Late Haemorrhagic Disease of Newborn: Can It be Prevented by Changing Prophylaxis Policy?

Main Article Content

K. R. Sachin
H. Ramesh
K. A. Chaya


Background: Vitamin K deficiency can cause severe haemorrhage in the newborn and is an important cause of infant morbidity and mortality. HDN can be classified according to the time of presentation after birth into early (0–24 hours), classical (1–14 days) and late (2–12 weeks) HDN. Late HDN, which presents after the first week of life, mainly manifests as intracranial haemorrhage, depending upon the site and amount of bleeding, it either results in mortality or life long sequelae in the form of cerebral palsy and scar epilepsy with or without cognitive impairment.

Objective: To determine the frequency of ICH about vitamin K deficiency and outcome in infants aged 2 to 24 weeks.

Materials and Methods: From 1 September 2017 to 30 September 2019 we retrieved the retrospective data of 8 patients with late HDN admitted to Bapuji Child Health Institute and Chigateri Government General Hospital, Davangere.

Results: Six of eight cases with late HDN had an intracranial haemorrhage, of whom 5 patients died (62%), one ended up with neurological sequelae (12%) and 2 cases had an extracranial bleed. Out of these 8 cases, 5 had not received vitamin K at birth.

Conclusion: For neonates on strict breastfeeding, despite some with vitamin K prophylaxis, some patients still may suffer from intracranial and extracranial bleeding due to late HDN. Therefore, a change in strategy in the form of making the paediatricians and Anganwadi workers working in subcenters to give vitamin K, who have been vaccinating the babies after birth, would increase the vitamin K coverage.

Late haemorrhagic disease, newborn, prevalence, prophylaxis.

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How to Cite
Sachin, K. R., Ramesh, H., & Chaya, K. A. (2020). Late Haemorrhagic Disease of Newborn: Can It be Prevented by Changing Prophylaxis Policy?. Asian Journal of Pediatric Research, 3(1), 14-19.
Original Research Article


Williams MD, Chalmers EA, Gibson BE. The investigation and management of neonatal haemostasis and thrombosis. Br J. Haematol. 2002;119(2):295-309.

Townsend CW. The haemorrhagic disease of the newborn. Arch Paediatr. 1894;11: 559-565.

Lehmann J. Vitamin K as a prophylactic in 13,000 infants. Lancet. 1944;243(6294): 493-494.

Schulte R, Jordan LC, Morad A, Naftel RP, Wellons III JC, Sidonio R. Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth. Pediatric Neurology. 2014;50(6):564-568.

Karaci M, Toroslu E, Karsli T, Kanber Y, Uysal S, Albayrak D. Intracranial haemorrhage due to late-onset vitamin K deficiency. HK J. Paediatr. 2015;20:80-5.

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.

Sutor AH, von Kries R, Cornelissen EA, McNinch AW, Andrew M. Vitamin K deficiency bleeding (VKDB) in infancy: On behalf of the ISTH Pediatric/Perinatal Subcommittee. Thromb Haemost. 1999;81(3):456-461.

American Academy of Pediatrics, Committee on Fetus and Newborn. Controversies concerning vitamin K and the newborn. Pediatrics. 2003;112(1):191-192.

Centers for Disease Control and Prevention (CDC). Notes from the field: Late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxise Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(45):901-902.

von Kries R, Hachmeister A, Göbel U. Oral mixed micellar vitamin K for prevention of late vitamin K deficiency bleeding. Arch Dis Child Fetal Neonatal Ed. 2003;88(2):F109-F112.

Ijland MM, Pereira RR, Cornelissen EA. Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005: Evaluation of the current guideline. Eur J Pediatr. 2008;167(2):165-169.

Takahashi D, Shirahata A, Itoh S, Takahashi Y, Nishiguchi T, Matsuda Y. Vitamin K prophylaxis and late vitamin K deficiency bleeding in infants: Fifth nationwide survey in Japan. Pediatr Int. 2011;53(6):897-901.

Busfield A, Samuel R, McNinch A, Tripp JH. Vitamin K deficiency bleeding after NICE guidance and withdrawal of Konakion neonatal: British Paediatric Surveillance Unit study, 2006-2008. Arch Dis Child. 2013;98(1):41-47.

Laubscher B, Bänziger O, Schubiger G. Prevention of vitamin K deficiency bleeding with three oral mixed micellar phylloquinone doses: Results of a 6-year (2005-2011) surveillance in Switzerland. Eur J Pediatr. 2013;172(3):357-360.

Loughnan PM, McDougall PN. Epidemiology of late onset haemorrhagic disease: A pooled data analysis. J Paediatr Child Health. 1993;29(3):177-181.

Busfield A, McNinch A, Tripp J. Neonatal vitamin K prophylaxis in Great Britain and Ireland: The impact of perceived risk and product licensing on effectiveness. Arch Dis Child. 2007;92:754-758.

Sutor AH, Kunzer W. Time interval between vitamin K administration and effective hemostasis. In: Suzuki S, Hathaway WE, Bonnar J, Sutor AH, Eds. Perinatal thrombosis and haemostasis. Berlin, Heidelberg, New York, London, Tokyo, Hong Kong: Springer; 1991.

Wariyar U, Hilton S, Pagan J, Tin W, Hey E. Six years’ experience of prophylactic oral vitamin K. Arch Dis Child Fetal Neonatal. 2000;82:64–8.

Yncecik F, Hergeuner MO, Sangun EO, Ozcan KE, Altunbaþak P. Intracranial haemorrhage related with late haemorrhagic disease of the new born. Erciyes Med J. 2007;29:v31–4.

Pooni PA, Singh D, Singh H, Jain BK. Intracranial haemorrhage in late hemorrhagic disease of the newborn. Indian Pediatr. 2003;40:243–8.

Al Ghwass MM, Ahmed D. Prevalence and predictors of 6-month exclusive breastfeeding in a rural area in Egypt. Breastfeed Med. 2011;6:191–6.

Lane PA, Hathaway WME. Vitamin K in infancy. J Pediatr. 1985;106:351–9.

Tasker RC. Head and spinal cord trauma. In: Nichols DG, Editor. Roger’s Textbook of Pediatric Intensive Care, 4th Ed. Baltimore, MD: Lippincott Williams & Wilkins. 2008;888–911.

Yoshikawa H, Yamazaki S, Watanabe T, Abe T. Vitamin K deficiency in severely disabled children. J Child Neurol. 2003;18:93–7.

Aydinli N, Citak A, Caliskan M, Karabocuoglu M, Baysal S, Ozmen M. Vitamin K deficiency: Late onset intracranial haemorrhage. Eur J Paediatr Neurol. 1998;2:199–203.

Pirinccioglu AG, Gurkan F, Bosna MK, Acemoglu H, Davutoglu M. Intracranial hemorrhage: Clinical and demographic features of patients with late hemorrhagic disease. Pediatr Int. 2011;53:68–71.