RESUMO
Abstract Objective: To study the presenting clinical and demographic features, risk factors, and outcome of infants with late vitamin K deficiency bleeding. Methods: Over a 5-year study period, the presenting clinical features and outcome of all 47 infants observed aged less than 6 months, who were diagnosed with late-onset primary and secondary VKDB by detailed history, physical examination, and laboratory findings were evaluated. Confirmed primary late VKDB was diagnosed when no cause other than breastfeeding could be found, while in the secondary subtype additional risk factors compromising the vitamin K effect were diagnosed. Results: Secondary late VKDB (83%, 39 patients) was more common than the primary subtype. The mean age of patients was 10.50 ± 5.75 and 9.74 ± 6.04 weeks in primary and secondary VKDB subtypes, respectively, and the age of infants did not have a significant difference (> 0.05). The male to female ratio was 2.13:1. The residency, place and mode of delivery, gestational age, and types of feeding of patients did not have a significant difference between VKDB subtypes. The skin and gastrointestinal tract (GIT) (40.4%) followed by intracranial hemorrhage (ICH) (32%), were common sites of bleeding. Neurological complications were seen in 21% of patients; however, lethality was 23%, and the outcome of patients did not have a significant difference (p > 0.05) between VKDB subtypes. Conclusion: Secondary late VKDB is more common than the primary subtypes, and late VKDB is still a serious disease in developing countries, including Iraq, when vitamin K prophylaxis isn't routinely used at birth.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Sangramento por Deficiência de Vitamina K/complicações , Sangramento por Deficiência de Vitamina K/epidemiologia , Vitamina K , Aleitamento Materno , Estudos ProspectivosRESUMO
OBJECTIVE: To study the presenting clinical and demographic features, risk factors, and outcome of infants with late vitamin K deficiency bleeding. METHODS: Over a 5-year study period, the presenting clinical features and outcome of all 47 infants observed aged less than 6 months, who were diagnosed with late-onset primary and secondary VKDB by detailed history, physical examination, and laboratory findings were evaluated. Confirmed primary late VKDB was diagnosed when no cause other than breastfeeding could be found, while in the secondary subtype additional risk factors compromising the vitamin K effect were diagnosed. RESULTS: Secondary late VKDB (83%, 39 patients) was more common than the primary subtype. The mean age of patients was 10.50⯱â¯5.75 and 9.74⯱â¯6.04 weeks in primary and secondary VKDB subtypes, respectively, and the age of infants did not have a significant difference (pâ¯>â¯0.05). The male to female ratio was 2.13:1. The residency, place and mode of delivery, gestational age, and types of feeding of patients did not have a significant difference between VKDB subtypes. The skin and gastrointestinal tract (GIT) (40.4%) followed by intracranial hemorrhage (ICH) (32%), were common sites of bleeding. Neurological complications were seen in 21% of patients; however, lethality was 23%, and the outcome of patients did not have a significant difference (pâ¯>â¯0.05) between VKDB subtypes. CONCLUSION: Secondary late VKDB is more common than the primary subtypes, and late VKDB is still a serious disease in developing countries, including Iraq, when vitamin K prophylaxis isn't routinely used at birth.
Assuntos
Sangramento por Deficiência de Vitamina K , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Vitamina K , Sangramento por Deficiência de Vitamina K/complicações , Sangramento por Deficiência de Vitamina K/epidemiologiaRESUMO
Four-factor prothrombin complex concentrate is approved for use of life-threatening bleeding secondary to vitamin K antagonism in adults. We describe the use of four-factor prothrombin complex concentrate for hemostasis in a 6-week-old child with life-threatening vitamin K dependent-bleeding who never received vitamin K prophylaxis at birth.
Assuntos
Fatores de Coagulação Sanguínea/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Hemorragia Cerebral/tratamento farmacológico , Sangramento por Deficiência de Vitamina K/tratamento farmacológico , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Feminino , Humanos , Recém-Nascido , Injeções Intravenosas , Sangramento por Deficiência de Vitamina K/sangue , Sangramento por Deficiência de Vitamina K/complicaçõesRESUMO
El presente trabajo es producto de una revisión de la patogénesis, incidencia, tratamiento y pronóstico de la hemorragia intraventricular en el recién nacido prematuro. En las publicaciones revisadas, que incluyen series importantes de seguimiento, esta patología se presenta en 25% de los infantes menores de 1500 gramos de peso, en los que tanto la morbilidad como la mortalidad es mayor que los recién nacidos normales, ya que el desarrollo de la hemorragia intraventricular, puede producir alteraciones de flujo sanguíneo cerebral en la inmadura matriz germinal y en la red microvascular. En consecuencia la prevención de la hemorragia intraventricular está directamente relacionada con su patogénesis. Se pregona que el uso de esteroides tipo dexametazona en dosis bajas en el período prenatal y bajas dosis de endometacina en el período postnatal, pueden dar mejor neuroprotección. El tratamiento quirúrgico es excepcional y tiene indicaciones bien precisas, cuando se demuestra certeramente una hidrocefalia progresiva tardía. Por lo tanto en los neonatos prematuros con hemorragia intraventricular el mejor tratamiento actual, es el usar un sistema de seguimiento médico y farmacológico...(AU)
Assuntos
Humanos , Hemorragia Cerebral , Doenças do Prematuro/terapia , Sangramento por Deficiência de Vitamina K/complicações , Sangramento por Deficiência de Vitamina K/terapia , Mortalidade Infantil , Recém-Nascido , Indometacina/administração & dosagem , Indometacina/uso terapêuticoRESUMO
El presente trabajo es producto de una revisión de la patogénesis, incidencia, tratamiento y pronóstico de la hemorragia intraventricular en el recién nacido prematuro. En las publicaciones revisadas, que incluyen series importantes de seguimiento, esta patología se presenta en 25% de los infantes menores de 1500 gramos de peso, en los que tanto la morbilidad como la mortalidad es mayor que los recién nacidos normales, ya que el desarrollo de la hemorragia intraventricular, puede producir alteraciones de flujo sanguíneo cerebral en la inmadura matriz germinal y en la red microvascular. En consecuencia la prevención de la hemorragia intraventricular está directamente relacionada con su patogénesis. Se pregona que el uso de esteroides tipo dexametazona en dosis bajas en el período prenatal y bajas dosis de endometacina en el período postnatal, pueden dar mejor neuroprotección. El tratamiento quirúrgico es excepcional y tiene indicaciones bien precisas, cuando se demuestra certeramente una hidrocefalia progresiva tardía. Por lo tanto en los neonatos prematuros con hemorragia intraventricular el mejor tratamiento actual, es el usar un sistema de seguimiento médico y farmacológico...