Haemorrhagic Disease Of The New-born- A case study

 

What is Haemorrhagic Disease Of The New-born?

Haemorrhagic Disease Of The New-born is when a baby starts having uncontrollable bleeding from multiple sites, such as the umbilical stump, nostrils, gums, injection sites, and circumcision sites. And if care is not taken, the baby could exsanguinate [bleed out and die].

You see, Vitamin K is a fat-soluble vitamin used by the liver to produce certain proteins [clotting factors II, VI, IX, and X; and proteins C and S] which helps the blood to form clots, preventing excessive bleeding.

Why give vitamin k to newborns?

Why give vitamin k to newborns

Have you been wondering why are newborns given an injection of vitamin k? New-borns are given a shot of Vitamin K at birth to prevent this terrible condition called Haemorrhagic Disease Of The New-born [HDN].

To paint a clearer picture, why you did not bleed out from that small cut you had from a kitchen knife while cooking, is because you were able to form a clot to stop that bleed. Why every sneeze, or cough, you have does not rupture blood vessels, and lead to bleeding from your nostrils, or bleeding into your lungs, is because you are able to form clots.

Get the picture now? Without the ability to form clots, we would all bleed to death, even from minor injuries.

Haemorrhagic Disease Of The New-born- Case study

This one day old new-born was brought to the hospital bleeding from multiple sites: the umbilical stump, the site were some injections were administered at birth, the nostrils, and gums. The doctor, who is covering the hospital in my absence, had tried to find a line without any success. So, he sent a nurse to come and inform me.

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The baby was nothing like what I had expected to see even in my wildest imagination. The baby’s skin and conjunctiva were completely drained of blood, so drained he was almost as white as snow. I have seen various degrees of anaemia in my practice– which involves managing mostly chronically ill patients who are prone to severe anaemia; but I have never seen anything close to what I saw today.

Despite the fact that he was already in haemorrhagic shock, he was still losing blood from multiple sites: he was bleeding into his skin, from the mouth and nostrils, from the sites were attempts were made for IV cannulation, and from the umbilical stump. The blood was so thin, with no evidence of an attempt at clotting.

I used a more appropriate cord clamp to clamp the umbilical stump, and applied pressure dressings at the other sites. Next was to secure a line. This was pretty difficult as all the veins, including the large scalp veins, had collapsed. The umbilical vessels could not be used, because they had already applied some concoctions that left them thrombosed. An attempt at intraosseous cannulation also failed– the low quality needles were just not strong enough to bore a hole through the child’s bones.

Finally, I found a vein on his left foot. By this time, the baby was in a coma, breathing with great difficulty, and hanging onto life by just a thread. With a 10ml syringe, I started giving him boluses of normal saline, with the aim of giving him as much 20mls for each kg of his body weight. After this, I corrected for hypoglycaemia with 5O% dextrose, in double dilution.

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The boluses of normal saline were able to bring him out of shock: I could now feel the pulses, and the heartbeat was strong. However, he was still in a bad shape as he needed the blood he had lost replaced.

He did not need just the red cells replaced; he desperately needed the platelets, as well as the clotting factors. Red Cell Concentrate, and Fresh Frozen Plasma would have been the ideal blood products to use and replace those. But hey, we are talking about a Community Hospital in rural Benue. So, I decided to use a Fresh Whole Blood– that is, a blood that was freshly donated– which would have fair quantities of all of the above.

Meanwhile, the baby’s temperature was dropping below normal. So, I put on my gas cooker, boiled hot water, and used it to fill plastic water bags. That was how we were able to keep the baby warm. Still right there in my house, with the baby on his mother’s lap, I started transfusing him with blood in aliquots of 5mls, at a more rapid rate than the norm.

At that point, I could not afford a blood transfusion reaction. So, even though the blood had been screened, grouped and crossmatched, I had to pre-medicate with IV Hydrocortisone.

2 hours later, that is 4 hours from the time they came to my house, we had finished transfusion, and the baby was pink again. He was still struggling to breathe and needed oxygen so bad, unfortunately, we did not have any. But I knew he would be alright. With new red cells in his bloodstream, to help ferry oxygen to vital organs, it was just a matter of time before the breathlessness resolved. Also, a matter of time before he regained consciousness.

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About the author

Doctor

Dr Chibuike Joseph Chukwudum is a doctor who Studied Medicine and Surgery at Nnamdi Azikiwe University Awka. He is the former Medical Officer at Oakland specialist hospital,obosi.He also previously worked at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.