Vitamin K deficiency associated bleeding (VKDB), formerly known as hemorrhagic disease of the newborn, has become rare since the 1960s following the accepted use of Vitamin K prophylaxis at birth. In recent years parental refusal of vitamin K prophylaxis is increasing and as a result increasing numbers of infants are at risk for VKDB and life-threatening bleeding.
We report a case of a previously healthy 2 month old infant whose parents refused perinatal vaccinations and vitamin K administration who presented with severe intracranial bleeding and brain herniation with no evidence of trauma. Initial workup demonstrated a severe coagulopathy due to severe deficiency of factors X, IX, VII and II, with normal levels of factors V and VIII, consistent with Vitamin K deficiency. A CT scan demonstrated a large subdural hematoma and sub-flacinic herniation, with no evidence of trauma. The patient underwent emergent evacuation of the subdural hematoma and treated at the PICU with packed cells, fresh frozen plasma, cryoprecipitate, vitamin K, tranexamic acid and recombinant factor VIIa until clotting functions returned to normal. Repeat clotting functions remained subsequently normal since. The infant gradually improved and is further treated for sequels of the episode.
The above case is reprehensive of late VKDB with severe consequences. In-light of the increasing incidence of these cases which is the result of a current “trend” of parents refusing Vitamin K supplementation, it is crucial to raise awareness to this severe yet preventable disorder, and vigorously campaign for the mandatory use of perinatal Vitamin K supplementation.
