Vitamin K is essential to blood clotting in humans, newborn or adult, and can prevent the onset of hemolytic disease of the newborn (HDN). Vitamin K is regularly administered to newborns in the practice of modern medicine to decrease incidence of disease, serious brain injury, and death from hemorrhaging in children who have recently been born.
What is Hemolytic Disease of the Newborn?
Hemolytic disease of the newborn (HDN) is a condition that affects newborn babies in which a vitamin K deficiency impairs the production of coagulation proteins by the liver, which causes excessive internal bleeding. Because of the fragility of the newborn’s skin and organs, they are also vulnerable to external bleeding, which may occur around the umbilicus, gastrointestinal tract, or mucous membranes.
Newborns who are to be circumcised are also at an increased risk for dangerous levels of bleeding. Other procedures that break the skin, such as venipunctures, may cause hemorrhaging to create a bleeding problem above the skin.
Causes of HDN
Vitamin K is ordinarily produced by intestinal bacteria, which take time to grow and flourish. Before gut flora are able to establish a presence in the digestive system, vitamin K will usually come from breast milk. However, not all mothers produce breast milk with sufficient levels of vitamin K, which leaves newborns with no natural source of vitamin K.
During pregnancy, vitamin K may not pass the placenta properly, preventing the fetus from absorbing it. Malabsorption may cause a low store of vitamin K at birth that must be supplemented for blood to clot.
How HDN Is Treated in Newborns
Since newborns are at high risk for many problems following birth, vitamin K should be administered as soon as possible. Bleeding from vitamin K deficiency usually occurs after the first 24 hours following birth, usually somewhere in the range of the second day of life to the end of the first week. However, there is still a chance of excessive bleeding through the first month of life. Common treatments for HDN include:
• Supplementation by ingestible drops
• Supplementation by injection
Injection requires only a single dosage and helps the blood clotting process begin immediately in vulnerable babies. The risk associated with venipuncture is mitigated by the immediately presence and deployability of high levels of vitamin K, which will form a blood clot at the site of injection before excessive bleeding can occur.
Drops are available for parents who do not wish for their newborn to be subject to injection. However, drops must be administered 2-3 times during the first few weeks of the newborn’s life, and the incidence of HDN in babies who are treated with digestible vitamin K drops is significantly higher.
The most effective HDN prevention is vitamin K intake during pregnancy.
Administration of vitamin K directly to the mother 2-4 weeks before the end of pregnancy is the most effective preventive treatment method for HDN. Preventative treatment during pregnancy may also reduce the risk of other related diseases and deficiencies.
Education about the merits of vitamin K in newborns is paramount to the prevention of unexpected newborn death and permanent damage. Parents should learn treatment options for during and after pregnancy to help decide how to approach treatment of potential excessive bleeding.