Intracranial Haemorrhage Due to Late-Onset Vitamin K Deficiency

Abstract

Objective: Deficiency of vitamin K predisposes to bleeding and it can be divided into early, classical, or late vitamin K deficiency bleeding (VKDB) according to their onset. Late VKDB occurs after 7th day of life at neonatal period and is associated with intracranial bleeding, serious neurological sequels and death. This retrospective study reviewed the clinical presentations, demographic features and radiological findings of infants with intracranial haemorrhage due to late-onset VKDB. Materials and methods: We identified 26 cases of late VKDB admitted to our hospital from February 1992 to November 2006. Cranial computerised tomography was performed in all patients at diagnosis and at subsequent evaluation. Results: Sixteen of twenty-six patients with late VKDB (61.5%) had intracranial haemorrhage (ICH). The mean age of these 16 patients with ICH was 1.6+/-0.7 months. All of them were on breastfeeding. Eighteen of them received one mg of vitamin K intramuscularly (IM) shortly after birth. None of them received any other medication. The most common sign and symptom of patients with ICH was bulging fontanel (69%). The most common bleeding site was parenchymal (n=7, 43.7%). The mortality rate was 44% among patients with ICH. Conclusion: For neonates on strict breast-feeding, despite some with vitamin K prophylaxis, some patients still may suffer from intracranial and extracranial bleeding due to vitamin K deficiency. Therefore, additional IM dose of vitamin K may be needed. However, further evidence from larger prospective study is needed to verify this observation.