Late Onset Vitamin Research Articles

Поздняя витамин-K-зависимая коагулопатия у пациента с гемофилией A: описание клинического наблюдения

Late-onset Vitamin K deficiency bleeding is a rare disease that develops as a manifestation of Vitamin K deficiency in children from 8 days to 6 months of age with an incidence of 4.4 to 72 cases per 100,000 newborns in countries where prophylaxis with Vitamin K1 preparations is not carried out and of 0 to 3 cases per 100,000 in countries where prophylaxis is carried out. In Russia the prophylaxis is carried out using menadione sodium bisulfite, a Vitamin K3 preparation, the effectiveness of which is questionable. One of the specific manifestations of the late-onset Vitamin K deficiency bleeding is intracranial hemorrhage (ICH), which occurs in more than half of all cases of the disease. This disease has not been described in patients with hemophilia A until now. Authors represent a clinical case report of the development of the late-onset Vitamin K deficiency bleeding by a massive ICH in a patient with hemophilia A.

Late-onset vitamin K deficiency bleeding: a preventable yet prevailing cause of intracranial hemorrhage in young infants—an ambispective descriptive study

BackgroundVitamin K deficiency bleeding (VKDB) may present as intracranial hemorrhage (ICH) in young infants, which results in severe morbidity and mortality. This study aims to determine the clinical presentation, risk factors, and outcome of children with VKDB.MethodsThis was an ambispective descriptive study conducted from January 2015 to August 2023 in southern India. Infants from 8 days to 6 months of age, diagnosed as VKDB based on bleeding with elevated PIVKA (protein induced by vitamin K absence) and prolonged prothrombin time, which is rapidly corrected 24 h after administration of vitamin K, were included. Infants with bleeding due to other causes, such as inherited clotting factor deficiency, cholestasis, and sepsis, were excluded. A structured data collection proforma was used to collect data.ResultsOut of 62 cases, 28 were excluded due to various causes, and 34 were analyzed. The median age at symptom onset was 54 days, and males were 22 (64.7%). Term gestation was 25 (73.5%), and low birth weight was 13 (38.2%), and 8 (23.5%) required NICU admission. All received vitamin K prophylaxis at birth. Thirty-three (97%) were exclusively breastfed. The most common presenting complaints were poor activity and convulsion. A total of 97% of children had ICH, and 5 (14.7%) had skin bleed. Twenty-three (67.6%) infants had complete recovery, 6 (17.6%) had sequelae (2 had hemiparesis, 2 monoparesis, and 2 quadriplegia), and 5 (14.7%) children expired.ConclusionVitamin K deficiency commonly presents as intracranial hemorrhage in infants. Exclusive breastfeeding is a significant risk factor for vitamin K deficiency, followed by low birth weight and prematurity.

Cerebral Hemorrhage with Edema in A Five-Week-Old: A Case of Late-Onset Vitamin K Deficiency Bleeding, Rare Diagnosis in Resource-Limited Settings

Introduction: Vitamin K deficiency bleeding (VKDB) is a term that describes the condition of hemorrhagic disorders in newborns. Late-onset VKDB occurs between the second week and sixth month of life. Intracranial hemorrhage often occurs in cases of late-onset VKDB and can cause 14-20% mortality and 40% long-term neurological morbidity, so it is important to treat patients until they are stable, especially with limited health facilities. Case Report: A baby boy aged 1 month 8 days was brought by his parents to RSUD Deli Serdang Lubuk Pakam with the chief complaint of an enlarged stomach, accompanied by paleness, weakness, convulsions, and altered consciousness. A midwife assisted the delivery with unknown history of immediate vitamin K injection after birth. We diagnosed the patient with VKDB according to the clinical symptoms. The head CT scan showed subdural and subarachnoid hemorrhage with cerebral edema. We transfused the patient with Packed Red Cells and Fresh Frozen Plasma 20 cc/12 hours 5 times, administered Vitamin K injection 3 mg/IM for 3 days, and other supportive therapy. The patient's condition improved within the third day of hospitalization with recovered consciousness and was transferred to the referral hospital. Discussion: The key feature of late-onset VKDB is the incidence of ICH in 30-88% of patients, leading to a high incidence of mortality. This study highlights the importance of prompt, and early treatment of VKDB with proper history taking, clinical examination, and relevant investigations to reduce morbidity and mortality. Conclusion: In conclusion, secondary late-onset PDVC is more common than the primary subtype, and late-onset PDVC is still an important cause of morbidity and mortality in developing countries including Indonesia, where vitamin K prophylaxis is not routinely performed

A Case of Late-Onset Vitamin K Deficiency Bleeding in an Exclusively Breastfed Infant Emphasizing the Need for Revision of Vitamin K Prophylaxis Policy

A 4-month-old male child presented with a history of seizure and vomiting. There was no history of fever, fall, or any other trauma. On examination, there was anisocoria, and anterior fontanelle was bulging and nonpulsating. Computerized tomography revealed an acute on chronic bilateral subdural hematoma (left > right) with a midline shift. He had no relevant past or family history suggestive of any bleeding disorder. Blood investigations revealed anemia with prolonged prothrombin time (PT)/international normalized ratio/and activated partial thromboplastin time (APTT). Mixing study was done and it showed a correction with pooled normal plasma. The possibility of coagulation factor deficiency was confirmed. Further, mixing studies and factor assays revealed normal levels of fibrinogen and Factor VIII, with a reduced level of Factor IX. Since both PT and APTT were prolonged and Factor IX level was low, a deficiency of Vitamin K-dependent coagulation factors was suspected. The child was immediately given intravenous Vitamin K injection. The diagnosis of Vitamin K deficiency bleeding (VKDB) was confirmed by protein induced by Vitamin K absence testing. Unfortunately, the child succumbed to the complications of the intracranial bleed.

Late onset Vitamin K deficiency bleeding disorder presenting as nodular purpura in a 3-month-old exclusively breastfed infant

Late onset Vitamin K deficiency bleeding disorder presenting as nodular purpura in a 3-month-old exclusively breastfed infant

Vitamin K deficiency: a case report and review of current guidelines

BackgroundVitamin K, a fat soluble vitamin, is a necessary cofactor for the activation of coagulation factors II, VII, IX, X, and protein C and S. In neonatal period, vitamin K deficiency may lead to Vitamin K Deficiency Bleeding (VKDB).Case presentationWe present the case of a 2 months and 20 days Caucasian male, presented for bleeding from the injections sites of vaccines. At birth oral vitamin K prophylaxis was administered. Neonatal period was normal. He was exclusively breastfed and received a daily oral supplementation with 25 μg of vitamin K. A late onset vitamin K deficiency bleeding was suspected. Intravenous Vitamin K was administered with complete recovery.ConclusionsNevertheless the oral prophylaxis, our case developed a VKDB: it is necessary to revise the current guidelines in order to standardize timing and dosage in different clinical conditions.

Reasons for Refusal of Newborn Vitamin K Prophylaxis: Implications for Management and Education.

The American Academy of Pediatrics recommends intramuscular (IM) vitamin K prophylaxis for all newborns to prevent vitamin K deficiency bleeding. Given the serious implications of late-onset vitamin K deficiency bleeding, our objective was to examine factors influencing parents' decisions to refuse IM vitamin K prophylaxis. Parents intending to refuse IM vitamin K prophylaxis at delivery were recruited from 5 community hospitals, 1 academic medical center, and 2 birthing centers in a single Southeastern state. Participants completed a written survey including demographics, birth and parenting decisions (eg, breastfeeding), and open-ended questions about their vitamin K information sources, concerns, and knowledge of risks. The incidence of refusal was highest at the birthing centers. Fifty-four parents intending to refuse IM vitamin K completed the survey. Most were white (78%), over age 30 (57%), and college graduates (65%). All reported intention to exclusively breastfeed. Most refused hepatitis B vaccine (90%) and erythromycin eye ointment (77%). The most common source of information was the Internet (70%). Concerns included synthetic or toxic ingredients (37%), excessive dose (28%), and side effects (24%). Eighty-three percent of parents reported awareness of risks associated with vitamin K refusal. However, only 6 parents (11%) decided to accept IM prophylaxis. This study provides an understanding of the concerns, mindset, and information sources used by parents refusing IM vitamin K. Educating parents about the importance of IM prophylaxis should begin in the prenatal period and must address concerns parents identify on the Internet.

Another Disease Re-emerges Due to Parental Shot Refusal: Case Report of a Fussy Infant with Blood in Stool

BackgroundInfants may present to the emergency department (ED) with vague complaints worrisome to parents and may initially appear well, despite serious underlying pathology. Whereas sepsis and nonaccidental trauma are high on most providers' diagnostic considerations, we report a case representative of a worrisome trend secondary to the refusal of parenteral vitamin K at birth leading to significant neurologic sequelae. Case ReportA 10-week-old boy presented to the ED with gradual increase in fussiness for 2 weeks and new onset of blood flecks in the stool on the day of presentation. Careful physical examination revealed a pale-appearing infant, leading to diagnostic evaluation demonstrating profound anemia and intracranial bleeding. The patient was diagnosed with late-onset vitamin K-deficient bleeding (VKDB) secondary to parental refusal of the vitamin K shot at birth.Why Should Emergency Physicians be Aware of This? Emergency Medicine providers need to add this serious treatable disease into their diagnostic consideration for fussy infants, infants with unexplained bruising or bleeding, or infants with new-onset seizures. Rapid identification of VKDB can lead to prompt treatment and halt the rapid progression of symptoms. Emergency Medicine providers should ask all parents if their infant received parenteral vitamin K in the newborn period, especially if they are exclusively breastfed or born out of the hospital.

Intracranial haemorrhage is linked to late onset vitamin K deficiency in infants aged 2–24 weeks

Late vitamin K deficiency bleeding (VKDB) can be serious and manifest as early onset intracranial haemorrhage (ICH). This study aimed to determine the frequency of ICH in relation to vitamin K deficiency and the outcome in infants aged two to 24weeks. A hospital-based study was conducted in two main tertiary hospitals in Cairo, Egypt, from May 2011 to May 2012 with 40 patients with ICH and 50 age-matched controls without ICH. Forty patients with ICH were recruited, 19 were excluded for clinical reasons and the remaining 21 had a significantly low vitamin K level. Exclusive breast feeding (81% of patients), diarrhoea lasting more than 1week (38.1%) and antibiotic consumption within a week before the development of ICH (57.1%) were more common in the patients than in the control group (p value>0.05, <0.01 and <0.01, respectively). A high frequency of ICH due to late VKDB was reported in Egyptian infants aged two to 24weeks, with poorer outcomes than international studies. A national survey is required to evaluate the timing and protective value of a second booster vitamin K dose to reduce ICH, especially in high-risk patients in this age group.

Rise in Late Onset Vitamin K Deficiency Bleeding in Young Infants Because of Omission or Refusal of Prophylaxis at Birth

BackgroundNewborns are at risk for vitamin K deficiency and subsequent bleeding unless supplemented at birth. Vitamin K deficiency bleeding is an acquired coagulopathy in newborn infants because of accumulation of inactive vitamin K–dependent coagulation factors, which leads to an increased bleeding tendency. Supplementation of vitamin K at birth has been recommended in the United States since 1961 and successfully reduced the risk of major bleeding. Refusal or omission of vitamin K prophylaxis is increasing and puts newborn infants at risk for life-threatening bleeding. PatientsOver an eight month period, we encountered seven infants with confirmed vitamin K deficiency; five of these patients developed vitamin K deficiency bleeding. ResultsThe mean age of the seven infants with vitamin K deficiency was 10.3 weeks (range, 7-20 weeks); manifestations ranged from overt bleeding to vomiting, poor feeding, and lethargy. None of the infants had received vitamin K at birth, and all were found to have profound derangement of coagulation parameters, which corrected rapidly with administration of vitamin K in IV or intramuscular form. Four of the seven infants had intracranial hemorrhage; two of these infants required urgent neurosurgical intervention. ConclusionSupplementation of vitamin K at birth for all newborns prevents major hemorrhagic complications, such as intracranial bleeding, due to vitamin K deficiency. Parental refusal of vitamin K is increasingly common. It is critical that health care providers and the public be made aware of the varied presentation of this preventable acquired coagulopathy.

Late onset hemorrhagic disease of newborn due to CMV hepatitis presenting as scalp hematoma

Vitamin K deficiency bleeding (VKDB) according to recent studies is the preferred term for hemorrhagic disease of the newborn (HDN). This is due to deficiency of clotting factors as a result of vitamin K deficiency. VKDB was first described over a hundred years ago but its relationship to vitamin K was not released until 40 years later. Vitamin K is required for the production of clotting factors II, VII, IX and X. It is involved in the normal clotting of blood, is present in some plants and is also synthesized by some E. coli in the gut. Due to low levels of vitamin K all newborn infants are at risk of developing hemorrhagic disease of the newborn. The body has very limited ability to store the vitamin. We present an unusual case of Neonatal Hepatitis due to CMV as a rare cause of late onset vitamin kdeficiency bleeding.

Hemothorax and Hematocele: Unusual Presentations of Vitamin K Deficiency Bleeding Disorder

Sir, Hemothorax and hematocele are rare manifestations of Vitamin K deficiency bleeding disorder in newborns; hematocele being hitherto unreported in English literature. An exclusively breastfed, 1-mo-old male infant presented with sudden onset respiratory distress associated with swelling of left scrotum. Examination revealed that the infant was in shock with severe pallor, tachycardia, tachypnea, reduced air entry and vocal resonance over right hemithorax with dull percussion note on the same side. Heart sounds were normal with no organomegaly. The left scrotal sac was enlarged with a mild bluish hue (Fig. 1); the swelling being irreducible. Investigations showed a negative septic screen with hemoglobin 5 g/dl and platelets 200,000/cumm. Chest radiograph showed homogenous opacity involving right hemithorax with mediastinal shift to the left. Needle thoracentesis revealed a bloody tap and 100 ml of blood was drained by a water-seal drainage tube. Ultrasonography of the scrotum confirmed the presence of hematocele in left testis. Prothrombin Time (PT) and activated Partial Thromboplastin time (aPTT) were markedly deranged. Fibrinogen levels were normal. A review of history revealed no history of maternal intake of any drugs antenatally and no bleeding diathesis in the family. The patient had not received vitamin K at birth. He was managed with oxygen, intravenous fluids, red cell transfusion and intravenous vitamin K. Symptoms resolved within hours. A repeat PT and aPTT after 8 h showed normalization of values. Considering the clinical picture of hemothorax and hematocele in an exclusively breast fed baby with normal septic screen, in the context of deranged aPTT and PT which normalized after administration of vitamin K, a diagnosis of Late onset Vitamin K Deficiency Bleeding (VKDB) of the newborn was made. VKDB is characterized by hemorrhagic manifestations with INR≥4 with normal platelet and fibrinogen level. Diagnosis is confirmed by rapid (within 2 h) normalization of coagulation V. Aggarwal :K. Mishra : B. Rath : S. Chaudhary : P. Kumar Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children’s Hospital, New Delhi, India

Intracranial haemorrhage due to late onset vitamin K deficiency bleeding in Hanoi province, Vietnam

Background: In many developing countries vitamin K prophylaxis is not routinely administered at birth. There are insufficient data to assess the cost effectiveness of its implementation in such countries. Objective:...

NO INFLUENCE OF MATERNAL VITAMIN K SUPPLEMENTATION ON VITAMIN K CONCENTRATION IN BREASTMILK

Haemorrhagic disease in breastfed infants caused by vitamin K deficiency can be prevented by oral or parenteral vitamin K administration. Low vitamin K intake with breastmilk may be responsible for the late onset vitamin K deficiency. Therefore we measured vitamin K intake of 28 healthy term breastfed infants at 6, 28 and 90 days of age in a longitudinal randomized study. 16 mothers received a daily oral vitamin K1 supplement (100ug, Milusan®). Milk intake was evaluated by 24 hour testweighing and vitamin K1 concentration in milk was measured employing the HPLC-technique. Vitamin K, intake was similar in the two groups and no influence of age was detected. (Tab., intake in ug/d).However, vitamin K1 intake of all infants was substantially below the RDI value of 10ug/day. (Am.J.Clin.Nutr;1987;45;687-92). Therefore low vitamin K intake with breastmilk might be responsible for late onset vitamin K deficiency in some infants.