Hemorrhagic syndrome in newborns: clinical recommendations

Fortunately, hemorrhagic syndromes in newborns are very rare. And the severe form of this disease is even less common. But even these facts should not make you think that it will not affect you. After all, as you know, warned means armed. Therefore, it is worth taking a look at any symptoms of your baby in order to preserve his life and health. From this article, you will learn more about this disease, as well as possible symptoms and treatment methods.

Hemorrhagic syndrome in newborns: what is it?

Hemorrhagic disease of the newborn is a congenital or acquired disease. It is characterized by increased bleeding, which appeared as a result of a lack of certain coagulation factors, which depend directly on the content of vitamin K.

The prevalence of this disease is 0.3-0.5% among all newborn babies. But after the introduction of vitamin K prophylaxis, such cases began to occur even less frequently - 0.01%.

This disease manifests itself with vomiting blood masses, skin hematomas, bloody stools and internal bleeding. Sometimes there is hemorrhagic shock, jaundice and erosion of the gastrointestinal tract.

Vitamin K and its function in the body

Vitamin K - it is also called anti-hemorrhagic or coagulation factor. Vitamin K is a group of vitamins that are necessary for the synthesis of proteins and ensure a normal level of blood coagulation. It is also significant in the metabolism of connective tissues, in bones and kidney function.

A deficiency of such a vitamin develops as a result of a violation of the absorption of food in the intestine. This leads to incomplete formation of GLA radicals that do not fully fulfill their function. As a result of a lack of vitamin K, the normal functioning of the circulatory system is disrupted. In addition, this drawback can lead to ossification of cartilage, bone deformation or the deposition of salts in the vessels. It is proved that adults rarely suffer from a deficiency of such a vitamin, since intestinal bacteria produce it in sufficient quantities. But children have a number of reasons because of which skin and hemorrhagic syndrome develops in newborns.

Vitamin K is found in foods such as green tea, cabbage, spinach, wheat (bran), pumpkin, avocado, bananas, kiwi, dairy products, eggs, and parsley.

But, for example, an excess of vitamin K will lead to an increase in the number of platelets, an increase in blood viscosity. It is also undesirable to use products with vitamin K for people with thrombophlebitis, migraines, varicose veins, and people with high cholesterol.

Forms of the disease and symptoms

There are three forms of manifestation of hemorrhagic syndrome in newborns:

1. Early form. For the early form of this disease, such manifestations are characteristic: in the first hours or days of a child’s life, bloody vomiting, hemorrhages in organs (adrenal glands, spleen, liver) are observed. In addition, such a disease can begin in utero, and it will be revealed at birth, when the child will see skin hemorrhages and intracranial hemorrhage. This form is very rare and usually occurs as a result of the mother taking medication.
2. The classic form. This form is manifested by hemorrhage on the second or fifth day of the child's life. In the classical form, nosebleeds, skin hemorrhages appear after circumcision in boys or after residual navel fragments fall off. Children who have suffered birth injuries and hypoxia are also at risk for intracranial bleeding, internal hematomas, etc. Coronary necrosis of the skin due to thrombotic disorders is possible. According to medical institutions, this form of the disease is the most common.
3. Late form. Late hemorrhagic syndrome of newborns develops after two weeks of a baby's life. This happens against the background of past illnesses. It manifests itself in the form of intracranial bleeding (according to 50% of cases), as well as extensive hemorrhage, melena (semi-liquid black stool with an unpleasant odor) and bleeding from places of the skin where the injections were given. In cases of complications, hemorrhagic shock may occur.

Classification by type of bleeding

Hemorrhagic syndrome in newborns is a rather serious disease. In order to determine its connection with other ailments, in medicine, when diagnosing, types of bleeding are taken into account. The following are distinguished:

1. Hematomic. Often develops due to injuries and manifests itself in the form of bruises on the skin, joints, muscles. Due to these manifestations, various kinds of deformations are formed, as well as joint stiffness, severe fractures and contractures. Bleeding is a long-term manifestation, and further surgical intervention will be required. A similar ailment can be found with hemophilia.
2. Vasculitis purple. It occurs as a result of vascular inflammation caused by infection and disorders of the autoimmune system. Outwardly, it is represented by rashes all over the body, small bubbles that transform into scaly spots. If they appear on the gastric mucosa, they can cause severe hemorrhages, similar to a crisis. This type of bleeding can occur with Shenlein-Genoch disease or infectious hemorrhagic fevers.
3. Petechial spotted. It is manifested by small petechiae asymmetric in location. Large hematomas develop very rarely. Most often it is bleeding from the gums, from the nose, blood in the urine and uterine bleeding in women. There is a risk of stroke. This bleeding is typical for disorders: thrombocytopathy, blood coagulation, thrombocytopenic conditions and a lack of fibrinogen.
4. Angiomatous. It develops due to various kinds of angiomas, telangiectasias or arteriovenous shunts.
5. Mixed. Appears due to hereditary abnormalities in blood coagulation or an overdose of fibrinolytics and anticoagulants.

Pathogenesis. What's happening?

Primary hemorrhagic syndromes in newborns primarily arise due to the fact that the fetus has a low vitamin K content. Further, when the baby is born, a small dose of vitamin K is delivered to the mother’s breast milk. But the dynamic production of this vitamin by the intestines will be realized only 3-5 days after birth.

Babies born prematurely have a low level of synthesis of coagulation factors. In the late form of the disease, a blood clotting disorder occurs as a result of a liver disease or malabsorption syndrome (a disorder of processes and functions in the small intestine).

Melena is one of the constituent manifestations of hemorrhagic disease in newborns. The causes of its occurrence are the formation of small ulcers on the gastric mucosa, increased acidity of the gastric juice, gastroesophageal reflux (discharge of the contents of the stomach into the esophagus) and peptic esophagitis (heartburn, belching and dry cough).

In addition, factors that can trigger the development of a late form of hypovitaminosis K can be: diarrhea (lasts more than 1 week), atresia of the biliary tract (congenital pathology), hepatitis and jaundice.

Causes

Several possible causes of this disease have already been stated above, so it’s worth summing up what has been said and adding several factors. So, the causes of hemorrhagic syndrome in newborns can be:

• the birth of a premature baby;
• maternal use of anticoagulants during pregnancy;
• poor nutrition of the mother;
• use of antibiotics or anticonvulsants during pregnancy;
• enteropathy in the mother (violation or complete absence of the production of enzymes that take part in the digestion of food);
• hepatopathy in the mother (liver disease);
• intestinal dysbiosis;
• gestosis (late toxicosis of pregnant women);
• hepatitis in a child;
• malformations (abnormal structure of the biliary tract);
• malabsorption syndrome;
• lack of postpartum prophylaxis, administration of vitamin K analogues
• artificial feeding of the child;
• antibiotic therapy.

Primary diagnosis

Diagnosis of skin and hemorrhagic syndrome in newborns is carried out by elucidating factors, as well as a detailed examination, a study of laboratory results. After collecting an anamnesis, the pediatrician is supposed to detect:

• mother taking medication;
• eating disorders;
• diseases that can lead to hemorrhagic syndrome in a child.

In addition, the pediatrician asks questions about the first symptoms of the child’s disease and the intensity of its manifestation. With hemorrhagic syndrome in newborns, the protocol is completed after various studies of the body.

Then a physical examination is carried out, that is, examination and assessment of the state of consciousness of the child, his motor activity. Such an examination will be able to determine hemorrhages on the skin, jaundice, as well as hemorrhagic shock.

Laboratory diagnostics

Laboratory studies are prescribed to determine and evaluate hemostasis (body reactions whose functions include preventing and stopping bleeding). The analysis collection includes:

• thrombin time measurement (an indicator of blood coagulation);
• study of the amount of fibrinogen (involved in completing the process of blood coagulation);
• platelet count (ensure blood coagulation);
• determination of the time of retraction of a blood clot (the process of compaction and contraction of blood);
• measurement of coagulation time according to Burker;
• determination of plasma recalcification time (an indicator of the state of one of the stages of blood coagulation).

If the causes and consequences of hemorrhagic syndrome in newborns have not been clarified, then an ultrasound scan is prescribed, which will reveal bleeding in the bones of the skull.

In addition, they can prescribe additional diagnostics:

• hereditary coagulopathies;
• thrombocytopenic purpura (a disease characterized by a decreased presence of platelets);
• DIC-syndrome (increased blood coagulation due to the active release of thromboplastic substances from the tissues).

Treatment

Treatment of hemorrhagic syndromes in newborns occurs by introducing vitamin K analogues into the child's body (it is also called vikasol). This 1% solution is administered intramuscularly to the child for 2-3 days once every 24 hours.

If the life of a newborn is threatened by bleeding and their intensity is high, then doctors administer a prothrombin complex preparation at the rate of 15-30 U / kg or freshly frozen plasma of 10-15 ml per 1 kg of the baby’s body.

If the child has hemorrhagic shock, then specialists carry out infusion therapy (introducing a solution into the bloodstream after transfusion of freshly frozen plasma). After, if necessary, the child is transferred a red blood cell mass of 5-10 ml / kg.

First aid

First aid, as you know, can save lives, and with hemorrhagic syndromes in newborns - this is no exception. The following activities are recommended:

1. Stop the bleeding. To do this, you need compressive dressings (if there is blood from the veins), any container with ice (for internal hemorrhage), turunds or tampons (if it flows from the nose), a tourniquet (for arterial bleeding).
2. Introduce aminocaproic acid in a vein or drip.
3. Pour in blood substitutes: dextran, saline or plasma preparation.
4. Constantly monitor all indicators: respiration, body temperature, pulse and blood pressure.
5. It is mandatory to hospitalize a child in a hospital.

Forecast

With hemorrhagic syndrome in newborns, the consequences and prognoses can be very favorable. That is, if a mild degree of the disease is observed, and timely treatment is provided, then the prognosis will be good. But, unfortunately, in medicine cases are described when a late-discovered disease leads to a complication of the syndrome and even death.

The consequences of the disease

What are the consequences and how long does it take to treat hemorrhagic syndrome in newborns? This will depend on how soon the parents turned their attention to the external and internal changes of the child. Among the various consequences, the most common are:

• cerebral hemorrhages;
• adrenal insufficiency;
• heavy internal bleeding;
• disorders of the heart system;

Often the consequence is also hypovolemic shock, and it manifests itself in the form of increased body temperature, pallor of the skin, low blood pressure and general weakness.

In order to prevent all this from happening, as soon as the first signs of hemorrhagic syndrome appear, you should definitely consult a doctor as soon as possible.

Hemorrhagic syndrome in newborns - clinical recommendations

In order to avoid the hardest consequences of this syndrome, it is necessary to introduce Vikasol to newborns for prophylactic purposes, who fall into the risk group for the above reasons. This risk group includes children:

• if the mother during pregnancy was concerned about dysbiosis;
• undergoing difficult and injured childbirth;
• undergoing asphyxiation during birth;
• if the mother took medications that affect coagulation;
• born due to cesarean section.

If parents have hemorrhagic problems, then you need to adhere to a diet in which vitamins A, C, E (affect the strength of blood vessels) and K, vegetables, fruits and proteins must be mandatory. Try to avoid all kinds of injuries or other injuries. Also, people with such a diagnosis need to be examined often by doctors. If there are plans to have a baby, then it's worth going to genetics.

Everyone knows that it is best to take preventive measures and prevent the development of the disease than to be under the supervision of doctors all their lives.

This article once again convinces that all processes in the body, however it may be, are interconnected, and if one mechanism is broken, then the others will work incorrectly. The only thing that pleases is the fact that edematous hemorrhagic syndrome in newborns is very rarely observed in a critical condition and can be treated.