Attached
Introduction: Haemorrhagic disease of new-born (HDN)
may easily be misinterpreted as Sudden infant death
syndrome (SIDS)., HDN is now considered as vitamin K
deficiency related bleeding. They are apparently healthy
and dying during sleep can be traumatizing to the family. It
further complicates, when it is found a treatable condition.
Allegation of child abuse also can be levelled against
parents due to unexpected bleeding. By making loose
diagnosis such as “SIDS, overlay, or undetermined”,
without considering all the possibilities, may lead to risk of
putting other siblings at risk of dying of treatable
conditions. The three cases discussed below, shows the
value of performing histopathology and make objective
diagnosis of HDN.
Case report: Unexplained sudden deaths of three
apparently healthy neonates occurred during sleep on 3rf,
4,h and 5th day after birth respectively. Antenatal and post
natal histories were unremarkable. Prophylactic vitamin K
had not been given prior to discharge. At autopsies,
evidence of bleeding tendency was found and there were
bleeding in to lungs. Cijj sections appeared dark and
histopathology revealed massive pulmonary haemorrhages.
Case 1-Fig. 1, 2, 3, 4 & 5 show bleeding at nose, puncture
sites, scalp and lung
If not for the two important findings, the presence of
massive lung haemorrhages in histopathology and the
absence of prophylactic Vitamin K injection after birth, the
postmortem diagnosis would have been “undetermined" or
SIDS, creating parental anxiety. Therefore, in this case,
ultimately, SIDS was excluded and the diagnosis of HDN
was made.
New bom infants are potentially at risk of developing
hemorrhage due to deficiency of vitaminK. Therefore, they
should be provided exogenous vitamin K through IM
injections prophylactically [lj.This is a standard practice in
Sri Lanka and failure to give vitamin K. prior to discharge
of these three children may amount to medical malpractice
and negligence.
Conclusions
The main difference between HDN and SIDS may only be
the histological diagnosis of significant lung haemorrhages
in infants who had not been given prophylactic vitamin K.
This reiterates the importance of performing histopathology
and make objective diagnosis of HDN and prevent HDN
deaths in the future.
