About half a percent of all newborns have previously experienced hemorrhagic disease. This condition is associated with a violation of blood clotting with a lack of vitamin K. Sometimes the disease is called hemorrhagic diathesis. Recently, newborns are given vitamin K at birth, which made it possible to transfer hemorrhagic disease to the category of diseases that have become quite rare - only in 0.02% of cases.
What it is?
Hemorrhagic disease of the newborn is a condition in which the child has a deficiency of coagulation factors in the blood - there is a deficiency of prothrombin, proconvertin and antihemophilic globulin B. This condition develops in case of lack of vitamin K in the body.
These clotting factors are in direct proportion to the amount of the specified vitamin, and therefore its lack immediately affects the state of the blood and increases bleeding.
Causes
In fact, the insufficiency of the formation of coagulation factors, which was mentioned above, leads to increased bleeding. For their formation, vitamin K is needed, and if it is not enough, then the coagulation factors become immature, they may not bind to calcium, and fibrin (a protein responsible for blood viscosity) is not formed, blood clots cannot form.
Primary and secondary factors lead to the development of the disease... It is customary to refer to the primary deficiency of vitamin K during pregnancy. A woman can take anticonvulsants while carrying a baby (for example, if she suffers from epilepsy), anticoagulants and antibiotics (especially the tetracyclines and sulfonamides). In this case, the amount of vitamin K is significantly reduced and the child does not receive it even during the period of intrauterine development. The cause of primary pathology can also be premature birth, mother's liver disease, violation of the diet recommended for expectant mothers.
Secondary pathology develops due to the insufficiently correct functioning of the liver of the child himself, when it produces little of the so-called plasma precursors of coagulation factors. This occurs with hepatitis (congenital or acquired), with anomalies in the structure of the ducts that drain bile, with immaturity of liver tissue, against the background of long-term antibiotic treatment. In children who are bottle-fed, pathology develops more often than in children who feed on breast milk from the first days.
Types of disease
Depending on when exactly the child is diagnosed with hemorrhagic disease, there are several types of pathology.
- Early - external signs of the disease appear within a day from the moment the baby is born. This is a rather rare pathology.
- Classic - external signs become noticeable 2-6 days after the birth of the baby. This form is much more common.
- Late - external signs become apparent approximately 7 days after the birth of the child or at any other time until the baby reaches the age of 4 months.
If the early form of the disease usually speaks of intrauterine vitamin K deficiency and most often it is associated with the fact that the woman took medications during pregnancy, then the late one is a consequence of concomitant diseases of the baby himself.
Signs and symptoms
How hemorrhagic disease will manifest itself depends on its form. If we are talking about early coagulopathy in children, then already within the first 24 hours from the moment of birth, the crumbs usually manifest vomiting with impurities of blood, outwardly resembling coffee grounds, the occurrence of internal bleeding is possible. Most often, hemorrhages occur in the tissue of the liver, adrenal glands, lungs and spleen. Sometimes hemorrhages in the early form occur even before the moment of birth. In this case, usually the outpouring of blood occurs in the brain tissue, and the child is born with signs of vasculitis - pinpoint hemorrhages on the skin.
If we talk about classical pathology, then usually its characteristic signs appear 3-4 days after the birth of the child. As in the first case, vomiting with blood, bloody diarrhea appears. Dark, tar-like stools are common. The umbilical wound may begin to bleed. If gastric or intestinal bleeding develops, then bilirubin rises, the child develops prolonged and persistent jaundice.
With a late form of pathology, the probability of dangerous complications is higher. Most of it begins in the second week of a baby's life. About 16% of newborns experience hemorrhagic shock - they are pale, weak, their blood pressure drops, their body temperature drops. The rest of the symptoms, as in the first two cases, are considered starting.
Diagnostics
Establishing an accurate diagnosis usually does not cause difficulties - too characteristic symptomatic picture is accompanied by increased bleeding. If doctors suspect hemorrhagic disease, they conduct a full range of studies for the child, which includes both blood tests and instrumental methods.
The baby's skin is examined. Most often, hemorrhages are massive, less often they are observed only on the priest. The general condition of the baby is assessed. They take blood from him and determine the consistency of coagulation factors - the number of platelets, the amount of fibrinogen, and the clotting time.
It is imperative that an ultrasound of the internal organs is performed to determine possible internal hemorrhages, as well as neurosonography to determine possible cerebral hemorrhages.
Treatment
For treatment is used what the baby's body lacks - vitamin K. It is customary to use its synthetic analogs, for example, the drug "Vikasol". It is administered for several days and the baby's blood clotting indicators are constantly checked against the standard values.
If bloody vomiting occurs, the stomach is washed with saline. Aminocaproic acid is injected through a thin probe placed in the esophagus. In hemorrhagic shock, donor plasma, saline solutions, glucose are administered.
According to the reviews of parents who are faced with such a diagnosis, Within a few days of treatment, the child loses up to 10% of the birth weight in a few days of treatment, but in most cases everything ends well.
What are the predictions?
If the pathology proceeds without complications, then it is considered that the prognosis is quite favorable. Vitamin K is injected for several days, which normalizes the synthesis of blood factors and eliminates the problem. However, the very fact of hemorrhage can have various consequences. If a cerebral hemorrhage occurs, then about every third baby may have rather severe forms of damage to the central nervous system. No one can predict the consequences, everything will depend on which parts of the brain are damaged. In severe cases, death is possible. In the middle grave - disability.
It is noteworthy that after recovery, violations of the state of hemostasis usually do not occur, that is, the problem is completely solved. Relapses also usually do not occur. Even after increased bleeding after a single normalization of the synthesis of coagulation factors, repeated pathologies do not occur.
Clinical guidelines of the Ministry of Health suggest as prevention introduce to all children at risk "Vikasol" in the first hours after birth. This group includes babies born prematurely (up to the 38th week of pregnancy), children who received any injuries during childbirth, as well as all babies who were born weakened, are artificially fed, feed through a tube, which is injected with antibiotics according to indications.
But in order not to miss a child of the risk group and not to leave him without proper attention, today such an injection is administered once to all newborns, which helped to significantly reduce the prevalence of pathology among infants.
For the prevention of primary hemorrhagic disease in women during pregnancy you should monitor your diet, drink vitamins prescribed by your doctor, do not take without prescribing anticoagulants, antibiotics and anticonvulsants. In the event of diseases in the process of carrying a baby, it is recommended not self-medication, but adequate therapy. You need to visit the antenatal clinic on time, do general blood and urine tests, without missing a single direction, do not give up ultrasound diagnostics.
