Hemorrhage newborn

Infant respiratory distress syndrome (IRDS), also known as hyaline membrane disease, is one of the most common causes of respiratory disease in premature infants. In fact, it occurs in 30,000 to 50,000 newborns per year in the U.S. — most commonly in neonates bom before week 25 of gestation. IRDS is characterized by areas of atelectasis, hemorrhagic edema, and the formation of hyaline membranes within the alveoli. IRDS is caused by a deficiency of pulmonary surfactant. Alveolar type II cells, which produce surfactant, do not begin to mature until weeks 25 to 28 of... 

Parenteral Anticoagulant-induced prothrombin deficiency hypoprothrombinemia secondary to conditions limiting absorption or synthesis of vitamin K (eg, obstructive jaundice, biliary fistula, sprue, ulcerative colitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas, regional enteritis) drug-induced hypoprothrombinemias due to interference with vitamin K metabolism (eg, antibiotics, salicylates) prophylaxis and therapy of hemorrhagic disease of the newborn. 

Chiidren Safety and efficacy have not been determined in newborns germinal matrix intraventricular hemorrhage occurs more often in low-birth-weight infants receiving heparin. 

Hypoprothrombinemia may occur in malabsorption syndromes and also the use of broad-spectrum antibiotics may produce a hypoprothrombinemia that responds readily to small doses of vitamin K. In premature infants and in infants with hemorrhagic disease of the newborn the use of vitamin K may be indicated. However, the main indication for the use of vitamin K is to antagonize the anticoagulant activity of coumarins. Oral absorption of phytonadione and the menaquinones is by the lymph while menadione and its water-soluble derivatives are absorbed directly. The absorption of phytonadione is energy-dependent and saturable. Intravenous administration of phytonadione has produced flushing, dyspnea, chest pains, and cardiovascular collapse. 

Deficiency of vitamin K in the newborn Newborns have sterile intestines and cannot initially synthesize vitamin K. Because human milk provides only about one fifth of the daily requirement for vitamin K, it is recommended that all newborns receive a single intramuscular dose of vitamin K as prophylaxis against hemorrhagic disease. 

Vitamin K A. plays an essential role in preventing thrombosis. B. increases the coagulation time in newborn infants with hemorrhagic disease. C. is present in high concentration in cow or breast milk. D. is synthesized by intestinal bacteria. E. is a water-soluble vitamin. Correct answer = D. Vitamin K is essential for clot formation, decreases coagulation time, and is present in low concentrations in milk. 

Vitamin K is routinely administered to newborn infants to prevent hemorrhage.10,121 For the first 5 to 8... 

Vitamin K is an essential cofactor for the synthesis of prothrombin and other blood-clotting factors. Vitamin K deficiency occurs due to liver disease, longterm antimicrobial therapy, and malabsorption. Vitamin K deficiency can lead to hemorrhages in newborns and development of hypoprothrombobinemia. Rapid intravenous injection of emulsified vitamin K produces flushing, breathlessness, hypotension, and may lead to death. 

Analysis of the concentration of vitamin K in human milk by Canfield (1989, 1990) has shown that the amount of vitamin K in milk is not correlated with dietary intake. Further, human milk does not contain adequate vitamin K to prevent hemorrhagic disorders in newborns, in particular, pre-term infants with a very low liver store (Canfield et al., 1991). This evidence suggests that vitamin K should be supplemented in all infants younger than six months of age. 

Over the first 6 weeks of postnatal life, the plasma concentrations of clotting factors gradually rise to the adult level in the meantime, they are at risk of potentially fatal hemorrhage that was formerly called hemorrhagic disease of the newborn and is now known as vitamin K deficiency bleeding in infancy. It is usual to give all newborn infants prophylactic vitamin K, either orally or by intramuscular injection (Sutor et al., 1999). At one time, menadione was used, but, because of the association between menadione and childhood leukemia (Section 5.6.1), phylloquinone is preferred. 

DEFICIENCY Vitamin K among other things, is important in the blood clotting mechanism. Deficiency results in hemorrhages (especially in newborns—... 

Vitamin K is routinely administered in many countries to newborn babies in varying doses and by various routes, most commonly either orally or by intramuscular injection, to prevent hemorrhagic disease of the newborn (see Table 1). 

Hemorrhagic disease of the newborn can develop readily because of (1) poor placental transfer of vitamin K, (2) hepatic immaturity leading to inadequate synthesis of coagulation proteins, and (3) the low vitamin K content of early breast milk. Prothrombin levels during this period are only about 25% of the adult levels. Severe diarrhea and antibiotics used to suppress diarrhea readily exacerbate the situation, so prothrombin levels can drop below 5% of the adult level and bleeding can occur. This condition is routinely prevented by the prophylactic administration of 0.5 to 1.0 mg of phylloquinone intramuscularly, or 2.0 mg given orally immediately after birth. 

Rarely is a vitamin K deficiency caused by insufficient diet. It more likely is attributable to a medical condition. At one time, multivita-itdn supplements rarely contained vitamin K. It is now routinely found in these products. Causes of vitamin K deficiency include obstructive jaundice (now uncommon), loss of intestinal flora in preparation for intestinal surgery, and hemorrhagic disease of the newborn. 

The third cause is hemorrhagic disease of the newborn. Infants are born with a sterile intestinal tract. Until the flora are established, the infant will have to get along with the vitamin K they received from the mother. In the past an infant might die from hemorrhaging. Most states require that each newborn receive an injection of phytonadione. Menadione injection is not given because it can cause a hemolytic anemia in the newborn. 

The answer is c. (Murray, pp 627-661. Scriver, pp 3897—3964. Sack, pp 121-138. Wilson, pp 287-320.) Hemorrhagic disease of the newborn is caused by poor transfer of maternal vitamin K through the placenta and by lack of intestinal bacteria in the infant for synthesis of vitamin K. The intestine is sterile at birth and becomes colonized over the first few weeks. Because of these factors, vitamin K is routinely administered to newborns. Deficiencies of the fat-soluble vitamins A, E, D, and K can occur with intestinal malabsorption, but avid fetal uptake during pregnancy usually prevents infantile symptoms. Hypervltaminosis A can cause liver toxicity but not bleeding, and deficiencies of E (neonatal anemia) or C (extremely rare in neonates) have other symptoms besides bleeding. 

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