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Hemorrhagic disease of Newborn (HDN)/Infancy

  1. A moderate decrease in factors II, VII, IX and X normally occurs in all newborn infants by 48-72 hrs after birth, with a gradual return to birth levels by 7-10 days of age.
  2. This transient deficiency of Vitamin K dependent factors is probably due to lack of free Vitamin K in the mother and absence of the bacterial intestinal flora in newborn.
  3. Breast milk is a poor source of Vitamin K. HDN appeared more frequently in breast fed than in formula fed infants. 

Types of HDN:


Early onset   

Classic Disease         

Late onset



2-7 days

1-6 months

Site of Hemorrhage

Cephalohematoma, Subgaleal, Intracranial,GIT,


GIT,Ear-Nose-throat (Mucosal),Intracranial,
Circumcision, Cutaneous,injection sites

Intracranial,GIT, Cutaneous,
Ear-Nose-throat  (Mucosal),
injection sites

Etiology/ Risk

Maternal drugs (Phenobarbital, Phenytoin, Warfarin, INH, Rifampin) that interfere with vitamin K. Inherited coagulopathy.                


VitaminK deficiency, Breast feeding.

Cholestasis- Malabsoption of
Vit K (Biliary atresia, cystic
fibrosis, hepatitis)

• Warfarin ingestion                                         

• Abetalipoprotein deficiency

•Idiopathic in Asian breast
feed infants


Possible Vit K at birth or to mother (20 mg) before birth. Avoid high risk medication     

Parental Vit. K at birth. Oral vitamin K regimen requires repeated dosing over time.

Parental and high dose Vit
K during periods of mal- absorption/cholestasis.


Very rare

 2% if Vit K not given

Dependent on primary disease


* PIVKA (Protein induced in Vitamin K absence). This is sensitive marker for vitamin K Status.

Treatment: Vitamin K.

  1. Fresh frozen plasma for serious bleeding.
  2. PT/PTTK is prolonged. After Vit K administration → become normal.

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