Late hemorrhagic disease of the newborn

Background: Late hemorrhagic disease of the newborn (HDN) may occur without an underlying disorder or as a secondary manifestation of an underlying di sorder. It may be seen in fully breast-fed infants without a routine supple mentation of vitamin K. In contrast, idiopathic late HDN is defined as HDN without the presence of any risk factor, such as gastroenteritis or use of antibiotics. Severe hemorrhagic symptoms frequently occur. Methods: Between March 1987 and May 1997, we evaluated 15 infants with idio pathic late HDN, who were diagnosed by detailed history, physical examinati on and laboratory findings. Results: The age (mean +/- SD) at onset of symptoms was 62.4 +/- 33.9 days. All children were breast-fed infants and were born at term from healthy mo thers. The delivery histories were uneventful. There was no history of vita min K administration at birth. Signs and symptoms of the patients were conv ulsions (47%), feeding intolerance and poor sucking (47%), irritability (33 %) and pallor (20%). In physical examination; there was bulging or full fon tanel in 10 patients (67%), diminished or absent neonatal reflexes in nine patients (60%) and ecchymosis in three patients (20%). Before administratio n of vitamin K, prothrombin time (PT) was 76.1 +/- 43.0 s and pal tial thro mboplastin time (PTT) was 123.4 +/- 68.8 s. Six to 12 h after administratio n of vitamin K, PT was 15.6 +/- 1.8 s and PTT was 33.4 +/- 1.0 s. Neurologi c, gastrointestinal and skin hemorrhagic findings were found in 11 (73%), t hree (20%) and three patients (20%), respectively. There were both neurolog ic and skin bleeding symptoms in two patients. The mortality in the present study was 33%. Conclusions: Late HDN results in severe hemorrhage, especially hemorrhage i n the central nervous system. Administration of vitamin K (1 mg, i.m.) at t he birth can reduce these severe complications.