPHEN OVERDOSE</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="SHAKEN BABY SYNDROME"><U><B>SHAKEN BABY SYNDROME</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="NEONATAL JAUNDICE (HYPERBILIRUBINEMIA)"><U><B>NEONATAL JAUNDICE (HYPERBILIRUBINEMIA)</B></U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="Hyaline Membrane Disease (Respiratory Di"><U><B>Hyaline Membrane Disease (Respiratory Distress Syndrome) (HMD) (RDS</B></U></A></div> <div> <A HREF="id30.htm" TARGET="_top" TITLE="infectious disease"><U><B>infectious disease</B></U></A></div> <div> <B>HEMORRHAGIC DISEASE IN A NEW BORN</B></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="OPTIC NERVE GLIOMA"><U><B>OPTIC NERVE GLIOMA</B></U></A></div> <div> <A HREF="id36.htm" TARGET="_top" TITLE="New Born Assessment "><U><B>New Born Assessment </B></U></A></div> <div> <A HREF="id38.htm" TARGET="_top" TITLE="laryngomalacia"><U><B>laryngomalacia</B></U></A></div> <div> <A HREF="id39.htm" TARGET="_top" TITLE="CRANIOSYNOSTOSIS "><U><B>CRANIOSYNOSTOSIS </B></U></A></div> <div> <A HREF="id40.htm" TARGET="_top" TITLE="DANDYWALKER MALFORMATION "><U><B>DANDY-WALKER MALFORMATION </B></U></A></div> <div> <A HREF="id41.htm" TARGET="_top" TITLE="DEJERINESOTTAS DISEASE "><U><B>DEJERINE-SOTTAS DISEASE </B></U></A></div> <div> <A HREF="id42.htm" TARGET="_top" TITLE="DOWN SYNDROME "><U><B>DOWN SYNDROME </B></U></A></div> <div> <A HREF="id43.htm" TARGET="_top" TITLE="Respiratory Syncytial Virus (RSV)"><U><B>Respiratory Syncytial Virus (RSV)</B></U></A></div> <div> <A HREF="id44.htm" TARGET="_top" TITLE="FABRY DISEASE "><U><B>FABRY DISEASE </B></U></A></div> <div> <A HREF="id45.htm" TARGET="_top" TITLE="PRADERWILLI SYNDROME "><U><B>PRADER-WILLI SYNDROME </B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="new born fun"><U><B>new born fun</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="RETT SYNDROME "><U><B>RETT SYNDROME </B></U></A></div> <div> <A HREF="id47.htm" TARGET="_top" TITLE="Alexander Disease"><U><B>Alexander Disease</B></U></A></div> <div> <A HREF="id49.htm" TARGET="_top" TITLE="leukemia"><U><B>leukemia</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> HEMORRHAGIC DISEASE IN A NEW BORN</div> <div> <B><U>HEMORRHAGIC DISEASE OF THE NEWBORN </U></B></div> <bR> <bR> <div> Hemorrhagic disease of the newborn is a self-limited bleeding disorder resulting from a <B>deficiency of the coagulation factors dependent upon vitamin K</B>. </div> <bR> <div> <B>Most normal infants are born with deficient vitamin K stores,</B> but only a small minority develop the generalized bleeding diathesis. </div> <bR> <bR> <div> Before the routine use of prophylactic vitamin K, as many as 1% of neonates developed <I><B>bruising, cephalohematomas, gastrointestinal and umbilical </B></I>hemorrhage, and <I><B>oozing from puncture</B></I> sites at 2-3 days of age.</div> <bR> <div>  Marked prolongation of the prothrombin and partial thromboplastin times was demonstrated to be due to profound <B>deficiencies of Factors II,VII, IX, </B>and X. </div> <div> <B>The levels of these Factors are about 50% of normal in umbilical cord blood and decline rapidly to reach a nader at 48-72 hours of life.</B> </div> <bR> <div> Thereafter the levels of these factors slowly increase but remain below adult values for several weeks. </div> <bR> <div> <I>Studies have confirmed earlier observations that hemorrhagic disease of the newborn occurs primarily in breast-fed infants</I>.</div> <bR> <div>  Human breast milk has far less vitamin K (only 15mcg/L) than cow's milk (60mcg/L). </div> <div> Therefore, it supplies an insufficient quantity to the infant during the first days of life. </div> <bR> <div> In most instances hemorrhagic manifestations become evident on the second to third day of life. </div> <div> Melena, bleeding from the navel, and hematuria are frequent signs. </div> <div> Severe intracranial hemorrhage may occur suddenly and result in death or severe CNS dysfunction.</div> <div>  </div> <div> A recent survey in Japan reported an incidence of vitamin k deficiency of 1 in 1700 breast-fed infants and 1 in 4500 unselected infants, with 81% of these infants having intracranial hemorrhages. </div> <div> Several recent reports emphasize a late form of hemorrhagic disease occurring at 4-6 weeks of age, often manifest as intracranial bleeding, and occurring exclusively in breast-fed infants who did not receive vitamin K as newborns or have fat malabsorption. </div> <bR> <div> Laboratory studies typically show a markedly elevated PT and PTT with depressed levels of vitamin K dependent factors. </div> <bR> <div> Factor VIII, Factor V, platelet count and fibrinogen levels are within normal limits. </div> <bR> <div> In overt hemorrhagic disease 1mg of vitamin K should be a given IV or IM. Decreased hemorrhage and return of normal Factor levels usually occurs within 2-3 hours. If intracranial or other serious hemorrhage has occurred, an infusion of 10-15ml/k of fresh plasma is indicated. </div> <bR> <div> The usual recommended dose of 1mg of vitamin K oxide routinely given to newborns is in great excess of the 25mcg actually required to promote gamma carboxylation of the precursor clotting proteins. Intestinal malabsorption of fats and prolonged administration of broad spectrum antibiotics may result in vitamin deficiency, and cystic fibrosis and biliary atresia may be complicated by disorders of the prothrombin complex.</div> <bR> <div>  Although the potential risks of coumarin anticoagulants are well known, anticonvulsants, especially hydantoin derivitives, also possess this activity. </div> <bR> <div> Thus, vitamin K supplment should be given in late pregnancy and labor to all women receiving anticonvulsants, and the newborns of these women should have a prothrombin time assay performed and additional parental vitamin K administered shortly after birth.</div> <bR> <div>  Mothers given oral supplements of 0.5 - 3.omg vitamin K per day produce substantially increased breast milk vitamin K levels. </div> <bR> </td> </tr></table></body>