Late form of vitamin K deficiency bleeding. Description of four cases with various clinical picture and outcome

Late form of vitamin K deficiency bleeding (VKDB) occurs in infants who received none, or inadequate vitamin K prophylaxis after birth. Exclusively breastfed infants are especially prone to development of this disease. We present 4 cases of late VKDB with different clinical picture and outcome. In two patients intracranial bleeding of variable magnitude was detected, in one, bleeding into pleural cavity and in the fourth severe bleeding from injection sites without internal haemorrhage. Diagnosis was based on the clinical picture with special emphasis on the child's past history and results of coagulation tests. Treatment consisted mainly of vitamin K administration and infusion of fresh frozen plasma. One patient developed severe and definite brain damage after intracranial bleeding, the second only a mild brain dysfunction, the remaining two infants recovered fully. These observations and literature data suggest that in exclusively breastfed infants who did not receive vitamin K after birth, late VKDB should be taken into account as a cause of haemorrhage with different localization and magnitude. There is a need for more emphasis on teaching of physicians about late VKDB and for parenteral vitamin K prophylaxis programme for all newborn infants.