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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e1-e6
DOI: 10.1055/a-2219-5024
Case Report

Severe Early-Onset Vitamin K Deficiency Bleeding in a Neonate Born to a Mother with Crohn's Disease in Clinical Remission: A Case Report

Chiho Ikenaga
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Ryosuke Uchi
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Fumihiko Ishida
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Michisato Hirata
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Kazuhiro Iwama
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Shinichiro Ina
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Yuko Tatsuno
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Takahiro Kemmotsu
1   Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
,
Jun Shibasaki
2   Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
,
Shuichi Ito
3   Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Abstract

Vitamin K deficiency bleeding (VKDB) in neonates is a significant disorder that causes skin, gastrointestinal, and intracranial hemorrhaging. Early-onset VKDB occurs within 24 hours of birth, and its prognosis is poor due to severe hemorrhage. The causes of early-onset VKDB include maternal intake of warfarin and anticoagulants, and maternal vitamin K deficiency. We report the case of a neonate with early-onset VKDB born to a mother with Crohn's disease. The neonate developed severe cerebellar hemorrhage on the day of birth and subsequent noncommunicating hydrocephalus requiring a ventriculoperitoneal shunt. The mother had a 14-year history of Crohn's disease and short bowel owing to intestinal resection. She was in complete remission during pregnancy according to the Crohn's Disease Activity Index. Endoscopic examination performed shortly before pregnancy revealed inflammatory findings in the residual small intestine. Her blood tests at delivery showed an elevated prothrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) level of 26,900 mAU/mL. A definitive protocol to prevent early-onset VKDB in mothers with Crohn's disease complicated by a short bowel is lacking. Administering vitamin K to mothers with elevated PIVKA-II levels before delivery may help prevent early-onset VKDB.

Keywords

cerebellar hemorrhage - Crohn's disease - PIVKA-II - short bowel syndrome - vitamin K deficiency bleeding


Publication History

Received: 06 October 2023

Accepted: 28 November 2023

Accepted Manuscript online:
29 November 2023

Article published online:
23 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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