Case 1: A Term Neonate with Conjunctival Hemorrhage, Ecchymoses, and Umbilical Hematoma

Abstract

A term male neonate with a birthweight of 3,350 g is born via emergency cesarean delivery for the indication of abruptio placenta. The mother is a booked and immunized, gravida 4, para 3 woman with normal platelet counts and an uneventful antenatal course. The neonate was conceived spontaneously in a nonconsanguineous marriage and the family history is nonsignificant. The neonate has a normal transition after birth, is given a 1-mg intramuscular injection of vitamin K in the right thigh; he rooms in with the mother and is exclusively breastfed. Around 48 hours after birth, the neonate is noted to have bilateral conjunctival hemorrhages, ecchymoses on the face and trunk/back, boggy swelling over the scalp, and umbilical cord hematoma (Figs 1, 2 and 3). The neonate is noted to have pallor, but his vital sign parameters are normal (heart rate 140 beats/min, respiratory rate 40 breaths/min, temperature 98.6oF [37oC], capillary refill time <2 seconds, and oxygen saturation 96% in room air). There is no history of hematemesis, hematuria, or bleeding per rectum. Figure 1. Conjunctival hemorrhage. Figure 2. Ecchymoses on the face. Figure 3. Umbilical hematoma. ### Progression With a provisional clinical diagnosis of vitamin K deficiency bleeding (VKDB), the neonate is given a repeat 1-mg intramuscular injection of vitamin K and evaluated for the cause of the bleeding manifestations. Laboratory investigations reveal a hemoglobin of 6.4 …