late haemorrhagic disease of newborn

[selvanr4]

This week we had 2 babies who have received 1 mg of vit.k in the neonatal period presenting with intracranial bleed.

baby.1; 39 days old, B/o V mother anemic undernourished. Baby on exclusive breastfeeds.Baby had fever due to mastitis(skin laceration due to hook injury). Developed focal fits on LT side . Both PT & aPTT prolonged.platelets normal.CT shows bleed on RT side

needed 2 anticonvulsants to control convulsions.

Had blood transfusion for low Hb{8gms%}.

Now baby is better. Feeding well.

Any clues for the reason for the Intracranial bleed? Eventhough the baby received vit.K?

selvan rathinasamy

Erode, India

[Alex]

One year ago we treated baby second from twins weighted 420 g. His IVG began in 1.5 month of age, and it was first sign of CMV infection.

[drmangalabharathi@gmail.com]

How sick was the baby prior to bleed?

Did u evalutae for markers of DIVC?

Any significant family history? One need to rule out inherited abnormalities of coag system esp involving common pathways

[Stefan Johansson]

Two useful links

http://www.ncbi.nlm.nih.gov/pubmed/18625545

http://www.ncbi.nlm.nih.gov/pubmed/11949019

Investigate primary dysfunctions of coagulation (coagulation factors etc) and secondary causes like infections, as suggested by Alex above.

And please do not forget: although intracranial bleedings are usually spontaneous events, some infants have injuries as a result of trauma/abuse. Check for other signs of shaken-baby syndrome (such as retinal bleeds) if localization of cerebral bleeds indicate trauma.

[selvanr4]

the baby has responded well. convulsions controlled and discharged

[drakjaleel]

Are they delivered in an institution like yours

Some time preparations make lot of difference

Some authors suggest you can go upto 5 mg

Did you check D-dimor ? Any long term antibiotics?

Very crucial situations is altered perfusion states we need to monitor BP preferably invasive??