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Intracranial hemorrhage in infants as a serious, and preventable consequence of late form of vitamin K deficiency: a selfie picture of Turkey, strategies for tomorrow

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Abstract

Purpose

Vitamin K deficiency bleeding is one of the most common causes of acquired hemostatic disorder in early infancy. Although vitamin K is practiced routinely after every birth in Turkey, children with type of vitamin K deficiency bleedings (L-VKDB) can be encountered. We aimed to evaluate the clinical features of the children with L-VKDB reported from Turkey.

Methods

Between 1995 and 2013, 48 studies reporting 534 children with L-VKDB were evaluated in this study.

Results

Of the 534 reported children (178 girls, 356 boys), 486 (91 %) were extremely breastfed. The most common bleeding sites were intracranial hemorrhage, gastrointestinal, and umbilical in 414 (77.4 %), 33 (6.2 %), and 33 (6.2 %) children, respectively, and 35 (6.6 %) children had been diagnosed incidentally without any bleeding. The etiology of 399 (74.7 %) children were classified as idiopathic, whereas 135 (25.3 %) were secondary. Intramuscular vitamin K was administered in 248 (46.4 %), not administered in 228 (42.7 %), and the administration of vitamin K were not determined in 58 (10.9 %) children. The outcomes of Turkish cohort showed that 111 (20.8) children died, 257 (48.1 %) cases developed neurologic deficit (mainly epilepsy and psychomotor retardation), and only 166 (31.1 %) patients recovered without squeal.

Conclusions

The compliance of prophylactic measures in Turkey does not seem to be satisfactory. As a further measure of tomorrow, we vigorously emphasize that a national surveillance program may be initiated. An additional intramuscular dose or oral supplementation of vitamin K especially for exclusively breast-fed infants may reduce this catastrophic problem in our country.

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References

  1. Abuşoğlu Z, Arslankoylu AE, Ertug A, Uyar M, Unal S (2007) Geç tip Yenidoğanın hemorajik hastalığına bağlı olarak gelişen hemotoraks: olgu sunumu (Poster presentation in Turkish) 51. Türkiye Milli Pediatri Kongresi, 07-11 Kasım 2007, Girne, Turkish Republic of Northern Cyprus, 130

  2. Albayrak B, Omay B, Sencer A, Kırıs T (2002) Yenidoğanın geç hemorajik hastalığında görülen tekrarlayan hematom olgusu. (Poster presentation in Turkish) Türk Nöroşirürji Derneği 16. Bilimsel Kongresi, 03-08 Haziran 2002, İstanbul, Türkiye, 29

  3. American Academy of Pediatrics (1993) Vitamin K ad hoc task force: controversies concerning vitamin K and the newborn. Pediatrics 91:1001–1003

    Google Scholar 

  4. American Academy of Pediatrics Committee on Fetus and Newborn (2003) Controversies concerning vitamin K and the newborn. Am Acad Pediatr Comm Fetus Newborn Pediatr 112:191–192

    Google Scholar 

  5. American Academy of Pediatrics, Committee on Nutrition (1961) Vitamin K compounds and the water-soluble analogues: use in therapy and prophylaxis in pediatrics. Pediatrics 28:501–507

    Google Scholar 

  6. Arac E, Pekcan S (2011) Yenidoğanın geç hemorajik hastalığına bağlı 2 aylık olguda intrakranial kanama. (Poster presentation in Turkish) 55. Türkiye Milli Pediatri Kongresi, 12-16 Ekim 2011, Antalya, Turkiye, 151

  7. Aydinli N, Citak A, Calişkan M, Karaböcüoglu M, Baysal S, Ozmen M (1998) Vitamin K deficiency—late onset intracranial haemorrhage. Eur J Paed Neurol 2:199–203

    Article  CAS  Google Scholar 

  8. Bay A, Karaoglu O, Sivasli E, Leblebisatan G, Keskin M (2012) An infant with prolonged circumcision bleeding and unexplained coagulopathy. Indian J Hematol Blood Transfus 28:181–183

    Article  PubMed Central  PubMed  Google Scholar 

  9. Bolat A, Vurucu S, Tascılar E, Gursel O, Karaoglu A, Kurekci AE (2010) Late type vitamin K deficiency related with prolonged antibiotic therapy in a 7-month-old infant. UHOD—Uluslararası Hematol Onkol Derg 20:106–109

    Google Scholar 

  10. Bör O, Akgün N, Yakut A, Sarhuş F, Köse S (2000) Late hemorrhagic disease of the newborn. Pediatr Int 42:64–66

    Article  PubMed  Google Scholar 

  11. Burke CW (2013) Vitamin K deficiency bleeding: overview and considerations. J Pediatr Health Care 27:215–221

    Article  PubMed  Google Scholar 

  12. Caksen H, Odabaş D, Kaya A, Cesur Y, Kiymaz N, Etlik O, Turhan S (2005) Central diabetes insipidus following intracranial hemorrhage due to vitamin K deficiency in a neonate. Acta Paediatr Taiwan 46:42–45

    PubMed  Google Scholar 

  13. Calkavur S, Ural R, Agin H, Targan S, Vergin C, Bak M, Altihan F (2001) Yenidoğanın geç hemorajik hastaligi (Late Hemorrhagic disease of the newborn) (article in Turkish). Ege Pediatri Bulteni 8:195–200

    Google Scholar 

  14. Cekinmez M, Cemil T, Cekinmez EK, Altinörs N (2008) Intracranial hemorrhages due to late-type vitamin K deficiency bleeding. Childs Nerv Syst 24:821–825

    Article  PubMed  Google Scholar 

  15. Cengiz AB, Kanra G, Kara A, Ozen M, Konu M, Erdoğan I, Cetin M (2004) Back to the basics: hemorrhage after vaccination: a case report. Turk J Pediatr 46:259–261

    PubMed  Google Scholar 

  16. Cetin H, Istanbullu B, Tunc B (2005) Yenidoğan bebeklerde geç tip vitamin K yetersizliği kanamaları (Late onset vitamin K deficiency bleeding in newborn infants) (article in Turkish). Ege Pediatri Bulteni 12:77–82

    Google Scholar 

  17. Dallar Y, Tiras U, Catakli T, Gulal G, Sayar Y, Selvar B, Alioglu B (2011) Life-threatening intracranial bleeding in a newborn with congenital cytomegalovirus infection: late-onset neonatal hemorrhagic disease. Pediatr Hematol Oncol 28:78–82

    Article  PubMed  Google Scholar 

  18. Davutoğlu M, Guler E, Karabiber H, Garipardic M, Yuksel Z, Yuksel M (2010) A case of late hemorrhagic disease operated due to appearance of a cerebral mass. Turk Klin J Med Sci 30:1084–1086

    Article  Google Scholar 

  19. Demirören K, Yavuz H, Cam L (2004) Intracranial hemorrhage due to vitamin K deficiency after the newborn period. Pediatr Hematol Oncol 21:585–592

    Article  PubMed  Google Scholar 

  20. Demirören K, Yavuz H, Demirören S (2006) Intracranial hemorrhage due to vitamin K deficiency in an infant despite prophylaxis at birth. Fırat Üniv Sağlık Bilimleri Derg 20:327–329

    Google Scholar 

  21. Doneray H, Tan H, Buyukavci M, Karakelleoglu C (2007) Late vitamin K deficiency bleeding: 16 cases reviewed. Blood Coagul Fibrinolysis 18:529–530

    Article  PubMed  Google Scholar 

  22. Elalfy M, Elagouza I, Ibrahim F, Abdelmessieh S, Gadallah M (2014) Intracranial haemorrhage is linked to late onset vitamin K deficiency in infants aged 2-24 weeks. Acta Paediatr. doi:10.1111/apa.12598 [Epub ahead of print]

    PubMed  Google Scholar 

  23. Elli M, Cıtak EC, Tunaoglu FS, Serdaroglu A (2002) Çocuk kliniği yoğun bakım ünitesinde bir yıl içinde izlenen intracranial kanamalı olguların incelenmesi. (Analysis of the patients with intracranial hemorrhage followed up in pediatric intensive care unit during one-year-period.) (article in Turkish) Türkiye Klinikleri. J Pediatr 11:61–65

    Google Scholar 

  24. Erdem ZE, Akbas OT, Dursun O, Dulkadir R, Albayrak M, Aliefendioglu D (2012) Yenidoğanın hemorajik hastalığına bağlı intrakranial kanama. (Poster presentation in Turkish) 56th Turk Milli Pediatri Kongresi, 28 Kasım-02 Aralık 2012, Girne, Turkish Republic of Northern Cyprus, 151

  25. Erol M, Baysoy S, Ozturk B, Oner A, Kutanis A, Barut K, Mermercan L, Baysoy N (2009) Ağır bir klinik tabloda gelen ve sekelsiz iyileşen bir yenidoğanın geç hemorojik hastalığı. (Poster presentation in Turkish) 53. Türkiye Milli Pediatri Kongresi, 21-25 Ekim 2009, Muğla, Turkiye, 149

  26. Erol FS, Ozveren MF, Akdemir I, Topsakal C, Yakar H (2004) Yenidoğanda geç dönemde K vitamin eksikliğine bağlı oluşan kafa içi kanamalar. (Late-appearing intracranial hemorrhages due to vitamin K deficiency in newborns. (article in Turkish). Turk Nöroşirürji Derg 14:22–26

    Google Scholar 

  27. Ertekin V, Alp H, Altınkaynak S (2002) Yenidoğanın Geç Hemorajik Hastalığı: Beş Vakanın Değerlendirilmesi (Late hemorrahagic disease of the newborn: evaluation of five cases) (Article in Turkish). Çocuk Derg 2:273–276

    Google Scholar 

  28. Ertekin V, Selimoğlu MA, Gürsan N, Oztürk CF (2005) Image and diagnosis. Intracranial haemorrhage due to vitamin K deficiency, as the first symptom of extrahepatic biliary atresia. West Indian Med J 54:392–397

    Article  CAS  PubMed  Google Scholar 

  29. Eser O, Cosar M, Aslan A, Koken R, Aktepe F, Eser B (2008) Intracerebral hematoma complicated with brain abscess in an infant. Case report. Neurol Med Chir (Tokyo) 48:176–178

    Article  Google Scholar 

  30. Hatun S, Bereket A, Ozkan B, Coşkun T, Köse R, Calýkoğlu AS (2007) Free vitamin D supplementation for every infant in Turkey. Arch Dis Child 92:373–374

    Article  PubMed Central  PubMed  Google Scholar 

  31. Incecik F, Herguner MO, Sangun O, Ozcan K, Yildizdas D, Altunbasak S (2007) Intracranial hemorrhage related with late hemorrhagic disease of newborn. Erciyes Med J 29:31–34

    Google Scholar 

  32. İpek MS, Zenciroglu A, Ozkan M, Cınar HG, Aydın M, Okumus N (2012) Zamanında doğan bebeklerde kafa içi kanama; bir takip çalışması (Intracranial hemorrhage in full term infants; a follow-up study) (article in Turkish). J Curr Pediatr 10:8–91

    Google Scholar 

  33. Karapinar B, Yilmaz D, Arslan MT, Kavakli K (2004) Severe intracranial hemorrhage in healthy infants: importance of vitamin K prophylaxis. Ege Tıp Derg 43:29–32

    Google Scholar 

  34. Katar S, Özbek MN, Güzel A, Devecioğlu C, Ecer S (2006) Yenidoğanlarda K vitamin eksikliğine bağlı intrakranial kanama (Intracranial hemorrhage in newborns due to vitamin K deficiency) (article in Turkish). Çocuk Sağlığı ve Hastalıkları Derg 49:296–300

    Google Scholar 

  35. Kılıç I, Ergin H, Karaduman D, Akkoyunlu N, Aksit MA (1997) Yenidoğanın geç hemorajik hastalığı (Disease of the newborn due to vitamin K deficiency) (article in Turkish). Yeni Tıp Derg 14:90–92

    Google Scholar 

  36. Koc A, Cekin A, Sarraoglu S, Altuntas I, Iscan A (2006) Intracranial hemorrhagia due to late-onset vitamin K deficiency. 6th Turkish World congress of Pediatrics, 5-8 October 2006, Baku, Azerbaijan, 59–60.

  37. Koc A, Sarraoglu-Ercan S, Soker M, Cekin A, Varma M (2007) Geç K vitamin eksikliğinde klinik ve laboratuar bulguları ve hazırlayıcı nedenler (poster presentation in Turkish). 7. Ulusal Pediatrik Hematoloji Kongresi, 22-26 Mayıs 2007, Bursa, Turkey, Türk Çocuk Hematoloji Dergisi 1:154

  38. Korkut M, Özgen Ü, Kutlu O, Tabel Y (2001) Yenidoğanın geç başlangıçlı hemorajik hastalığına bağlı intrakraniyal kanama vakalarının sunumu (The presentation of the cases with intracranial bleeding due to late hemorrhagic disease of newborn) (article in Turkish). Inonu Üniv Tıp Fakültesi Derg 8:197–199

    Google Scholar 

  39. Kuloglu Z, Kansu A, Incesoy-Ozdemir S, Demirceken F, Erden E, Girgin N (2006) Ciddi kanamayla tanı alan alfa-1 antitripsin eksikliği olan bir olgu (A case of alpha-1 antitrypsin deficiency who had severe bleeding) (case report in Turkish). Turk Pediatri Arşivi 41:228–232

    Google Scholar 

  40. Loughnan PM, Mc Dougall PN (1993) Epidemiology of late onset haemorrhagic disease: a pooled data analysis. J Paediatr Child Health 29:177–181

    Article  CAS  PubMed  Google Scholar 

  41. Misirlioglu ED, Aliefendioglu D, Bademci G, Baydar Z, Kose G, Cakmak FN (2009) İnfantlarda K vitamin eksikliğine bağlı intrakraniyal kanama: Klinik ve radyolojik bulgular (Intracranial hemorrhage due to vitamin K deficiency in infancy: clinical and radiological findings) (Article in Turkish). J Neurol Sci (Turk) 26:18–25

    Google Scholar 

  42. Okan M, Hacimustafaoglu M, Tanrıtanır A, Koksal N, Eralp O (1995) Yenidoğanın geç hemorajik hastalığına bağlı intrakraniyal kanamalar (Neonatal intracranial hemorrhage due to vitamin K deficiency) (article in Turkish). Çocuk Sağlığı ve Hastalıkları Derg 38:203–209

    Google Scholar 

  43. Orbak Z, Selimoglu A, Doneray H (2003) Inherited vitamin K deficiency: case report and review of literature. Yonsei Med J 44:923–937

    PubMed  Google Scholar 

  44. Ören H, Kavaklı K, Ünüvar A, Uçar-Albayrak C, subcommittee of homeostasis and thrombosis of Turkish Pediatric Hematology Association, Koç A, Toksoy HB, Tunç B, Öner AF, Akarsu S, Patıroglu T, Gülen H, Özgen Ü, Sarper N, Yılmaz Ş, Gürgey A, Erduran E, Sipahi T (2007) Son iki yılda K vitamin eksikliğine bağlı kanama tanısıyla izlenmiş infantların değerlendirilmesi. (oral presentation in Turkish) 7. Ulusal Pediatrik Hematoloji Kongresi, 22-26 Mayıs 2007, Bursa, Turkey, Türk Çocuk Hematoloji Dergisi, 1:32

  45. Ozdemir MA, Karakukcu M, Per H, Unal E, Gumus H, Patiroglu T (2012) Late-type vitamin K deficiency bleeding: experience from 120 patients. Childs Nerv Syst 28:247–251

    Article  PubMed  Google Scholar 

  46. Ozen IO, Moralioğlu S, Karabulut R, Bagbanci B, Turkyilmaz Z, Demirogullari B, Sonmez K, Basaklar AC, Kale N (2008) Cefoperazone induced gastro-intestinal haemorrhage. A case report. Acta Chir Belg 108:777–778

    CAS  PubMed  Google Scholar 

  47. Peker E, Akcora B, Balci A, Karazincir S (2010) Life-threatening retroperitoneal hemorrhage due to late vitamin K deficiency. Pediatr Int 52:e89–e91

    Article  PubMed  Google Scholar 

  48. Per H, Arslan D, Gümüş H, Coskun A, Kumandaş S (2013) Intracranial hemorrhages and late hemorrhagic disease associated cholestatic liver disease. Neurol Sci 34:51–56

    Article  PubMed Central  PubMed  Google Scholar 

  49. Per H, Kumandaş S, Ozdemir MA, Gümüş H, Karakukcu M (2006) Intracranial hemorrhage due to late hemorrhagic disease in two siblings. J Emerg Med 31:49–52

    Article  PubMed  Google Scholar 

  50. Pirinccioglu AG, Gurkan F, Bosnak M, Acemoglu H, Davutoglu M (2011) Intracranial hemorrhage: clinical and demographic features of patients with late hemorrhagic disease. Pediatr Int 53:68–71

    Article  PubMed  Google Scholar 

  51. Shearer MJ (2009) Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev 23:49–59

    Article  CAS  PubMed  Google Scholar 

  52. Soylu H, Aslan Y, Sari A, Erduran E (1997) Intracerebral hemorrhage: a rare late manifestation of vitamin-K deficiency in a breastfed infant. A case report. Turk J Pediatr 39:265–269

    CAS  PubMed  Google Scholar 

  53. Sutor AH, Dagres N, Niederhoff H (1995) Late form of vitamin K deficiency bleeding in Germany. Klin Padiatr 207(3):89–97

    Article  CAS  PubMed  Google Scholar 

  54. Sutor AH, von Kries R, Cornelissen EAM, McNinich AW, Andrew M, ISTH Pediatric/Perinatal Subcommittee International Society on Thrombosis and Haemostasis (1999) Vitamin K deficiency bleeding (VKDB) in infancy. Thromb Haemost 81:456–461

    CAS  PubMed  Google Scholar 

  55. Totan M (2002) Adrenal hemorrhage due to vitamin-K deficiency. Indian J Pediatr 69:99–100

    Article  PubMed  Google Scholar 

  56. Turgut M, Yılmaz E, Kabakuş N, Aydınoğlu H, Taşkın E, Doğan Y, Aygün AD (2001) Yenidoganın hemorajik hastalığı ve intrakraniyal kanama: Dört vakanın değerlendirlmesi. (Hemorrhagic disease of newborn and intracranial hemorrhage: case report of four patients). Turk Klin J Pediatr 10:213–218

    Google Scholar 

  57. Türk HS, Oba S, Totoz T, Selçuk E, Paksoy I (2008) Yenidoğanın geç hemorajik hastalığı (Poster presentation in Turkish). 14. Ulusal Yoğun Bakım Kongresi, 23-27 Nisan 2008, Istanbul, Türkiye 19

  58. Türkmenoğlu Y, Taş BT, Türkkan E, Aydınol FN, Kafadar I, Adal SE (2012) Tek doz K vitamin Yenidoğanın geç hemorajik hastalığını önlemede yeterli bir proflaksi mi? İki olgu sunumu (Is single dose of vitamin K prophylaxis sufficient in newborn infant for prevention of hemorrhagic disease? Two case report) (article in Turkish). Okmeydanı Tıp Derg 28:162–166

    Article  Google Scholar 

  59. Ünal E, Karakükçü M, Yıkılmaz A, Doğanay S, Özdemir MA, Patıroğlu T, Coşkun A (2007) Geç tip K vitamin eksikliği olan hastalarda merkezi sinir sistemi görüntüleme bulguları. (poster presentation in Turkish) 7. Ulusal Pediatrik Hematoloji Kongresi, 22-26 Mayıs 2007, Bursa, Turkey, Türk Çocuk Hematoloji Dergisi 1(1):50

  60. von Kries R, Hanawa Y (1993) Neonatal vitamin K prophylaxis. Report of Scientific and Standardization Subcommittee on Perinatal Haemostasis. Thromb Haemost 69:293–295

    Google Scholar 

  61. Yilmaz C, Yuca SA, Yilmaz N, Bektaş MS, Caksen H (2009) Intracranial hemorrhage due to vitamin K deficiency in infants: a clinical study. Int J Neurosci 119:2250–2256

    Article  CAS  PubMed  Google Scholar 

  62. Zengin E, Sarper N, Türker G, Corapcioğlu F, Etus V (2006) Late haemorrhagic disease of the newborn. Ann Trop Paediatr 26:225–231

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank their colleagues for sharing their cases and to the National Societies of Pediatric Neurology, Pediatric Hematology and Neurosurgery for obtaining the poster presentations.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes University, 38039, Talas, Kayseri, Turkey

    Ekrem Unal, Mehmet Akif Ozdemir & Ebru Yilmaz

  2. Department of Pediatrics, Faculty of Medicine, Erciyes University, 38039, Talas, Kayseri, Turkey

    Serkan Ozsoylu

  3. Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Erciyes University, 38039, Talas, Kayseri, Turkey

    Ayse Bayram, Mehmet Canpolat & Huseyin Per

  4. Department of Neurosurgery, Faculty of Medicine, Erciyes University, 38039, Talas, Kayseri, Turkey

    Abdulfettah Tumturk

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  1. Ekrem Unal
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Correspondence to Huseyin Per.

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Unal, E., Ozsoylu, S., Bayram, A. et al. Intracranial hemorrhage in infants as a serious, and preventable consequence of late form of vitamin K deficiency: a selfie picture of Turkey, strategies for tomorrow. Childs Nerv Syst 30, 1375–1382 (2014). https://doi.org/10.1007/s00381-014-2419-2

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