Hemorrhagic syndromes in newborns, fortunately, are very rare. And the severe form of this disease is even rarer. But even these facts should not make you think that this will not affect you. After all, as you know, forewarned is forearmed. Therefore, it is worth looking closely at any symptoms in your baby in order to save his life and he alth. Read this article to learn more about this disease, as well as possible symptoms and treatments.
Hemorrhagic syndrome in newborns: what is it?
Hemorrhagic disease of the newborn is a congenital or acquired disease. It is characterized by increased bleeding resulting from a lack of certain clotting factors that 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 became even rarer - 0.01%.
This disease is manifested by 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 antihemorrhagic or coagulation factor. Vitamin K is a group of vitamins that are essential for protein synthesis and normal blood clotting. It is also significant in the metabolism of connective tissues, in bones and kidney function.
Deficiency of this vitamin develops as a result of impaired absorption of food in the intestines. This leads to incomplete formation of HLA radicals, which 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, such a deficiency can lead to cartilage ossification, bone deformity, or the deposition of s alts in the vessels. It has been proven that adults rarely suffer from a deficiency of this vitamin, since intestinal bacteria produce it in sufficient quantities. But in children, there are a number of reasons due to which skin hemorrhagic syndrome develops in newborns.
Vitamin K is found in the following foods: green tea, kale, spinach, wheat (bran), pumpkin, avocado, banana, 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. Alsoit is undesirable to use foods with vitamin K for people with thrombophlebitis, migraines, varicose veins, and people with high cholesterol.
Disease forms and symptoms
There are three forms of manifestation of hemorrhagic syndrome in newborns:
- Early form. The early form of this disease is characterized by such manifestations: in the first hours or days of a child's life, hematemesis, hemorrhages in organs (adrenal glands, spleen, liver) are observed. In addition, such a disease can begin in utero, and this will be detected at birth, when the child will have visible skin hemorrhages and intracranial hemorrhage. This form is very rare and usually results from the mother's medication.
- Classic shape. This form is manifested by hemorrhage on the second or fifth day of the child's life. In the classic form, nosebleeds, skin hemorrhages appear after circumcision of the flesh in boys or after the residual fragments of the navel fall off. Children who have suffered birth trauma and hypoxia are also at risk of intracranial bleeding, internal hematomas, etc. Ischemic skin necrosis due to thrombotic disorders may occur. According to medical institutions, this form of the disease is the most common.
- Late form. Late hemorrhagic syndrome of the newborn develops after two weeks of the baby's life. This happens against the background of past diseases. Manifested as intracranial bleeding(according to 50% of cases), as well as extensive hemorrhage, chalky (semi-liquid black stools with an unpleasant odor) and bleeding from the skin where the injections were made. 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 relationship with other ailments, in medicine, the types of bleeding are taken into account in the diagnosis. The following are distinguished:
- Hematoma. It often develops as a result of injuries and manifests itself in the form of bruises on the skin, joints, muscles. Because of these manifestations, various kinds of deformities are formed, as well as stiffness of the joints, severe fractures and contractures. Bleeding has a long-term nature of manifestations, and in the future, surgical intervention will be required. A similar ailment can be found in hemophilia.
- Vasculitis purple. Occurs as a result of inflammation of blood vessels caused by infection and disorders of the autoimmune system. Outwardly, it is represented by rashes all over the body, small bubbles that turn into scaly spots. If they appear on the gastric mucosa, they can cause severe hemorrhages, similar to a crisis. This type of bleeding can be with Henoch-Schonlein disease or infectious hemorrhagic fevers.
- Petechial spotted. It is manifested by asymmetrical arrangement of small petechiae. Large hematomas develop very rarely. Most often, these are 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 characteristic of disorders: thrombocytopathies, blood clotting, thrombocytopenic conditions and lack of fibrinogen.
- Angiomatous. It develops due to various kinds of angiomas, telangiectasias or arteriovenous shunts.
- Mixed. Appears due to hereditary abnormalities in blood clotting or an overdose of fibrinolytics and anticoagulants.
Pathogenesis. What's going on?
Primary hemorrhagic syndromes in newborns are primarily due to the fact that the fetus has a low content of vitamin K. Further, when the baby is born, a small dose of vitamin K comes from the mother's breast milk. But the dynamic production of this vitamin by the intestines will be realized only 3-5 days after birth.
Children born prematurely have a low level of synthesis of blood coagulation factors. In the late form of the disease, a blood clotting disorder occurs as a result of liver disease or malabsorption syndrome (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 (the release of stomach contents into the esophagus) and peptic esophagitis (heartburn, belching and drycough).
In addition, factors that can trigger the development of a late form of hypovitaminosis K can be: diarrhea (lasting more than 1 week), biliary atresia (congenital pathology), hepatitis and jaundice.
Reasons
Several possible causes of this disease have already been outlined above, so it's worth summarizing what has been said and adding a few factors. So, the causes of hemorrhagic syndrome in newborns can be:
- birth of a premature baby;
- mother's use of anticoagulants during pregnancy;
- malnutrition of the mother;
- use of antibiotics or anticonvulsants during pregnancy;
- enteropathy in the mother (violation or complete absence of the production of enzymes that are involved in the digestion of food);
- maternal hepatopathy (liver disease);
- intestinal dysbacteriosis;
- preeclampsia (late toxicosis of pregnant women);
- hepatitis in a child;
- malformations (improper structure of the biliary tract);
- malabsorption syndrome;
- lack of postpartum prophylaxis, administration of vitamin K analogs;
- artificial feeding of the baby;
- antibiotic therapy.
Primary diagnostics
Diagnosis of skin-hemorrhagic syndrome in newborns is carried out by clarifying the factors, andalso a detailed examination, examination of laboratory results. After taking the history, the pediatrician is expected to find:
- mother taking medication;
- malnutrition;
- diseases that can lead to hemorrhagic syndrome in a child.
In addition, the pediatrician asks questions about the first symptoms of the child's illness and the intensity of its manifestation. With hemorrhagic syndrome in newborns, the protocol is filled out after all kinds of body studies.
Then a physical examination is carried out, that is, an examination and assessment of the state of consciousness of the child, his physical activity. Such an examination will be able to determine hemorrhages on the skin, jaundice, as well as hemorrhagic shock.
Laboratory diagnostics
Laboratory studies are assigned to determine and evaluate hemostasis (the body's reactions, the function of which is to prevent and stop bleeding). The collection of analyzes includes:
- measurement of thrombin time (an indicator of blood coagulation);
- study of the amount of fibrinogen (participates in the completion of the blood coagulation process);
- checking the level of platelets (ensure blood clotting);
- determining the time of retraction of a blood clot (the process of compaction and contraction of blood);
- Measurement of blood clotting time according to Burker;
- determining the time of plasma recalcification (an indicator of the state of one of the stages of blood coagulation).
If the causes and consequences of hemorrhagic syndrome innewborns have not been identified, then an ultrasound is prescribed, which will reveal bleeding in the bones of the skull.
In addition, additional diagnostics may be prescribed:
- hereditary coagulopathy;
- thrombocytopenic purpura (a disease characterized by low platelet count);
- DIC (increased blood clotting due to active release of thromboplastic substances from tissues).
Treatment
Hemorrhagic syndromes in newborns are treated by introducing vitamin K analogs (also called vikasol) into the child's body. This 1% solution is administered to the child intramuscularly 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 fresh frozen plasma 10-15 ml per 1 kg of the baby's body.
If a child has hemorrhagic shock, then specialists carry out infusion therapy (introduction of a solution into the bloodstream after transfusion of fresh frozen plasma). After that, if necessary, the child is transfused with erythrocyte mass 5-10 ml/kg.
First Aid
First aid, as you know, can save lives, and with hemorrhagic syndromes in newborns - this is no exception. Recommended activities are:
- Stop the bleeding. To do this, you will need pressure bandages (if there is blood from the veins), anyice pack (in case of internal hemorrhage), turundas or swabs (if nosebleed), tourniquet (in case of arterial bleeding).
- Inject aminocaproic acid by jet or drip into a vein.
- Inject blood substitutes: dextran, saline or plasma preparation.
- Constantly monitor all indicators: breathing, body temperature, pulse and blood pressure.
- It is imperative that the child be hospitalized.
Forecast
When hemorrhagic syndrome in newborns, the consequences and prognosis 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, cases are described in medicine when a late-discovered disease leads to a complication of the syndrome and even death.
Consequences of illness
What are the consequences and how long to treat hemorrhagic syndrome in newborns? This will depend on how soon the parents paid attention to the external and internal changes in the child. Among the possible consequences, the most common ones can be distinguished:
- brain hemorrhages;
- adrenal insufficiency;
- heavy internal bleeding;
- disorders of the cardiac system;
Hypovolemic shock is also often a consequence, and it manifests itself in the form of increased body temperature, pallor of the skin, low blood pressure and general weakness.
To prevent all this, howonly the first signs of hemorrhagic syndrome appeared, it is imperative to consult a doctor as soon as possible.
Hemorrhagic syndrome in newborns - clinical guidelines
In order to avoid the most severe consequences of this syndrome, it is necessary to administer vikasol for prophylactic purposes to newborns who are at risk for the above reasons. This risk group includes children:
- if the mother was concerned about dysbacteriosis during pregnancy;
- surviving a difficult and traumatic birth;
- suffered asphyxia at birth;
- if the mother was taking medications that affect coagulation;
- those born by caesarean section.
If parents have hemorrhagic problems, then you need to follow a diet that must contain vitamins A, C, E (affect the strength of blood vessels) and K, vegetables, fruits and proteins. Try to avoid getting any kind of injury or other damage. Also, people with such a diagnosis should be frequently examined by doctors. If you are planning to have a baby, then you should go to a geneticist.
Everyone knows that it is best to take preventive measures and prevent the development of the disease than to be under the control of doctors all your life.
This article once again proves that all processes in the body, however it may be, are interconnected, and if one mechanism is broken, then others will not work correctly. The only thing that pleases is the fact that edematous-hemorrhagic syndrome in newborns is very rarely observed in critical condition and can be treated.
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