Abstract
Vitamin K deficiency bleeding (VKDB) in neonates is a significant disorder that causes
skin, gastrointestinal, and intracranial hemorrhaging. Early-onset VKDB occurs within
24 hours of birth, and its prognosis is poor due to severe hemorrhage. The causes
of early-onset VKDB include maternal intake of warfarin and anticoagulants, and maternal
vitamin K deficiency. We report the case of a neonate with early-onset VKDB born to
a mother with Crohn's disease. The neonate developed severe cerebellar hemorrhage
on the day of birth and subsequent noncommunicating hydrocephalus requiring a ventriculoperitoneal
shunt. The mother had a 14-year history of Crohn's disease and short bowel owing to
intestinal resection. She was in complete remission during pregnancy according to
the Crohn's Disease Activity Index. Endoscopic examination performed shortly before
pregnancy revealed inflammatory findings in the residual small intestine. Her blood
tests at delivery showed an elevated prothrombin induced by vitamin K deficiency or
antagonist II (PIVKA-II) level of 26,900 mAU/mL. A definitive protocol to prevent
early-onset VKDB in mothers with Crohn's disease complicated by a short bowel is lacking.
Administering vitamin K to mothers with elevated PIVKA-II levels before delivery may
help prevent early-onset VKDB.
Keywords
cerebellar hemorrhage - Crohn's disease - PIVKA-II - short bowel syndrome - vitamin
K deficiency bleeding
