Hemorrhagic syndrome in children: what diseases accompany it and how it manifests itself. Hemorrhagic disease of newborns: causes, forms, consequences

– a pathology that occurs when there is a deficiency of blood coagulation factors against the background of endogenous or exogenous vitamin K deficiency. Manifested by vomiting mixed with blood, bloody tarry stools, skin hemorrhages, hematomas and internal hemorrhages. Rarely accompanied by hemorrhagic shock, the development of jaundice and the formation of erosions of the mucous membranes of the gastrointestinal tract. Diagnosis is based on determining the number of platelets, studying a coagulogram, ultrasound and neurosonography. Treatment consists of replacement therapy with synthetic analogues of vitamin K, stopping internal bleeding and correction of hypovolemia.

General information

hemorrhagic diathesis, characterized by a deficiency of II (prothrombin), VII (proconvertin), IX (antihemophilic globulin B) and X (Stewart-Power factor) coagulation factors with vitamin K deficiency in the child’s body. The pathology was first described in 1894 by Ch. Townsend, but the introduced term was initially used for all congenital hemorrhagic conditions. Prevalence is 0.3-0.5% among all newborns. After the introduction of mandatory prophylaxis with vitamin K analogues at birth, the incidence decreased to 0.02%. About 3-6% of cases of hemorrhagic disease of newborns are a consequence of the mother taking pharmacotherapeutic drugs during pregnancy.

Causes of hemorrhagic disease of newborns

The cause of hemorrhagic disease of newborns is insufficiency of synthesis of blood coagulation factors II, VII, IX and X. The formation of these factors takes place in liver tissues by γ-carboxylation of glutamic acid under the influence of vitamin K. With endogenous or exogenous vitamin K deficiency, functionally immature factors are produced that have a stronger negative charge on its surface. Such factors cannot bind to Ca ++ and then to phosphatidylcholine. As a result, fibrin is not formed and a red blood clot does not form.

Primary, or exogenous, vitamin K deficiency is caused by insufficient intake of it into the body during pregnancy. Provoking factors for hemorrhagic disease of newborns are maternal disorders: the use of anticonvulsants (carbamazepine, convulex), anticoagulants and antibacterial drugs broad spectrum of action (cephalosporins, tetracyclines, sulfonamides), premature birth, liver disease, enteropathy, eclampsia, dysbacteriosis, poor nutrition.

Secondary, or endogenous, deficiency is caused by insufficient synthesis of polypeptide precursors of plasma coagulation factors (PPPF) in the child’s liver tissues. This form diseases, as a rule, are provoked by disorders on the part of the newborn: liver diseases (hepatitis), malformations (anomalies in the structure of the biliary tract), functional immaturity of the liver parenchyma, malabsorption syndrome, antibiotic therapy, lack of prophylactic administration of vikasol (an analogue of vitamin K) after childbirth, artificial or long-term parenteral feeding. The first few days of a child’s life, his gastrointestinal tract is in a sterile state - the microflora that promotes the absorption of vitamin K has not yet had time to form, which also aggravates the secondary endogenous deficiency of this compound.

Classification of hemorrhagic disease of newborns

Taking into account the period of onset of the first symptoms, hemorrhagic disease of newborns has the following forms:

1. Early. Symptoms occur in the first 12-36 hours after birth. Rarely seen. Usually a consequence drug therapy mother.
2. Classic. The manifestation of symptoms occurs on days 2-6. The most common form.
3. Late. Develops after 1 week of life, rarely occurs before the age of 4 months. As a rule, it is formed against the background of provoking diseases or the absence of preventive injections of vitamin K.

Symptoms of hemorrhagic disease of newborns

Symptoms of hemorrhagic disease of newborns depend on the time of development of the disease. The early form gives detailed symptoms in the first 24 hours of a child’s life. The primary manifestation is vomiting with blood of the type “ coffee grounds"(hematemesis). Internal bleeding may occur (more often in the parenchyma of the liver, adrenal glands, spleen and lungs). IN in some cases this pathology occurs even before birth and manifests itself as hemorrhages in the brain tissue, petechiae and ecchymoses on the skin from the moment of birth.

The classic form most often manifests itself on the 4th day. Its clinical picture includes hematemesis, melena, petechiae, and ecchymoses throughout the body. The first symptom is usually black tarry stool. Bleeding from the umbilical wound and cephalohematoma are often observed. When using obstetric instruments during childbirth and severe asphyxia against the background of vitamin K deficiency, subcutaneous hematomas, subgaleal and intracranial hemorrhages can form. With severe gastrointestinal bleeding, an increase in bilirubin is detected (mainly due to the indirect fraction) as a consequence of massive hemolysis of erythrocytes in the digestive tract under the influence of gastric juice. This condition is accompanied by prolonged jaundice, erosions of the mucous membranes of the duodenum and pylorus. The last two complications can aggravate blood loss and form a “vicious circle”.

The late form has a clinical picture similar to the classic one, but usually occurs on days 7-14 of life and more often occurs with complications. About 15% of children with this form are at risk of developing hemorrhagic shock, manifested general weakness, pallor of the skin, a drop in blood pressure and a decrease in body temperature.

Diagnosis of hemorrhagic disease of newborns

Diagnosis of hemorrhagic disease of newborns consists of identifying risk factors, conducting an objective examination, studying the results of laboratory and instrumental methods research. When collecting an anamnesis, a neonatologist or pediatrician is able to detect predisposing factors: the mother’s medication intake, poor diet, concomitant diseases, etc. Also, during the interview, it is important to establish the first symptoms of the child’s disease and their severity at the time of occurrence.

Physical examination makes it possible to determine diffuse hemorrhages on the skin (rarely - locally, on the buttocks), jaundice with hyperbilirubinemia, disorder general condition and symptoms of hypovolemia in hemorrhagic shock. Laboratory tests are aimed at assessing the hemostatic system. The platelet level, thrombin time and fibrinogen amount are determined. The blood clot retraction time (indicators within normal limits), activated partial thromboplastin time (aPTT), Bürker blood clotting time and plasma recalcification time are determined (results indicate a deficiency of coagulation factors). In the UAC, signs of anemia are possible. Ultrasound and neurosonography can detect hemorrhages in the periosteum of the skull bones, central nervous system tissue and other organs.

The disease is differentiated from the syndrome of “swallowing of maternal blood”, disseminated intravascular coagulation, idiopathic thrombocytopenic purpura, hemophilia A and B, von Willebrand disease. During the differential diagnosis, an Apta test, platelet count assessment, coagulogram and determination of coagulation factor deficiency are performed.

Treatment of hemorrhagic disease of newborns

Etiotropic treatment of hemorrhagic disease of newborns involves replacement therapy analogues of vitamin K. In pediatrics, synthetic preparations of vitamin K (vicasol) are used. The duration of administration is from 2 to 4 days, depending on the results of control tests. If hematemesis is present, gastric lavage is performed saline solution, aminocaproic acid is administered through a probe. For confirmed gastrointestinal bleeding, an enteral mixture containing thrombin, adroxon and aminocaproic acid is indicated. Treatment of hemorrhagic shock involves restoration of bcc using infusion therapy using 10% glucose solution, 0.9% NaCl, fresh frozen plasma and prothrombin complex (PP5B).

Forecast and prevention of hemorrhagic disease of newborns

With uncomplicated hemorrhagic disease of newborns, the prognosis is favorable. With the development of hemorrhages in the brain tissue, 30% of children experience severe damage to the central nervous system. In some cases, death is possible. There are no relapses. The formation of other hemostasis disorders after recovery is not typical.

Prevention is carried out for all children at risk. The risk group includes premature patients with a gestation period of 22 to 37 weeks, children with birth trauma of newborns, patients on artificial or parenteral feeding, newborns receiving antibacterial agents, and babies born from mothers with risk factors. Preventive measures consist of a one-time administration of Vikasol, early and full breastfeeding. On this moment Vitamin K analogues are recommended to be administered to absolutely all children at birth. On the mother's part, it is necessary to limit the intake of provoking medications as much as possible and provide adequate treatment concomitant diseases during pregnancy, visit regularly antenatal clinic and undergo appropriate examinations (ultrasound, OAC, OAM and others).

Hemorrhagic disease in newborns is a common disease that many parents have to deal with. Having encountered this diagnosis, many parents begin to grab their heads and look for all sorts of ways to eliminate the pathology. To accept correct solution to eliminate the disease, let's find out what its features are and how to protect the child from this disease.

Features of the disease and causes

Hemorrhagic disease is a pathological change in the blood, during which a violation of its coagulation occurs. Because of this, people often experience diathesis, which is caused by a violation of the synthesis of blood clotting and a lack of vitamin K. As a rule, this pathological condition is more often diagnosed in newborns. Bruising and signs of bleeding are the main symptoms of the disease in the first days of life.

Among all diseases of newborns in our country, hemorrhagic disease accounts for 1.5%. In European countries, this pathological condition is diagnosed in 0.01% of cases. total number postpartum diseases. This is due to the fact that many European countries practice prophylactic administration of vitamin K to infants.

According to experts, this pathology can be classified into primary and secondary disease. Primary disorders usually occur during intrauterine development or in the first days after birth. More often than usual, this is due to a natural lack of vitamin K. Hemorrhagic disease in newborns has various causes.

Primary causes of the disease

• Use of prohibited medications during pregnancy;
• disruption of the liver and intestines in a pregnant woman;
• gestosis and toxicosis during pregnancy;
• disturbed and immature intestinal microflora of the infant;
• placental vitamin K impermeability;
• minimum vitamin content in breast milk.

At the heart of development secondary causes diseases, there are disturbances in the functioning of plasma blood clotting factors occurring in the liver; more often than usual they have a late form. In addition, an important cause of vitamin deficiency may be the use of vitamin K antagonist drugs by the mother.

Secondary causes of the disease

• Premature birth up to 37 weeks;
• fetal hypoxia;
• intestinal dysbiosis;
• dysfunction of the liver, intestines, pancreas and bile ducts;
• long-term use of antibiotics.

There are many reasons for the occurrence of diseases. In order to correctly determine what exactly triggered the development of the pathological condition, it is necessary to carry out appropriate diagnostics. Since the method and method of treating the disease will depend on what exactly underlies the occurrence of hemorrhagic disease.

Features of vitamin K and its importance in the functioning of the body

Up to ten proteins are involved in the process of blood clotting, 5 of which are synthesized with the help of vitamin K. In addition, it is of no small importance in the process of blood thickening that occurs in the liver. With help of this vitamin, the human body retains such released trace elements as calcium, which plays an important role in the functioning of the skeletal system.

A lack of vitamin K causes detrimental harm to the body. Therefore, if its deficiency occurs, it is necessary to immediately begin to eliminate this pathology. In adults, deficiency of this vitamin is much less common than in children. Since the body of an adult can compensate for its deficiency by consuming vegetables and other foods.

Symptoms of the disease

The first and most important symptom of the disease is bleeding and bruising. Often this disorder occurs in the prenatal period, when the doctor diagnoses bleeding of the baby’s internal organs. Presence bloody discharge after bowel movements or after regurgitation, is also an important symptom of the disease.

As a rule, this symptom appears on the 7th day of the child’s life. Hemorrhagic disease of newborns has early and late symptoms, which differ in the time of appearance and forms of manifestation.

Early symptoms of the disease:

1. bruises on the baby’s body detected after childbirth;
2. nose bleed;
3. the presence of blood in the baby's stool or after regurgitation;
4. constant bleeding of wounds after injections;
5. signs of anemia.

Late symptoms of the disease:

1. frequent vomiting mixed with blood;
2. intracranial hemorrhages;
3. spontaneously occurring bruises of the skin;
4. the presence of blood in the urine;
5. obvious symptoms of gastrointestinal dysfunction;
6. permanent and long bleeding umbilical wound.

In most cases, the late form of symptoms underlies liver disorders. In the case of an acute illness, the child experiences symptoms of hypovolemic shock. Due to frequent vomiting and broken stools, the child’s body experiences a lack of fluid, which provokes a decrease in the volume of circulating blood. This pathological condition is very dangerous for the life and health of the child.

In order to prevent the development serious complications, you must promptly apply for medical assistance, since it is better to treat the disease with initial stage occurrence.

Diagnosis of the disease

Treatment of hemorrhagic disease of the newborn is important for normal life child. Timely diagnosis- This is the key to a speedy recovery for the baby. When early symptoms, the doctor will inform the mother about the need for an examination. As a rule, the most informative method diagnostics is a blood test. In addition, the specialist can offer additional methods studies that will help assess the condition of the newborn. When conducting diagnostic studies children do not experience severe stress, diagnosis is carried out quickly and painlessly.

Research methods

1. general blood analysis;
2. blood clotting test;
3. stool occult blood test;
4. ultrasound examination of internal organs.

An in-depth diagnosis of the child’s condition is carried out if the doctor is not clear about the causes of the deviation. If the parents of a newborn have a tendency to develop these pathological changes, a specialist may also suggest diagnosing the baby’s health. As a rule, this is a classic blood test and ultrasound examination of the child’s organs. Held this procedure, to prevent the development of internal bleeding.

Treatment options

The method of treating the disease depends on the severity of the pathology. If the child has a moderate form of the disease, without obvious signs of complications, then vitamin therapy will be used. Over the course of three days, the child will be given synthetic vitamin K, which compensates for its lack. According to experts, the vitamin is better absorbed if it is administered intravenously or intramuscularly. Oral administration vitamin is considered ineffective.

In the case of a severe form of the disease, measures will be taken first to eliminate pathological conditions and the causes of their occurrence. If hemorrhage poses a danger to the child's life, fresh frozen blood plasma is administered. After its administration, the child’s condition stabilizes.

Disease prognosis

The prognosis of the disease will be positive, in mild case forms of the disease when the child’s life is not in danger. Timely diagnosis combined with modern methods treatment, are able to easily cope with the existing pathology.

In case of major changes, and in particular with a large number of internal hemorrhages, the child’s life may be at risk.

Preventive measures

To reduce the risk of developing pathology, prevention of hemorrhagic disease of newborns plays an important role. During pregnancy, young mothers should be attentive to their health.

Preventive measures for pregnant women:

1. the use of antibacterial drugs is possible if the risk of complications in the mother is much higher than in the child;
2. Avoid the use of drugs that displace vitamin K.

In our country, the use of vitamin K for preventive measures in newborns is not a constant practice. Despite this, having special indications, some experts may recommend the introduction vitamin preparation. This is done in case of obvious vitamin deficiency, without complications.

Indications for vitamin administration

• intrauterine hypoxia;
• prematurity;
• postpartum complications;
• use of antagonistic drugs during pregnancy;
• clear signs of vitamin K deficiency in a woman in labor.

Some perinatal centers practice additional diagnostics of the child's health. By agreement with the doctor, babies can undergo in-depth postnatal health diagnostics. This will be relevant if during pregnancy the mother suffered from conditions that affect the content of vitamin K in the body. If there is a pronounced deficiency of this vitamin, young parents may be advised to conduct a course of vitamin therapy for their baby.

FAQ

After diagnosis, early hemorrhagic disease of newborns, parents have a large number of questions. In this section we have collected the most relevant ones. Thanks to the specialist's answers, you can get useful information on this topic.

My baby is three months old and is bottle-fed. After regurgitation, there is an admixture of blood in the mixture. Does it this sign a symptom of a disease?

Answer: “Late hemorrhagic disease of newborns can be caused by disorders of the digestive system. Frequent vomiting, mixed with blood and stool disturbances, may be a symptom of the development of a deviation. Of course, the presence of blood in the regurgitated mixture is a sign of disruption of the digestive system. But this does not mean that it is hemorrhagic disease that is the cause of the development of this deviation. In this situation, it is necessary to diagnose the child’s health condition in order to identify the cause of the pathological change.”

The child was diagnosed with hemorrhagic disease. The baby’s condition is stable, but the maternity hospital recommended that we refuse vaccinations for 6 months. During a routine medical examination, the pediatrician started talking about the need for vaccination, although we are only 4 months old. What to do in this situation? A conversation with the doctor did not give a concrete answer.

Answer: “According to the protocol, this pathological condition has a clear medical exemption from vaccinations. The duration of withdrawal directly depends on the stage, degree and form of the disease. If we're talking about O mild form pathology, which is characterized only by a clear lack of vitamin K, then the period of medical withdrawal is minimal. In case of severe forms of disruption of the body, with multiple hematomas and hemorrhages, it will be significantly increased, up to full recovery body. Before deciding whether to start vaccination, you should at least take a blood clotting test.”

After birth, the baby was sent to the neonatal intensive care unit. The doctor diagnosed an acute form of hemorrhagic disease. Multiple cephalohematomas, jaundice and hypoxia are the main reasons for transferring a child. I'm very worried about the baby. Why was the decision made to transfer when his life is not in danger?

Answer: “The decision to transfer infants to the intensive care unit is made by a neonatologist, after assessing the state of his health. To exclude development serious pathologies, it is necessary to conduct an in-depth diagnosis of the baby’s health. After all, hidden forms of organ dysfunction can lead to irreversible consequences. An early form of diagnosis and specific nursing care will help the baby get stronger. Since traumatized children are monitored under the strict guidance of a neonatologist throughout their stay in the maternity hospital, the babies’ recovery is much faster.”

One month during a routine examination, the doctor said that he suspected the development of a hemorrhagic disease. We received a referral for a prothrombin complex test. Is it necessary to do it?

Answer: “Prothrombin analysis is a screening test that plays an important role in diagnosis of this disease. Using the analysis, the doctor will be able to assess the deficiency of factors of the prothrombin complex and the external coagulation pathway. If a specialist has ordered this study, then it is necessary. All methods for diagnosing the disease are selected at the discretion of the attending physician, based on the characteristics of the pathology.”

Hemorrhagic disease of newborns is a pathology based on a blood clotting disorder (in medicine this process is called coagulopathy), which in most cases is caused by a lack of vitamin K in the body and manifests itself in the first days of a baby’s life. Externally, the disease is expressed by increased bleeding and bruising.

According to statistical data, the incidence of newborns in our country ranges from 0.25-1.5%. In those countries where there is a preventive program aimed at administering vitamin K supplements to children after birth, the problem has been reduced to almost zero - 0.01% of infants or fewer become ill.

About vitamin K and its role in the body

The very name of the vitamin, designated by the letter K, comes from the phrase “coagulation factor,” which directly indicates its the most important function. It has been proven that blood clotting requires at least 10 active proteins, 5 of which are synthesized with the participation of vitamin K. The liver needs it to produce prothrombin, a substance that allows blood to thicken. Vitamin K is necessary not only for the circulatory system, it also helps retain calcium in bone tissue.

It is impossible without vitamin K normal operation circulatory system

In adults, a deficiency of this vitamin is rare, since it is produced in sufficient quantities by intestinal bacteria, and it is also present in many vegetables without breaking down after heat treatment. But in babies, deficiency is possible for a number of reasons, then hemorrhagic syndrome develops in newborns.

Causes of hemorrhagic disease

Let's look at the situations in which K-hypovitaminosis occurs:

• Intestinal dysbiosis. It is associated with either taking antibiotics or physiological reasons, when the bacterial intestinal flora simply did not have time to develop. Its production begins only on the 4th-5th day of life, provided that the colonization of bacteria occurs unhindered.
• The fetus has a small supply of the vitamin. Vitamin K passes through the placental barrier poorly, so its content in a newborn is half that of an adult.
• Its content in milk is low. The fact is that both breast and cow's milk do not cover daily requirement in vitamin. Therefore, breastfeeding can become a provoking factor in the development of hemorrhagic disease. But this does not mean that you need to give up breastfeeding, there is simply a need for a small nutritional correction.

The following factors can aggravate the situation:

• during pregnancy the woman took anticoagulants or anticonvulsants;
• presence of liver or intestinal diseases;
• prematurity of the child;
• gestosis and toxicosis of a pregnant woman;
• the baby was put to the breast late;
• if the baby has been on parenteral nutrition for a long time;
• malabsorption syndrome was detected - when the absorption process occurs in the intestines nutrients disturbed; the main symptom is diarrhea for more than 7 days;
• pathologies of the biliary tract (obstruction or complete absence).

Forms of the disease

There are primary and secondary hemorrhages. Primary is said to be when the fetus initially had a deficiency of the vitamin, and its supply through mother’s milk is minimal. By the 5th day, the deficiency can be compensated for by its intestinal production.

The secondary form is diagnosed if liver lesions are present, when the synthesis of polypeptide precursors of plasma factors (PPPP) is impaired.

The disease is classified according to the time of onset:

• early - bleeding makes itself felt on 1, maximum 2 days after birth;
• classic - appears on days 3-5;
• late - occurs at any time during the first 8 weeks of life.

Symptoms

In the early form, hemorrhages often begin in the prenatal period. The child is born with intracranial, pulmonary and skin hemorrhages. Internal bleeding into the liver, spleen, adrenal glands, as well as into the abdominal organs, and vomiting with blood are typical.

The classic reaction is characterized by the presence of blood in the stool and vomit around the 7th day of life. Poor coagulation is visible from the bleeding of the navel, and from long-term non-healing in case of circumcision foreskin in boys, by nosebleeds, cephalohematoma on the head and bruises on the skin. The wounds do not heal for a long time after injections. In severe cases, anemia and hemorrhagic damage to internal organs are detected.

The late form develops as a result of liver diseases and dysfunctions of the gastrointestinal tract along with breastfeeding. Leading symptoms:

• hematemesis (bloody vomiting);
• in half of the cases there are intracranial hemorrhages and cephalohematomas;
• extensive bruising on the skin and mucous membranes;
• hematuria (blood in the urine);
• melena - a disease accompanied by black stools and indicating gastrointestinal bleeding; the development of melena is possible with gastroesophageal reflux;
• the umbilical wound is bleeding.

Melena is often accompanied by hyperbilirubinemia, since red blood cells in large quantities disintegrate and die in the intestines. Ulcers appear on the mucous membrane of the stomach and duodenum. This condition is explained by the stress of birth, during which glucocorticoids are released in large quantities.

At severe course disease, hypovolemic shock is possible - a condition characterized by a rapid decrease in circulating blood volume due to fluid loss with persistent vomiting and diarrhea. The child's blood pressure and temperature drop, he is weak, and his skin is pale. The condition requires urgent resuscitation.

Diagnostics

If there is any doubt about the presence of hemorrhagic disease of newborns, the blood is tested for its ability to clot (coagulogram). To do this, evaluate:

• prothrombin time; prothrombin - a protein contained in blood plasma; when there is a need for blood clotting, it is transformed into thrombin and participates in the formation of blood clots; norm: 13-16 sec;
• activated partial thromboplastin time (abbreviated APTT); norm - 45-60 seconds;
• platelet count; parameters: 131-402 thousand/µl;
• thrombin time; boundaries: 10-16 sec;
• bleeding time; borders: 2-4 min;
• Bürker clotting time; normal - 4 minutes;
• hematocrit;
• hemoglobin.

What the results show clinical tests when is the disease confirmed? Although the platelet count and bleeding time will be normal, blood clotting will take longer than usual. An anemic state develops only after 2-3 days of bleeding. In parallel, neurosonography and ultrasound of the abdominal organs may be prescribed.

Differential diagnosis is carried out with the following diseases:

• Thrombocytopenic purpura. A disease in which bleeding occurs due to reduced content platelets.
• Hereditary coagulopathies (afibrinogenemia, hemophilia).
• DIC syndrome. Blood clotting as a result of extensive release of thromboplastic substances from tissues. Accompanies various states of shock and severe injuries.

Treatment

In mild situations, treatment begins with the administration of Vikasol 1% (vitamin K, obtained synthetically). Unlike its natural representative, which has a fat-soluble form, Vikasol is water-soluble. Recommended routes of administration: intravenously or intramuscularly at a dose of 0.1 ml/kg per day. The course of treatment is 3 days.

If hemorrhagic effusions become life-threatening, it is suggested to administer fresh frozen plasma.

IN in rare cases The use of vitamin K in oral form is prescribed, but there are currently insufficient studies to prove the effectiveness of such therapy.

Predictions and prevention

In most cases, the prognosis is favorable. But to avoid severe consequences diseases in the form of hypovolemic shock, it is recommended to administer Vikasol to newborns at risk for prophylactic purposes, without waiting for clinical symptoms of the disease.

Let us remind you that this group includes children:

• those who suffered from intrauterine hypoxia or suffered asphyxia during childbirth;
• injured during childbirth;
• babies born through caesarean section;
• premature birth with low baby weight;
• infants whose mother took one of the drugs that affects coagulation during pregnancy;
• if the mother suffered from dysbacteriosis during pregnancy, had liver problems, or suffered from toxicosis and gestosis.

So, it is better to prevent the disease than to later treat it with transfusions and constant control blood indicators. Consideration of this topic once again convinces that in human body there are a lot of substances interacting with each other, and even disruption of the functions of one of them entails a chain negative consequences. However, it is comforting to know that the disease rarely becomes critical and is generally treatable.

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Hemorrhagic disease of the newborn (late, early): what is dangerous, treatment, prognosis

This pathology is relatively rare - it is diagnosed in only less than 1.5% of born babies. In Western European countries and the USA, hemorrhagic disease is even less common (less than 0.1%). This is due to the mandatory use of vitamin K for its prevention in all newborns in the first day after birth.

The role of vitamin K

The main cause of the pathological condition is insufficient intake or formation of vitamin K in the baby’s body. Therefore, in ICD-10 this disease also has the second name “vitamin K deficiency in a newborn.” In 1943, scientists who established the cause of hemorrhagic disease were awarded the Nobel Prize.

Vitamin K does important function in the human body. This substance is primarily responsible for the activation of certain components of the blood coagulation system. Vitamin K plays a decisive role in the implementation of their blood coagulation properties; its deficiency significantly increases the risk of bleeding.

Immediate cause Increased bleeding is caused by a lack of the following components of the coagulation system:

• antihemophilic protein B;
• prothrombin;
• Stewart factor.

In addition, with hemorrhagic disease, the process of activation of other coagulation factors is disrupted. In this case, calcium ions are not included in the process of blood clot formation, which causes bleeding.

Unfortunately, vitamin K does not cross the placenta well during pregnancy. In addition, breast milk contains very little of it on the first day; the concentration of the vitamin gradually increases only in the next day. That is why small children in the first days after birth, especially those who are breastfed, are extremely sensitive to its deficiency.

Depending on the root cause, this pathology can be primary or secondary. The main primary causes of hemorrhagic disease of the newborn are as follows:

• mother taking anticoagulant medications during pregnancy;
• premature birth;
• delivery by caesarean section;
• taking antibiotics or anticonvulsants by a pregnant woman;
• liver and intestinal diseases in women;
• dysbiosis in the mother;
• late toxicosis of pregnancy.

Secondary pathology is often associated with impaired liver function in the child. This can occur when it is infected (hepatitis), congenital pathologies. In this case, the factors necessary for complete blood clotting do not form sufficiently, which becomes the cause of bleeding.

Depending on the time of appearance characteristic symptoms hemorrhagic disease occurs:

• early - hemorrhagic disease of newborns manifests itself in the first 24-48 hours after birth;
• classic - symptoms appear on the third to fifth day;
• late - bleeding occurs in the first weeks or months of the child’s life.

With early or classic version The symptoms of hemorrhagic disease of newborns are as follows:

• vomiting blood;
• the presence of blood in the stool (melena);
• subcutaneous hemorrhages of various sizes (hematomas, “bruises”);
• hematomas in the head area;
• increased bleeding in the area of ​​the umbilical wound;
• blood in the urine;
• internal bleeding (pulmonary, intracranial).

Late hemorrhagic disease of newborns in most cases is caused by insufficient intake of vitamin K in breast milk, as well as a violation of its formation in the intestines. In this case, the reasons may be the use of antibacterial agents, dysbacteriosis, or congenital enzymopathies. It manifests itself during the first months of the child’s life with the same symptoms as the early form of the disease.

Hemorrhagic disease of newborns is especially dangerous because it can cause intracerebral hemorrhage. In some cases, this condition causes severe neurological deficits and even death.

Most often, bleeding is localized under the membranes (subarachnoid hemorrhage) or in the substance of the brain. In this case, against the background of signs of blood coagulation disorders, other symptoms appear, indicating the involvement of intracranial structures:

• impaired consciousness of varying degrees;
• frequent regurgitation, vomiting;
• constant, causeless crying of the child;
• fontanelle tension;
• divergence of the sutures of the skull;
• convulsive syndrome.

If there are signs of intracranial hemorrhage, the child must be urgently hospitalized in the neurosurgical department and undergo specific therapy aimed at eliminating vitamin K deficiency. Late presentation significantly worsens the prognosis for the child in terms of neurological manifestations and life.

How is it diagnosed?

You can suspect the presence of a hemorrhagic disease in a child by the presence of characteristic external signs: the appearance of “bruises” on the skin even with slight pressure, petechial rash on the palate, increased bleeding in the area of ​​the umbilical wound or injection. Some children also develop yellowing of the skin, which is associated with bleeding in the digestive tract, breakdown of the blood and increased bilirubin levels.

For additional diagnostics A number of laboratory tests are indicated:

• general clinical blood test with platelet count;
• coagulogram and determination of prothrombin index;
• determination of bleeding time;
• APTT (activated partial prothrombin time).

Hemorrhagic disease of newborns is characterized by normal bleeding time and platelet count. However, clotting time and APTT are prolonged. At prolonged bleeding a decrease in hemoglobin and red blood cell count may be detected.

Availability intracranial hematoma determined using neurosonography. If intra-abdominal bleeding is suspected, it is indicated endoscopic examination, ultrasound scanning of the abdominal organs.

According to modern clinical guidelines The main method of treating hemorrhagic disease of newborns is injections of vitamin K3 (Vikasol). The medicine is administered intramuscularly, the dosage is calculated by the neonatologist individually based on the child’s weight, the maximum daily dose is no more than 4 mg. The medicine is prescribed once a day, the duration of treatment usually does not exceed three to four days.

Additionally, if necessary, the following medications and blood products are used:

• fresh frozen plasma;
• red blood cell mass;
• plasma expanders;
• prothrombin complex (“UMAN-complex D.I.”);
• drugs to maintain cardiovascular activity.

In severe cases of the disease and the presence of complications, treatment of hemorrhagic disease of the newborn is carried out in the intensive care unit. The presence of intracranial hemorrhage with symptoms of dislocation of the midline structures of the brain requires urgent surgical intervention and removal of the hematoma.

Forecast

If the disease is detected in the early stages and specific therapy is carried out, the prognosis is favorable. As a rule, relapses of hemorrhagic disease do not occur in the future.

Late stages of hemorrhagic disease of the newborn can cause complications in some children in the form of damage to the central nervous system. Less commonly, the disease ends in death.

Prevention

Preventive actions indicated primarily for children at risk:

• having varying degrees of prematurity;
• receiving antibiotic therapy;
• with birth injuries;
• born asphyxia or as a result of caesarean section;
• if the mother’s pregnancy proceeded with complications;
• whose mothers suffered from liver diseases, dysbacteriosis, and took anticoagulants or antibacterial drugs.

In addition, prevention is also indicated for children who are bottle-fed. Although breast milk contains small amounts of vitamin K, it contains high levels of factors necessary for blood clotting. Therefore, children who do not receive breast milk require additional administration of artificial vitamin K.

In some European countries and the United States, prevention of hemorrhagic disease is mandatory for all newborns. In this case, vitamin K is given orally in a dose significantly higher than its content in breast milk. This introduction is repeated three times:

• in the first days after birth;
• on the fourth to seventh day;
• in the third to sixth week of life.

For newborns at risk, administration of vitamin K supplements is indicated even in the absence of obvious signs of hemorrhagic disease. "Vikasol" is administered intramuscularly for one to three days. The duration of treatment is determined individually according to the data laboratory parameters.

The consequences of hemorrhagic disease of the newborn can be quite serious and life-threatening for the child. With absence timely treatment the disease may cause severe complications with subsequent disability or even death. That is why it is so important to identify the pathology in a timely manner and start as early as possible. therapeutic measures.

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Hemorrhagic disease of the newborn

Unfortunately, even after a successful birth and a positive assessment of the baby’s condition by doctors, not everyone can hope that they will not have health problems. Some diseases appear a little later, but are very dangerous and insidious. For example, hemorrhagic disease of newborns can be diagnosed both by the third day after birth and more late period when mother and child are already at home. It can sometimes be very difficult to suspect this pathology, but it needs to be done, because with such a problem, life can count for minutes!

Features of the disease

The list of coagulopathies, or diseases related to disorders of the blood clotting system, does not include last place occupies the most serious pathology - hemorrhagic disease of newborns. It is a disease of recently born children, which is associated with increased bleeding of the skin and internal organs due to insufficiency of blood clotting factors, in particular due to vitamin K deficiency.

In most cases, coagulopathy, which belongs to the group of hemorrhagic diathesis, develops between the end of the first and the end of the third day after birth. As a result of a lack of vitamin K in the baby’s body, acute shortage coagulation factors (thrombin index factors) - II, VII, IX, C, S, X. Since the disease is directly related to the neonatal period, it is considered congenital. The incidence of hemorrhagic disease of newborns in different countries is 0.25-1.5%, but in last years in many countries, due to early parenteral administration of vitamin K, this figure has dropped to 0.01% or less.

Causes of the disease

Vitamin K in the body of any person is responsible for activating the phenomena of gamma-carboxylation of glutamic acid in coagulation factors, which are listed below:

• prothrombin (II);
• proconvertin (VII);
• antihemophilic globulin B (IX);
• Stewart-Prower factor (X).

Also, the role of vitamin K is great in the proteins of the anticoagulant system (C, S), in osteocalcin and many other proteins. If this vitamin is not enough in the child’s body, then the thrombin index factors remain inactive and cannot bind calcium and carry out the blood clotting process. Early forms of hemorrhagic disease of newborns are associated with the fact that vitamin K very poorly penetrates the mother’s bloodstream through the placenta, so initially there is not enough of it in the newborn’s body (only 50% of the required value). Only by 3-5 days from birth does vitamin K begin to be actively produced by microorganisms inhabiting the intestines. Before this period, the prothrombin time may be prolonged, as well as the activated partial thromboplastin time, which causes the appearance of symptoms of hemorrhagic disease of the newborn.

However, the frequency of this disease is quite low, that is, the triggering of the mechanism of coagulopathy does not occur in all newborns. In healthy children, even taking into account the low content of vitamin K in the body, the hemostasis system works stably. Early forms of pathology arise, as a rule, under the influence of factors related to events or diseases of the mother’s body during pregnancy. The main ones are listed below:

• taking Aspirin, NSAIDs;
• long-term treatment indirect anticoagulants;
• taking anticonvulsants and certain broad-spectrum antibiotics;
• carrying out specific treatment tuberculosis;
• intestinal dysbiosis;
• liver diseases;
• enteropathy;
• gestosis;
• a serious decrease in estrogen levels.

Also, hemorrhagic disease of the newborn occurs more often in premature babies born at the wrong time. In such babies, the liver's production of PPPF - polypeptide precursors of plasma blood coagulation factors - is reduced. This can happen with some liver diseases - hepatitis, biliary atresia. In addition, there is late hemorrhagic disease, which is caused by a number of pathogenic factors on the part of the child’s body. So, the synthesis of vitamin K may be impaired, which happens for the following reasons:

• long-term parenteral nutrition;
• malabsorption syndrome;
• taking vitamin K antagonist drugs, for example, Neodicoumarin, Coumarin;
• intestinal immaturity;
• late breastfeeding;
• artificial feeding;
• taking broad-spectrum antibiotics, especially 3rd generation cephalosporins;
• perinatal hypoxia;
• birth by caesarean section;
• asphyxia during childbirth;
• birth injuries.

Despite the fact that breast milk contains an insufficient amount of vitamin K for the child’s body, early breastfeeding seriously reduces the likelihood of developing hemorrhagic disease of newborns, since lactation promotes an earlier colonization of the intestines with microflora and the beginning of the production of this substance directly in the child’s body.

Classification and symptoms

The classification of hemorrhagic disease of newborns includes two types:

1. Primary hemorrhagic disease. Occurs when the child’s blood levels of vitamin K are initially low.
2. Secondary hemorrhagic disease. Includes a violation of the production of PPPF blood clotting due to liver disease and other pathologies and risk factors.

In addition, the disease is divided into three forms:

1. The early form occurs on the 1st-2nd day of a child’s life and is characterized by high tissue bleeding.
2. The classic form develops on the 3rd-5th day of a baby’s life, bleeding appears by this time.
3. The late form is possible from the 2nd to the 8th week after the birth of the child; its consequences can be very serious, as they most often include hemorrhages in the brain and internal organs.

The early form of the disease develops very difficult. Usually it appears immediately after birth, no later than the end of the first or second day. It most often manifests itself in the form of cutaneous hemorrhagic syndrome - rashes with hemorrhages on the buttocks, and sometimes throughout the skin. If the pathology began in utero, after birth, swelling is noticeable on the baby’s head - cephalohematomas, on which pinpoint hemorrhages- petechiae. Blood is also observed in the child's stool, bloody vomiting (hematemesis) and melena - black blood-colored stool - are possible. Severe manifestations early form The disease can become pulmonary hemorrhages, hemorrhages in the skull, spleen, liver, adrenal glands. The amount of hemoglobin in the blood drops, and anemia develops.

Symptoms of the classic form of the disease may be:

• weakness, lethargy of the child;
• cutaneous hemorrhagic syndrome, the appearance of bruises, petechiae and ecchymoses on the skin;
• umbilical bleeding when the remainder of the umbilical cord falls off, bleeding that does not stop after circumcision of the foreskin;
• edematous-hemorrhagic syndrome - swelling on the head and body with areas of hemorrhage;
• recurrent nosebleeds;
• bloody vomiting, the appearance of blood in the stool (intestinal bleeding) against the background of the formation of ulcers and erosions in the small intestine;
• increased bilirubin due to the breakdown of red blood cells in the blood and intestines;
• intracranial hemorrhages with neurological symptoms;
• shortness of breath, cough with bloody streaks, reflecting pulmonary hemorrhages;
• symptoms acute abdomen against the background of hemorrhages in the liver;
• lack of appetite, decreased motor activity, back pain due to hemorrhages in the adrenal glands;
• the appearance of blood in the urine due to bleeding in the kidneys;
• severe anemia.

Typically, the most severe hemorrhages and hematomas in the brain appear in children who were born prematurely, with severe hypoxia, or birth injuries. Babies with liver pathologies and other serious abnormalities in the digestive system may develop a late form of hemorrhagic disease of newborns. As a rule, it occurs no later than the end of the second month of the baby’s life, but cases of the development of pathology within 10-12 weeks have been recorded. In half of the patients, the disease begins with intracranial hemorrhage, which is preceded by large and multiple, but sometimes small, single bruises on the skin. Others possible symptoms:

• bleeding into internal organs;
• melena - blood in stool;
• vomiting blood;
• extensive hemorrhages in the mucous membranes and skin;
• hematuria;
• anemia;
• cephalohematomas;
• bleeding from the injection area.

Thus, the development of a hemorrhagic disease should be suspected when bruises are detected on the baby’s body, especially on the chest, because a child of this age could not hit himself. You also need to urgently call an ambulance if, after taking blood for analysis, the child’s finger continues to bleed for a long time, which with 100% accuracy reflects the presence of any problems with blood clotting. Within a few hours or a couple of days initial symptoms will develop into more severe problems, so the importance of early consultation with a doctor is undeniable.

Possible complications

The danger and severity of this disease is very high. The risk is especially serious in the late form of the pathology, which develops when the child is outside the walls of the maternity hospital without the supervision of doctors, and its initial symptoms can be erased and blurred. It is in the late form that intracranial hemorrhages cannot be avoided if treatment is not started as early as possible. The difficulty of recognizing hemorrhagic disease of newborns in the late form and its rarity causes high mortality at this stage, because not every local pediatrician is familiar with the symptoms of the disease.

Possible complications of hemorrhagic disease of newborns may include:

• hypovolemic shock;
• drop in blood pressure and temperature to critical levels;
• ischemic necrosis of the skin of the legs, arms, abdomen;
• severe hemorrhages in internal organs up to their dysfunction and cessation of work.

The prognosis for recovery is favorable only in mild forms of pathology and early start treatment. If the functioning of the lungs, heart, kidneys and other organs is impaired, with serious blood loss and cerebral hemorrhage, the prognosis is poor and the risk of death is high.

Diagnostic methods

When conducting an examination and physical examination, the doctor pays attention to the presence of cutaneous hemorrhagic syndrome in the form of hemorrhages and pinpoint petechiae, hematomas. Other signs of bleeding are possible - melena, bloody vomiting, etc. Instrumental examinations of the child usually include ultrasound of the kidneys, liver, adrenal glands, neurosonography, and ultrasound of the heart.

Diagnosis can be confirmed laboratory research blood. Characterized by an increase in blood clotting time (PT - prothrombin time, APTT - partial thromboplastin time), the platelet count is increased or close to normal, it is noted normal time bleeding (TV - thrombin time). Anemia is also detected - a decrease in the number of red blood cells, hemoglobin, and hematocrit. By 2-3 days of hemorrhage, anemia can be pronounced.

It is mandatory to differentiate hemorrhagic disease of newborns from other anomalies and pathologies of the first days of life. Thus, melena should be distinguished from the child ingesting the mother’s blood during childbirth, which occurs in 30% of children with blood in the stool in the first day of life. To do this, feces or vomiting blood is taken for analysis using an Apta-Downer test. Water solution the raw materials are centrifuged, special reagents are added and the type of hemoglobin is determined. Hemoglobin type A is characteristic of the mother's blood, other cases are due to the presence of the child's blood.

Bleeding from the intestines when hemorrhagic disease of newborns is suspected is also differentiated from anorectal trauma, intestinal angiomatosis, papillomas, and other surgical problems. It is also necessary to distinguish the pathology from other hereditary (congenital) coagulopathies, from disseminated intravascular coagulation syndrome, and from thrombocytopenic purpura.

Treatment methods

Treatment methods for hemorrhagic disease of newborns should be used in combination, and the start of therapy is practiced from the first minutes after the appearance of the first signs of the early or classic form of the pathology. The following treatment methods are used:

1. Feeding the baby up to 7-8 times a day with expressed breast milk from the mother is normal, corresponding to age requirements. If the pathology is accompanied by thrombocytopenic purpura, then feeding is continued for at least 3 weeks.
2. Intravenous administration of vitamin K, in mild cases intramuscular administration. The dosage is 1-2 mg, the interval of use is every 12 hours.
3. Administration of Vikasol, a hemostatic drug (replaces the use of vitamin K, but is less effective). Dose - from 2 to 5 mg. in 12 hours.
4. For recurrent bleeding - intravenous transfusion of fresh or frozen plasma, administration of prothrombin complexes PP5B (Prothromplex, Octaplex).
5. Infusion of sodium bicarbonate solution, thrombin solution with aminocaproic acid, non-caproic acid solution with Adroxon solution.
6. Treatment ascorbic acid, Rutin, calcium gluconate, calcium chloride, calcium pantothenate.
7. If necessary, glucocorticosteroids and antibiotics are introduced into the course of treatment.
8. If hypovolemic shock occurs, red blood cell transfusion and intensive infusion therapy are given.

All measures for the treatment of hemorrhagic disease of newborns are carried out under the constant supervision of a neonatologist.

What not to do

It is prohibited to administer excessive doses of hemostatic drugs due to the high risk of the appearance of Heinz bodies and the development of hyperbilirubinemia due to increased hemolysis of red blood cells. On the part of the child’s parents, under no circumstances should they hesitate to go to the hospital if even small bruises are detected on the baby’s skin and other alarming symptoms.

Preventive measures

To prevent pathology, all premature babies are administered 0.5 mg. vitamin K once after birth, and for children born on time and with normal weight body - 1 mg. intramuscularly or orally. It is especially important to administer the drug to children who were born with asphyxia and birth trauma, as well as from mothers whose pregnancy was accompanied by toxicosis, or the baby was infected in utero.

Early latching of the baby to the breast after birth is also a good prevention of the disease, but this method does not replace the administration of drugs to optimize blood clotting. If a woman has already given birth to children with hemorrhagic disease of the newborn from previous pregnancies, then they spend the entire gestational period under constant medical supervision, and before birth - in a hospital.

AtlasVen.ru

All about hemorrhagic disease of the newborn

Hemorrhagic disease of newborns in our time is quite a rare event. The early form of this disease occurs in a maximum of five cases out of a thousand, while the late form occurs even less often - up to twenty cases per hundred thousand. What causes hemorrhagic disease of the newborn? How does it manifest itself and what is it like? What are the consequences of early and late forms of the disease? How to treat this disease, and what is the prognosis? further development child after treatment? Is there an effective prevention of hemorrhagic disease of the newborn?

What's happened

Hemorrhagic disease of the newborn (HDN) is a disease characterized by poor blood clotting. There are two stages of the disease. The first - early - appears on the second or third day of the baby's life (less often - immediately after birth), while the late form occurs between the ages of one and four months (most clearly manifests itself at two or three months of age). The cause of this disease is a deficiency of vitamin K, which is responsible for blood clotting. If treatment is not started in time, the consequences can be quite dire - hemorrhages in the abdominal cavity, internal organs, and brain.

As a rule, timely surgical intervention, properly selected medication and further medical supervision ensure a complete recovery and a positive prognosis for the child’s development. If symptoms are not detected in time and a doctor is not consulted, hemorrhagic disease of newborns can lead to death.

Causes of the disease

The main reason The occurrence of hemorrhagic disease of newborns is a lack of vitamin K in the blood. But this is not the primary factor. The reasons leading to poor blood clotting in an infant may be the following:

• Metabolic disorders in the mother during pregnancy;
• Taking medications by the mother that affect metabolism;
• Premature birth;
• Childbirth by caesarean section.

This is the most common reasons early form of the disease. The late form is caused by liver failure, untimely breastfeeding, a poorly developed digestive system and, oddly enough, breastfeeding.

Who is most susceptible to the disease?

At risk are:

• premature babies;
• infants with birth injuries;
• children of mothers who took a complex of antibiotics during pregnancy;
• children whose mothers suffered from intestinal dysbiosis and late toxicosis during pregnancy;
• children born by caesarean section.

If a woman took medications that affect metabolism during pregnancy, the risk of hemorrhagic disease in the newborn increases. Vitamin K, which is responsible for blood clotting, does not pass well through the placenta, and poor metabolism can lead to its deficiency in the baby’s body.

Early form of hemorrhagic disease of newborns

Since the early form of GRBN occurs in the first days of a child’s life - that is, the period when the mother and baby are in the maternity hospital - the chances of a positive outcome are quite high. Based on its characteristic signs, the disease is recognized instantly, and treatment begins immediately. The symptoms indicating the presence of the disease are so obvious that it is difficult not to identify this disease, even despite the fact that it is among the rare ones. Bleeding wound in the navel area, vomiting and bloody bowel movements, nosebleeds, poor clotting blood after vaccination - all these symptoms in the first days of a baby’s life are alarm signal. If there is untimely intervention, the child may die from blood loss.

Early stage treatment

Treatment is carried out directly in the maternity hospital, and the mother’s main task is not to interfere with the actions of doctors and strictly follow all their recommendations. In especially severe cases - with large blood loss - the child is given a plasma transfusion. In most cases, Vikasol containing vitamin K is administered intramuscularly. The medicine is administered for 3-4 days, then the course is repeated with a break of the same 3-4 days. The baby is also given expressed breast milk, which contains hemostatic agents. As a rule, with timely intervention, treatment is successful, and the baby fully recovers and develops on par with his peers.

Late form: features

Much more dangerous is the late form of GRBN. The danger is that this disease is quite rare, and only an experienced pediatrician can accurately recognize it. Therefore, if you discover symptoms that may indicate hemorrhagic disease of the newborn, you should immediately call " ambulance" This is one of those cases when it is definitely better to be overprotective than underdressed.

Both premature babies and babies born in due date. The causes of the development of the disease are congenital or acquired weakness of the digestive system, untimely nutrition and... breastfeeding. Infants who are exclusively breastfed, along with their mother’s milk, “eat” flora, which does not cope well enough with the synthesis of vitamin K. In addition, despite the presence of thromboplastin in breast milk - a substance responsible for blood clotting - vitamin K itself is almost doubled in it less than in artificial milk formulas.

Symptoms of the late form

The following symptoms indicate problems with blood clotting in a child:

• The appearance of bruises, hematomas, bruises on the body;
• Increased bleeding;
• Gastrointestinal bleeding;
• Lethargy, weakness, painful pallor of the skin.

Uninformed parents often attribute the appearance of bruises to buttons on clothes or careless behavior of the child - hitting the crib with a hand or lying with his chest on a rattle. In fact, a bruise or hematoma can signal hemorrhagic disease of the newborn. When alarming symptoms It is necessary to consult a doctor immediately, since the consequences in the form of internal bleeding or cerebral hemorrhage can lead to disability or even fatal outcome. And these consequences can occur already on the second or third day after the appearance of bruises.

Treatment of late form

First of all, the baby is examined to clarify at what stage the disease is. If the disease is detected in a timely manner and no internal hemorrhages are detected, the child is prescribed a prothrombin complex, which increases blood clotting. In severe cases, surgery is performed, followed by drug treatment, medical supervision and rehabilitation period.

After this, the child may lag behind his peers in development for several weeks, but with proper therapy and the patience of the parents (as well as their compliance with doctors’ recommendations), the prognosis is quite favorable. The baby’s body is completely restored, he catches up with his peers in terms of development, and in the future the disease does not make itself felt at all.

Possible complications

In addition to internal hemorrhages, complications of hemorrhagic disease of newborns include weakness, a sharp decline blood pressure, drop in body temperature to subnormal levels. Doctors call all these symptoms hypovolemic shock. Complications also include the development of adrenal insufficiency and disruption of the cardiovascular system. All this can lead to death in severe cases, however, with timely intervention and proper therapy can be achieved full recovery.

Prevention

Direct prevention of hemorrhagic disease of newborns consists in the fact that infants at risk are given an intramuscular dose of Vikasol after birth (by the way, in America this measure is applied to all newborns, regardless of the degree of risk of developing hemorrhagic hemorrhagic disease). If necessary, the drug is administered once over two to three days. But the mother can (and should!) also take care of the health of the unborn child.

During pregnancy, it is necessary to adhere to a daily routine, diet, and avoid bad habits and do not take any medications without a doctor's prescription. If the pregnancy proceeds without complications and childbirth occurs naturally, then the likelihood that the baby will be born healthy and strong increases significantly. Simply put, the best prevention hemorrhagic disease of newborns is the mother’s concern for the health of her own and her unborn baby.

Anti-colic drug for newborns

Hemorrhagic disease of the newborn (HDN) is a hemorrhagic diathesis resulting from the inferiority of blood clotting factors, the activity of which is determined by the concentration of vitamin K in the body.

Causes

Hemorrhagic disease of newborns is diagnosed with a frequency of 0.25-1.5% in post-Soviet countries. In those countries where children are given vitamin K immediately after birth for preventive purposes, the incidence rate does not exceed 0.01%.

Based on the mechanism of development, primary and secondary GRBN are distinguished. Primary hemorrhagic disease of the newborn is caused by a violation of the synthesis of blood coagulation factors due to a lack of vitamin K. The tendency to develop pathology in the first days of life is associated with a natural deficiency of vitamin K, which occurs for the following reasons:

• its synthesis occurs in the intestines, the microflora of which in the child is in the process of formation;
• vitamin K practically does not penetrate the placenta;
• Breast milk contains very little of it - 2 mcg/l.

But to start pathological process these factors are not enough. Hemorrhagic disease of newborns, as a rule, develops in the presence of certain prerequisites. Among them:

• taking during pregnancy indirect anticoagulants, anticonvulsants and broad-spectrum antibiotics;
• gestosis, toxicosis;
• liver diseases and chronic non-inflammatory intestinal pathologies in the expectant mother.

The causes of secondary hemorrhagic disease of newborns are a decrease in the production of PPPF (polypeptide precursors of plasma factors) of blood coagulation, which occurs in the liver. In addition, the pathology can be caused by the administration of coumarin and neodicoumarin (vitamin K antagonists).

The main factors on the part of the child that can provoke a decrease in the synthesis of PPPF and a lack of vitamin K:

• prematurity;
• hypoxia;
• long-term intravenous nutrition;
• late breastfeeding;
• deterioration in the absorption of microelements in the intestine due to dysbiosis or malabsorption syndrome;
• diseases of the pancreas, liver, biliary tract, intestines;
• antibiotic treatment.

Pathogenesis

Hematological functions of vitamin K:

• activation of the processes of gamma-carboxylation of excess glutamic acid in prothrombin (blood coagulation factor II), proconvertin (VII), antihemophilic globulin B (IX) and Stuart Prower factor (X);
• stimulation of plasma proteins C and S, which are involved in coagulation mechanisms.

With vitamin K deficiency, passive factors II, VII, IX and X are formed in the liver: they are not able to bind calcium and participate in blood clotting. As a result, the prothrombin and activated partial thromboplastic time is prolonged, which manifests itself in the form of an increased tendency to bleeding. This is how hemorrhagic disease of newborns develops.

Symptoms

Depending on the specifics clinical picture There are early, classic (typical) and late forms of hemorrhagic disease of newborns.

The early version of the pathology is rare and is characterized by the manifestation of symptoms during the first day of the child’s life. Main manifestations:

• hemorrhagic spots (hemorrhages) on the skin, especially in the buttocks;
• cephalohematoma - an accumulation of blood between the periosteum and the skull, on the surface of which pinpoint hemorrhages (petechiae) are visible;
• bleeding in the lungs;
• hemorrhages in the spleen, liver, adrenal glands;
• hematemesis - vomiting blood;
• intracranial hemorrhages;
• anemia.

Signs of hemorrhages in internal organs:

• brain – the appearance of neurological disorders;
• lungs – shortness of breath, blood in sputum discharged when coughing;
• liver – increase in its size, abdominal pain;
• adrenal glands – weakness, decreased activity, refusal to eat.

Classic hemorrhagic disease of newborns develops 2-4 days after birth. Its symptoms are similar to those of the early form. Added to them:

• hemorrhagic spots on the skin throughout the body;
• bleeding from the nose and navel;
• melena – intestinal bleeding that occurs due to the formation of ulcers on the intestinal mucosa and is diagnosed when blood is detected in the stool;
• hemorrhage in the kidneys, accompanied by the appearance of blood in the urine.
• uterine bleeding.

As a rule, bleeding is not profuse. But in severe cases, blood is released continuously. Without help, the child may die from shock as a result of blood loss.

Late hemorrhagic disease of newborns begins at 2-8 weeks of a child’s life. Its signs:

• bruises on the epithelial membranes and skin;
• internal hemorrhages;
• intestinal bleeding;
• blood in vomit;
• cerebral hemorrhages;
• severe anemia.

A possible consequence of hemorrhagic disease of the newborn - which occurs as a result significant loss blood and anemia (hemoglobin level decreases by 2-3 times). It is accompanied by pallor, weakness, decreased blood pressure and impaired thermoregulation.

Diagnostics

Hemorrhagic disease of the newborn is diagnosed based on clinical symptoms and laboratory tests.

Main research:

• blood test - allows you to detect a decrease in the concentration of hemoglobin and red blood cells, as well as a normal platelet count;
• urine and stool tests show blood impurities;
• check of the coagulation system (coagulogram) - demonstrates prolongation of prothrombin and activated partial thromboplastic time with normal level thrombin time;
• assessment of blood clotting time – increased (more than 4 minutes);
• bleeding time calculation is normal (2-4 minutes).

Instrumental methods that make it possible to identify internal hematomas and bleeding:

• neurosonography;
• Ultrasound of the abdominal cavity and retroperitoneal zone.

Hemorrhagic disease of newborns is differentiated from hemophilia, von Willebrand disease, thrombocytopenic purpura and thrombasthenia.

In addition, bloody vomiting and melena can be the consequences of a child swallowing maternal blood. This is checked using the Apta test. Water is added to the biomaterial sample and it is centrifuged. Then a sodium alkali solution is dripped into the liquid and the color reaction is monitored: yellow-brown coloring indicates the presence of age-related hemoglobin from the mother’s blood, and pink coloring indicates the presence of fetal hemoglobin from the child’s blood.

Treatment

The basis for the treatment of hemorrhagic disease of newborns is the replenishment of vitamin K deficiency. The drug “Vikasol” in the form of a solution is most often used. It is an artificial analogue of vitamin K.

A 1% vitamin solution is administered intramuscularly or intravenously for 2-3 days. The approximate dose is 0.1-0.15 ml per 1 kg of child’s weight. Injections or infusions are carried out once a day. During therapy, hematological parameters are monitored, in particular, changes in blood clotting factors dependent on vitamin K are assessed.

During treatment, it is important to control the dosage of vitamin K. If it is in excess, complications may occur:

• anemia with intracellular inclusions;
• increased bilirubin levels, which can cause kernicterus;
• hemolytic anemia.

In case of severe bleeding, to compensate for blood loss, a bolus (rapid) intravenous transfusion of one of two drugs is performed:

• fresh frozen plasma – 15 ml/kg;
• concentrated prothrombin complex – 30 units/kg.

To eliminate the consequences of a decrease in hemoglobin, a transfusion of red blood cells (5-10 ml/kg) is performed. In addition, glucocorticoids may be prescribed to strengthen the capillary walls, vitamin A and calcium gluconate.

In case of hemorrhagic disease of newborns, breastfeeding should not be stopped. If the child is very weak or is separated from the mother, he is fed expressed milk based on age needs. Breast milk contains thrombokinase, a substance that has a hemostatic effect.

Forecast

Uncomplicated HRBN has favorable prognosis given that adequate treatment. As a rule, in the future the pathology does not transform into other hemorrhagic diseases.

The risk of death occurs when:

• massive bleeding;
• disruption of the heart;
• development of adrenal insufficiency;
• hemorrhages in the brain.

Prevention

Prevention of hemorrhagic disease of newborns consists of preventive administration of vitamin K. The dosage for the “Vikasol” solution is 0.1 ml/kg. The treatment regimen is 1 time per day for 1-3 days.

Vitamin K is administered to children at risk, including:

• born significantly prematurely;
• receiving antibiotics;
• those on parenteral nutrition;
• suffered birth trauma, hypoxia or asphyxia;
• born by caesarean section.

In addition, newborns are at risk if during pregnancy a woman:

• took anticoagulants, antibiotics, antituberculosis or anticonvulsants;
• suffered from gestosis due to estrogen deficiency, enteropathy, hepatopathy or intestinal dysbiosis.

In these cases, vitamin K can be prescribed to expectant mothers shortly before and after childbirth.

In addition, early breastfeeding and natural feeding are considered preventive measures for GRBN.