title: Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth.
abstract: In infants, intracerebral hemorrhage (ICH) is most likely the result of trauma or disturbances of coagulation function. Routine and standard care of the newborn includes the administration of vitamin K to prevent hemorrhagic disease of the newborn. We present two infants, the products of home deliveries, who did not receive vitamin K at birth. Both infants developed ICH at 5 weeks of age and presented with signs and symptoms of increased IC pressure. In both cases, recombinant factor VIIa was administered to correct coagulation function and allow immediate surgical intervention which included craniotomy and hematoma evacuation in one patient and placement of a ventriculostomy in the other to treat increased IC pressure. Despite this therapy, both infants were left with severe neurologic sequelae. These two cases illustrate that hemorrhagic disease of the newborn can occur when prophylactic vitamin K is not administered and that it can have devastating consequences. Given these issues, the routine administration of vitamin K to all infants is mandatory and should not be considered optional.
authors.affiliation: Department of Pediatrics, University of Missouri, 3W-27G HSC, One Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Dena
authors.initials: D
authors.lastname: Hubbard
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D005167:Factor VII / Q000627:therapeutic use; D015942:Factor VIIa; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014812:Vitamin K / Q000627:therapeutic use*; D006475:Vitamin K Deficiency Bleeding / Q000150:complications* / Q000517:prevention & control
chemical_list: D000933:Antifibrinolytic Agents; D011994:Recombinant Proteins; D014812:Vitamin K; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa