Late form of vitamin K deficiency bleeding in Germany.
BACKGROUND
The evaluation of the disease of vitamin K deficiency bleeding (VKDB).


METHODS
108 reported cases between 1980 and 1990 from Germany.


RESULTS
VKDB occurs preferentially (90%) in fully breastfed infants, males are affected nearly twice as often as females. The peak age is four weeks; the majority (79%) of the infants are between three and seven weeks old. 58% of the patients suffer from intracranial bleeding, which results in a total mortality rate of 19% and in neurological damage in 21%. Generally the VKDB occurred suddenly as no warning signs were noticed or they were so insignificant as not to be heeded. In at least 37% of the patients cholestasis was detected. The Quick value was pathologically low in every case. Vitamin K dependent factors were low and PIVKA was detectable, whereas vitamin K independent hemostatic parameters were normal or even elevated. The combination of low Quick value and normal fibrinogen as well as platelet level is a good diagnostic indicator which can be confirmed by administration of vitamin K, after which the Quick value will rise within 30 minutes. Vitamin K prophylaxis reduces the incidence of VKDB from 5.13 per 100,000 births to a tenth of that; single dose oral prophylaxis reduces the risk by a factor of 3.3 and a single parenteral dose by 14.3. Parenteral prophylaxis is more effective in patients with hepatobiliary disorders. Patients who suffered VKDB despite having received vitamin K prophylaxis are older at onset (without prophylaxis 32 days, with oral prophylaxis 37 days, and with parenteral prophylaxis 63 days) and have less intracranial bleeding (35%) than patients who received none (62%).


CONCLUSIONS
Late form of VKDB is a rare but serious disease which can be prevented by VK-prophylaxis.
Sutor
A H
AH
Universitäts-Kinderklinik Freiburg/Germany.
Dagres
N
N
Niederhoff
H
H
D001780:Blood Coagulation Tests; D001925:Brain Damage, Chronic / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D001942:Breast Feeding; D002543:Cerebral Hemorrhage / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009751:Nutritional Requirements; D014812:Vitamin K / Q000008:administration & dosage / Q000097:blood; D014813:Vitamin K Deficiency / Q000097:blood* / Q000401:mortality / Q000517:prevention & control; D006475:Vitamin K Deficiency Bleeding / Q000097:blood* / Q000401:mortality / Q000517:prevention & control
D014812:Vitamin K