Hayley Timm and Ann Anderson Berry
Background: A female neonate was born at 40 weeks and 5 days gestation via spontaneous vaginal delivery with no complications. At 6 hours of life she was noted to have respiratory distress and bloody emesis. Following a non-traumatic intubation on the first attempt, bright red blood was suctioned from the endotracheal tube and a pulmonary hemorrhage was diagnosed. Initial labs revealed a prolonged PTT and INR. The infant did not receive vitamin K prior to development of respiratory distress and admission to the neonatal intensive care unit due to parental refusal. Purpose: Vitamin K Deficiency bleeding in the neonatal period is a growing concern in the medical community as increasing numbers of parents are refusing vitamin K prophylaxis at birth. We herein report a complication of vitamin K deficiency that may be underreported in the literature. Case findings/Results: After initial decompensation including suspected gastrointestinal bleeding, respiratory distress requiring intubation, and pulmonary hemorrhage, the infant improved clinically, the PT corrected, and the hemorrhage subsided following vitamin K administration. Implications for practice: Pulmonary hemorrhage is not a commonly reported complication of early vitamin K deficiency bleeding, but health professionals should be aware of this as a potential complication of vitamin K prophylaxis refusal. Implications for research: More research is necessary to describe the incidence of pulmonary hemorrhage attributable to vitamin K Deficiency.
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