title: Another Disease Re-emerges Due to Parental Shot Refusal: Case Report of a Fussy Infant with Blood in Stool.
abstract: BACKGROUND
  Infants 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.
  
  
  METHODS
  A 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.
authors.affiliation: Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Karyn L
authors.initials: KL
authors.lastname: Kassis
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Wada
authors.affiliation: Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Alana
authors.initials: A
authors.lastname: Milton
mesh_terms: D000740:Anemia / Q000209:etiology; D001942:Breast Feeding; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006408:Hematoma, Subdural / Q000209:etiology; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D016312:Treatment Refusal; D014812:Vitamin K / Q000008:administration & dosage*; D006475:Vitamin K Deficiency Bleeding / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D014812:Vitamin K
keywords: bleeding; bruising; hematology; infant; intracranial bleeding; neurology; pediatrics; radiology; subdural hematoma; vaccine refusal; vitamin K