The role of vitamin K in the etiology, prevention, and treatment of hemorrhage in the newborn infant

Summary

Four cases of subclinical hemorrhagic disease are reported all associatedwith high prothrombin times. In each instance vitamin K concentrate administered by mouth in a few hours' time promptly reduced the prothrombin times to a safe and normal level.

One case of hemorrhagic disease of the usual variety is reported, in which vitamin K administered by mouth promptly stopped all bleeding and reduced the prothrombin time to a safe and normal level.

The hypothesis is advanced that marked prothrombin deficiency is the immediate cause of the syndrome now known as hemorrhagic disease of the newborn and that subclinical cases without spontaneous bleeding are of frequent occurrence. Evidence is presented in support of our suggestion that the prothrombin deficiency encountered at this age period is directly concerned with an insufficient amount of vitamin K.

This same condition of bleeding is probably present at birth and may in fact account for many instances of intracranial hemorrhage associated with normal labor and delivery.

The effect of vitamin K on prothrombin time and clotting time in a series of infants to whose mothers vitamin K has been administered previous to, and after the onset of, labor is described. The authors are encouraged to believe that when more cases have been studied, similar results will be shown in those infants vitamin K-treated through the mother and that intracranial bleeding associated with normal delivery can be materially lessened by such methods of preventive therapy.

In vitamin K concentrate an agent is now available which will preventand control unnatural bleeding associated with prothrombin deficiency and occurring in the neonatal period. Synthetic vitamin K (2-methyl-1, 4-napthoquinone) has been found to be equally efficacious.