Vitamin K Deficiency Bleeding in Newborns

Diagnosis and Immediate Management

The American Academy of Pediatrics recommends administering vitamin K immediately (1 mg IM or IV) as this clinical presentation is diagnostic of vitamin K deficiency bleeding (VKDB) in newborns with normal PT and PTT 1
Normal PT and PTT with active bleeding in a newborn is pathognomonic for vitamin K deficiency because the coagulation cascade is still partially functional, but vitamin K-dependent factors (II, VII, IX, X) are critically depleted 1
If bleeding is life-threatening (intracranial, massive GI bleeding), immediately give fresh frozen plasma (FFP) 10-20 mL/kg in addition to vitamin K for immediate factor replacement, as recommended by the American College of Chest Physicians 2
FFP provides immediate coagulation factors while waiting for vitamin K to stimulate endogenous production, according to the American College of Chest Physicians 2, 3

Determine if vitamin K was given at birth, as compliance varies and some institutions do not mandate it, according to the American Academy of Pediatrics 1
Breast-feeding is a primary risk factor as breast milk contains insufficient vitamin K, as noted by the American Academy of Pediatrics 1

Rapid correction of PT/PTT within 30 minutes to 2-4 hours after vitamin K administration confirms VKDB, as stated by the American Academy of Pediatrics 1
Measurement of PIVKA (proteins induced by vitamin K absence) can confirm diagnosis retrospectively, according to the American Academy of Pediatrics 1

Never delay vitamin K administration waiting for coagulation studies, as the diagnosis is clinical and treatment is both safe and diagnostic, as recommended by the American Academy of Pediatrics 1
Do not assume vitamin K was given at birth without verification, according to the American Academy of Pediatrics 1