Vitamin K Deficiency Bleeding

Overview and Considerations

Caroline W. Burke, MSN, RN, CPNP

Disclosures

J Pediatr Health Care. 2013;27(3):215-221. 

In This Article

Hospital Course

Shortly after arrival in the pediatric intensive care unit, the infant became difficult to arouse, and he began having apneic episodes lasting up to 30 seconds with associated oxygen desaturation. He was intubated and supported by invasive mechanical ventilation, along with continuous sedative infusions of morphine and midazolam. A femoral central venous catheter was placed, and dextrose 5% with 0.9% normal saline solution was administered to deliver maintenance fluids.

Although an ICP monitor was not yet in place, 3% hypertonic saline solution boluses were administered to maintain the infant's serum sodium at 145 to 150 mEq/L with the goal of decreasing any possible intracranial hypertension. The head of the infant's bed was kept at 30° elevation, his temperature was maintained 36° to 37°C with a cooling blanket, acetaminophen was scheduled every 6 hours, and he was kept on nothing by mouth status. Keppra was administered for seizure prophylaxis. Follow-up coagulation studies revealed a normalized PT of 14.5 seconds, a PTT of 32.6 seconds, and an international normalized ratio of 0.98 (normal, 1.0). In light of the infant's history, corrected coagulation studies, and normal platelet and fibrinogen levels, he was diagnosed with vitamin K deficiency bleeding (VKDB).

On hospital day 2, the infant underwent an emergent craniotomy after an acute decompensation in which his left pupil became fixed and dilated and he experienced the onset of clinical seizure activity. The left frontal hemorrhage was evacuated in the operating room, an ICP bolt was placed, and Fosphenytoin was administered for seizure management. He received numerous blood products intraoperatively. A continuous electroencephalogram was placed, which revealed subclinical seizure activity. The child's midazolam drip was increased, and Topiramate and Phenobarbital were administered, which led to a cessation in seizure activity by hospital day 4. He briefly required inotropic support for hypotension. Magnetic resonance imaging and magnetic resonance angiography of the brain on hospital day 7 revealed no vascular abnormalities or new hemorrhage or injury, although he was noted to have decreased movement on his right side. The infant was extubated on hospital day 11 and subsequently was able to breastfeed. He was discharged home on hospital day 17.

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