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# Vitamin K deficiency bleeding of the newborn

Bleeding in a newborn or young baby from lack of vitamin K; it can affect the brain and is prevented by an injection at birth.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Liver](https://durgical.com/en/anatomy/liver/)
- [Lateral ventricles](https://durgical.com/en/anatomy/lateral-ventricle/)
- [White matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/)

## In biochemistry

- [Vitamin K (phylloquinone)](https://durgical.com/en/biochemistry/molecules/vitamin-k/)

## In the clinical exam

- [Bleeding syndromes: platelet vs coagulation pattern](https://durgical.com/en/clinical-exam/bleeding-syndromes-platelet-vs-coagulation-pattern/)

## In physiology

- [The coagulation cascade](https://durgical.com/en/physiology/the-coagulation-cascade/)
- [Coagulation tests: PT/INR, aPTT and platelets](https://durgical.com/en/physiology/coagulation-tests-pt-inr-aptt-and-platelets/)
- [Thrombosis and bleeding: Virchow's triad and hemostatic defects](https://durgical.com/en/physiology/thrombosis-and-bleeding-virchow-s-triad-and-hemostatic-defects/)
- [Newborn physiology and fetal maturation](https://durgical.com/en/physiology/newborn-physiology-and-fetal-maturation/)

## Why it happens

- [Vitamin deficiencies: what each one does to tissue](https://durgical.com/en/general-pathology/vitamin-deficiencies-what-each-one-does-to-tissue/)
- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)

## What it is

A bleeding disorder of newborns and young infants caused by deficiency of the vitamin K-dependent clotting factors (II, VII, IX and X). It used to be called haemorrhagic disease of the newborn.

## Who gets it

Without prophylaxis it affects a notable share of newborns (the classic form) and the late form is severe; with vitamin K at birth it becomes very rare. Current cases cluster in babies whose parents declined prophylaxis or who have liver disease.

## Causes

- Little vitamin K crosses the placenta
- Breast milk contains little vitamin K
- Gut without bacteria to make menaquinones
- Immature liver
- Maternal drugs: anticonvulsants, warfarin, rifampicin, isoniazid (early form)
- Infant cholestasis or malabsorption: biliary atresia, cystic fibrosis (late form)

## Risk factors

- No vitamin K at birth
- Exclusive breastfeeding
- Prematurity
- Prolonged diarrhoea or antibiotic use in the infant

## Pathophysiology

Without vitamin K the liver's γ-glutamyl carboxylase cannot form the Gla residues of factors II, VII, IX and X and proteins C and S; the factors are released but cannot bind calcium or platelets. Clotting is prolonged and bleeding occurs in [skin](https://durgical.com/en/anatomy/skin/), mucosa, umbilicus, gut and brain. Platelets and fibrinogen are normal.

## Classification

- Early: first 24 hours, from maternal drugs
- Classic: days 2 to 7, gut, umbilical or circumcision bleeding
- Late: weeks 2 to 12 (up to 6 months), often intracranial haemorrhage

## Symptoms and signs

- Bleeding from the umbilicus, circumcision or puncture sites
- Vomiting blood or black or bloody stools
- Bruises and petechiae
- Pallor
- Irritability, seizures, bulging fontanelle or drowsiness (intracranial haemorrhage)

## Red flags

- Seizures, projectile vomiting or bulging fontanelle in an infant
- Active bleeding with pallor or shock
- Any bleeding in a baby who did not get vitamin K at birth

## Diagnosis

**Clinical**
Bleeding in an otherwise well baby who had no prophylaxis (or who has cholestasis); treatment starts without waiting for results.

**Tests**
Very prolonged prothrombin time and INR, prolonged aPTT, normal platelets and fibrinogen; high PIVKA-II; rapid correction after vitamin K. Direct bilirubin and [liver](https://durgical.com/en/anatomy/liver/) tests to look for cholestasis.

**Imaging**
Cranial ultrasound through the fontanelle or head CT if intracranial haemorrhage is suspected; abdominal ultrasound if biliary atresia is suspected.

## Treatment

**Acute**
Intravenous or subcutaneous vitamin K immediately when suspected

**Acute**
Fresh frozen plasma or prothrombin complex concentrate for severe bleeding

**Procedure**
Neurosurgical management of intracranial haemorrhage when needed

**Medical**
Find and treat the cause: cholestasis, malabsorption, maternal drugs

## Drugs for this condition

- [Phytomenadione (vitamin K1)](https://durgical.com/en/pharmacology/phytomenadione/)

## Complications

- Intracranial haemorrhage with permanent neurological damage
- Hypovolaemic shock
- Death

## Prognosis

It responds within hours to vitamin K; intracranial haemorrhage in the late form leaves deficits in many survivors.

## Prevention

- Intramuscular vitamin K for every newborn at birth
- Vitamin K for mothers on anticonvulsants in pregnancy, when indicated
- Early detection of cholestatic jaundice (pale stools, dark urine)

## Test yourself

Think of the answer, then tap the question to see it.

## Why do newborns have little vitamin K?

Little crosses the placenta, breast milk contains little, the gut has no bacteria yet and the liver is immature.

## Which clotting pattern does vitamin K deficiency bleeding show?

Prolonged PT/INR and aPTT with normal platelets and fibrinogen, corrected by vitamin K.

## Which form is most severe, and why?

The late form (2 to 12 weeks), because it often presents as intracranial haemorrhage.

## What is the preventive measure?

One intramuscular dose of vitamin K for every newborn soon after birth.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/vitamin-k-deficiency-bleeding-of-the-newborn/)

## Related conditions

- [Intracerebral haemorrhage](https://durgical.com/en/conditions/intracerebral-haemorrhage/)
- [Subdural haematoma](https://durgical.com/en/conditions/subdural-haematoma/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Vitamin K deficiency bleeding of the newborn: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007320.htm) (MedlinePlus, US National Library of Medicine, 2026); [Vitamin K: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002407.htm) (MedlinePlus, US National Library of Medicine, 2026); [Prothrombin Time Test and INR (PT/INR): MedlinePlus Medical Test](https://medlineplus.gov/lab-tests/prothrombin-time-test-and-inr-ptinr/) (MedlinePlus, US National Library of Medicine, 2026); Textbook of Biochemistry for Medical Students, 6th ed. (Jaypee Brothers Medical Publishers (Vasudevan DM, Sreekumari S, Vaidyanathan K), 2011).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/vitamin-k-deficiency-bleeding-of-the-newborn/