Late Vitamin K Deficient Bleeding in 2 Young Infants – Renaissance of a Preventable Disease

 

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Abstract

Introduction: Late vitamin K deficiency bleeding in young infants is a rare disorder which occurs almost exclusively in breast-fed infants who did not receive proper vitamin K prophylaxis at birth and who might additionally suffer from cholestasis. Its impact on morbidity is high since in 50% of the cases it presents with intracranial hemorrhage with a mortality rate of 20% and life-long neurologic sequelae in 30% of the affected infants.

Case reports: 2 male infants were both admitted to our unit at the age of 5 weeks with subdural hematoma with midline shift due to late vitamin K deficiency bleeding. Both infants did not receive the recommended Vitamin K prophylaxis in Germany. One patient presented with cholestatic jaundice on admission as an additional risk factor.

Discussion: Parents who in the apparent best interest for their children refuse the recommended and well established vitamin K prophylaxis at birth leading to the reappearance of late vitamin K deficiency bleeding. These parents also tend to refuse routine immunizations of childhood in later life, which not only have an impact on their own child but might bear a risk for the whole community.

Conclusion: It is the responsibility of health-care takers to show increased awareness to the growing number of parents refusing vitamin K prophylaxis at birth and educate them properly about the devastating consequences of late vitamin K deficiency bleeding.

Zusammenfassung

Hintergrund: Die späte Vitamin-K-Mangelblutung tritt sehr selten auf. Betroffen sind in der Regel ausschließlich gestillte Säuglinge, die entweder keine oder nur eine unzureichende Vitamin-K-Prophylaxe bei Geburt erhalten haben und/oder bei denen zusätzlich eine Cholestase besteht. In 50% der Fälle manifestiert sich die Erkrankung mit einer Hirnblutung. Es besteht dann eine Mortalitätsrate von 20% und neurologische Defizite treten bei 30% der betroffenen Kinder auf.

Patienten: 2 männliche Säuglinge wurden beide im Alter von 5 Wochen jeweils mit einem raumfordernden Subduralhämatom aufgrund einer späten Vitamin-K-Mangelblutung auf unsere Intensivstation aufgenommen. Beide Säuglinge hatten nicht die in Deutschland empfohlene Vitamin-K-Prophylaxe erhalten. Bei einem Patienten bestand bei Aufnahme als zusätzlicher Risikofaktor ein cholestatischer Ikterus.

Diskussion:  Eltern, die die etablierte Vitamin-K-Prophylaxe bei Geburt verweigern, lassen im Weiteren auch häufiger die Routineimpfungen des Kindesalters nicht durchführen. Dieses Vorgehen mag nicht nur eine potentiell vermeidbare Auswirkung – wie im Fall der Vitamin-K-Mangelblutung – auf das eigene Kind haben, sondern birgt auch ein Erkrankungs- und Infektionsrisiko für die Gesellschaft in sich.

Zusammenfassung: Es liegt in der Verantwortung von Hebammen, Geburtshelfern und Kinderärzten, die steigende Anzahl der Eltern, die eine Vitamin-K-Prophylaxe verweigern, zu identifizieren und hinreichend aufzuklären, um ein gehäuftes Wiederauftreten der späten Vitamin-K-Mangelblutung zu vermeiden.

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