Vitamin K deficiency, intracranial hemorrhage, and a subgaleal hematoma: a fatal combination.
An exclusively breast-fed infant, who did not receive vitamin K prophylaxis at birth, presented with signs of raised intracranial pressure. Her clinical course was compounded by a lumbar puncture, which revealed blood in the cerebrospinal fluid, and a large subgaleal hematoma, which developed at the puncture site of an attempted scalp vein catheterization, resulting in coning, hypovolemic shock, and death. A major coagulopathy was present, probably caused by vitamin K deficiency. The necessity for vitamin K prophylaxis in all newborns and the timing of lumbar puncture in the critically ill child are discussed.
Ryan
C A
CA
Pediatric Intensive Care Unit, University of Alberta Hospitals, Edmonton, Canada.
Gayle
M
M
D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D012535:Scalp; D013129:Spinal Puncture / Q000009:adverse effects; D014813:Vitamin K Deficiency / Q000150:complications*; D006475:Vitamin K Deficiency Bleeding / Q000150:complications* / Q000209:etiology / Q000503:physiopathology