ACW Lee, CH Li, Kt So

Abstract

We report a case of late vitamin K deficiency bleeding (VKDB) in a two-month-old girl who had not received prophylaxis at birth. She was exclusively breastfed without oral vitamin K supplement. She presented with catastrophic central nervous system bleeding when laboratory findings revealed mild cholestasis and coagulopathy compatible with vitamin K deficiency. She died despite intensive care and correction of coagulopathy. VKDB remains an uncommon but significant risk to infants without vitamin K prophylaxis. The current medical literature supports that intramuscular vitamin K injection given at the time of birth is the most effective and reliable means of prophylaxis. The risk of childhood cancer associated with parenteral vitamin K injection at birth has not been proven and is unlikely to be clarified in the near future. If a regimen of oral prophylaxis is adopted, the physicians and the parents must closely follow the drug administration and accept the slightly increased risk of VKDB.

我們報道一例遲發性維生素 K 缺乏性出血（VKDB），患兒為 2 個月大的女嬰，出生時未接受預防治療，出生後完全母乳餵養，未曾口服補充維生素 K。患兒出現重症中樞神經系統出血症狀，實驗報告顯示中度膽汁鬱積及維生素 K 缺乏性凝血異常。儘管採取重症監護，並糾正凝血異常，但患兒仍舊不治。對於未曾預防性補充維生素 K 的嬰兒，VKDB 儘管並不常見，但一直是一個高危因素。醫學文獻報道出生時肌肉內注射維生素 K 是目前最有效可靠的預防方法。出生時胃腸道外補充維生素 K 與兒童期腫瘤發病率的關係尚未被證實，而且現階段也難以確定。如果採用口服預防治療，內科醫生與家長必須密切注意藥物劑量，並認識到由此會造成 VKDB 的發病率輕微增高。