Hemorrhagic disease of the newborn is a bleeding disorder that usually develops shortly after a baby is born.

Vitamin K deficiency bleeding; VKDB

A lack of vitamin K causes hemorrhagic disease of the newborn. Vitamin K plays an important role in blood clotting.

Babies usually have low levels of vitamin K for a variety of reasons. Vitamin K doesn't move easily across the placenta from the mother to the baby. As a result, a newborn doesn't have much vitamin K stored up at birth. Also, there isn't much vitamin K in breast milk.

Your baby may develop this condition if:

• A preventive vitamin K shot is not given at birth (if vitamin K is given by mouth instead of as a shot, it must be given more than once and it may not be as effective)
• You take certain anti-seizure or blood thinning drugs

The condition is grouped into three categories:

• Early onset hemorrhagic disease of the newborn is very rare. It occurs during the first hours of birth and certainly within 24 hours. Use of anti-seizure drugs or a blood thinner called coumadin during pregnancy is a common cause.
• Classic onset disease may be seen in breastfed infants who did not receive a vitamin K shot within the first week after birth. It is also rare.
• The late onset form is seen in infants older than 2 weeks up to 2 months old. It is more common in children who did not receive a vitamin K shot, and in those of Asian descent.

Newborns and infants with the following problems are more likely to develop this disorder:

• Alpha1-antitrypsin deficiency
• Biliary atresia
• Celiac disease
• Cystic fibrosis
• Diarrhea
• Hepatitis

The condition causes bleeding. The most common areas of bleeding include:

• A boy's penis if he has been circumcised
• Belly button area
• Gastrointestinal tract (may result in blood in the baby's bowel movements)
• Mucus membranes (such as the lining of the nose and mouth)
• Places where there has been a needle stick

There may also be:

• Blood in the urine
• Bruising
• Raised lump on the baby's head (suggesting bleeding underneath one of the skull bones)

Blood clotting tests will be done.

The diagnosis is confirmed if a vitamin K shot stops the bleeding and blood clotting time (prothrombin time) is within normal limits.

Vitamin K is given if bleeding occurs. Patients with severe bleeding may need blood transfusions.

The outlook tends to be worse for babies with late onset hemorrhagic disease than other forms. There is a higher rate of bleeding inside the skull (intracranial hemorrhage) associated with the late onset condition.

• Bleeding inside the skull (intracranial hemorrhage), with possible brain damage
• Death
• Severe bleeding

Call your doctor if your baby has any unexplained bleeding.

The American Academy of Pediatrics recommends giving every baby a shot of vitamin K immediately after birth. This practice has helped prevent the condition, which is now rare in the U.S.

The early onset form of the disease may be prevented by giving vitamin K shots to pregnant women who take anti-seizure medications.

Blood Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011.

American Academy of Pediatrics Committee on Fetus and Newborn. Policy statement: controversies concerning vitamin K and the newborn. Pediatrics. 2003;112:191-192.