Late-onset vitamin K deficiency bleeding: a preventable yet prevailing cause of intracranial hemorrhage in young infants—an ambispective descriptive study

• Published in: Intensive Care Medicine – Paediatric and Neonatal Vol. 2; no. 1
• Main Authors: Annadurai, Aswini, Delhi Kumar, C. G., S. M., Praveen, Parameswaran, Narayanan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 24.01.2024
• Subjects: Critical Care Medicine; Intensive; Medicine; Medicine & Public Health; Original Research; Pediatrics; Intracranial hemorrhage; Vitamin K deficiency; Infants; PIVKA
• ISSN: 2731-944X; 2731-944X
• DOI: 10.1007/s44253-024-00028-3

Background Vitamin K deficiency bleeding (VKDB) may present as intracranial hemorrhage (ICH) in young infants, which results in severe morbidity and mortality. This study aims to determine the clinical presentation, risk factors, and outcome of children with VKDB. Methods This was an ambispective descriptive study conducted from January 2015 to August 2023 in southern India. Infants from 8 days to 6 months of age, diagnosed as VKDB based on bleeding with elevated PIVKA (protein induced by vitamin K absence) and prolonged prothrombin time, which is rapidly corrected 24 h after administration of vitamin K, were included. Infants with bleeding due to other causes, such as inherited clotting factor deficiency, cholestasis, and sepsis, were excluded. A structured data collection proforma was used to collect data. Results Out of 62 cases, 28 were excluded due to various causes, and 34 were analyzed. The median age at symptom onset was 54 days, and males were 22 (64.7%). Term gestation was 25 (73.5%), and low birth weight was 13 (38.2%), and 8 (23.5%) required NICU admission. All received vitamin K prophylaxis at birth. Thirty-three (97%) were exclusively breastfed. The most common presenting complaints were poor activity and convulsion. A total of 97% of children had ICH, and 5 (14.7%) had skin bleed. Twenty-three (67.6%) infants had complete recovery, 6 (17.6%) had sequelae (2 had hemiparesis, 2 monoparesis, and 2 quadriplegia), and 5 (14.7%) children expired. Conclusion Vitamin K deficiency commonly presents as intracranial hemorrhage in infants. Exclusive breastfeeding is a significant risk factor for vitamin K deficiency, followed by low birth weight and prematurity.