Q 1:
Aweek-old infant presents blood in his stools. He was born at home, with the father assisting in the delivery; no physician or midwife was present. He has been breast-fed and has been nursing well. On examination, you also note some blood in his nose. He is not jaundiced; a rectal examination and guaic test of the stool
confirms that blood is present. His examination is otherwise normal. He is on no medications.
Which of the following is the most likely diagnosis?
(A) child abuse
(B) vitamin K deficiency
(C) breast milk allergy
(D) sepsis
(E) liver disease
Answer:
(B)
Neonates are routinely given intramuscular vitamin K at the time of birth. This is done to prevent the transient deficiency of vitamin- K-dependent factors, which occurs because of absence of bacterial intestinal flora which synthesize vitamin K. Hemorrhagic disease in the newborn because of vitamin K deficiency may
result in GI, nasal, subgaleal, and intracranial bleeding, or bleeding after circumcision. The prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time are prolonged.
These all correct after administration of vitamin K. Child abuse should always be considered with unusual bleeding, but the history reveals the etiology in this case. Babies are more likely to be allergic to formula than breast milk; however, it occurs rarely and may present with bloody stools. It does not, however, cause
epistaxis.
Neonatal sepsis may result in disseminated intravascular coagulation and bleeding; the infant is usually ill appearing, with associated acidosis or shock. Liver disease may cause factor deficiencies and should be excluded if there is no response to vitamin K.
Answer:
(B)
Neonates are routinely given intramuscular vitamin K at the time of birth. This is done to prevent the transient deficiency of vitamin- K-dependent factors, which occurs because of absence of bacterial intestinal flora which synthesize vitamin K. Hemorrhagic disease in the newborn because of vitamin K deficiency may
result in GI, nasal, subgaleal, and intracranial bleeding, or bleeding after circumcision. The prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time are prolonged.
These all correct after administration of vitamin K. Child abuse should always be considered with unusual bleeding, but the history reveals the etiology in this case. Babies are more likely to be allergic to formula than breast milk; however, it occurs rarely and may present with bloody stools. It does not, however, cause
epistaxis.
Neonatal sepsis may result in disseminated intravascular coagulation and bleeding; the infant is usually ill appearing, with associated acidosis or shock. Liver disease may cause factor deficiencies and should be excluded if there is no response to vitamin K.
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