Intracranial hemorrhage due to late vitamin K deficiency in infants in Albania

Sažetak

With vitamin K prophylaxis, late vitamin K defi ciency bleeding disease (VKDB) has been reduced, but can still occur and in 50% of cases it presents with intracranial hemorrhage (ICH). We emphasize that vitamin K prophylaxis prevents the classical form of hemorrhagic disease and to a lesser extent prevents late VKDB. Our aim is to increase the awareness of late VKDB in all pediatricians. Data on seven infants treated for ICH due to late VKDB in Albania during January-December 2012 are analyzed. Diagnosis was made according to the International Consensus defi nition of VKDB. We evaluated clinical presentation, time to diagnosis, coagulation data, hospital course and outcome. During the one-year period, there was an increase in the incidence of late VKDB in Albania, presented with ICH in ≈20/100 000 live births, even with the vitamin K 1 mg i.m. prophylaxis in the fi rst hour of life. The most frequent presenting complaints were seizures (100%) and vomiting (42.8%). The most frequent examination fi ndings were coma (85.7%) and fontanelle bulging (71.4%). Radiologic fi ndings varied and included subdural (71.4%), parenchymal (14.3%) and intraventricular (14.3%) fi ndings. Only one patient underwent surgery for ICH evacuation. Delayed diagnosis was recorded in two cases (28.6%), both died. In conclusion, prophylaxis with vitamin K 1 mg i.m. at birth may be insuffi cient to prevent late VKDB. Pediatricians should keep in mind the probability of VKDB in infants because early recognition and management are important to decrease the mortality associated with VKDB.