# Vitamin K Deficiency Bleeding of Newborn

> Vitamin K deficiency bleeding of newborn for NEET-PG Paediatrics: early, classic and late forms, risk factors and the prophylactic vitamin K dose schedule.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/vitamin-k-deficiency-bleeding-of-newborn
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Nelson Textbook of Pediatrics; Avery's Diseases of the Newborn; IAP Textbook of Pediatrics
- How to cite: "Vitamin K Deficiency Bleeding of Newborn", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/vitamin-k-deficiency-bleeding-of-newborn

## Direct answer

Vitamin K deficiency bleeding of the newborn is haemorrhage caused by low levels of vitamin K-dependent clotting factors II, VII, IX and X. Levels are low at birth because vitamin K crosses the placenta poorly, breast milk is low in it and the gut is not yet colonised to make it. The disease presents as early, classic or late forms, and prophylactic intramuscular vitamin K at birth prevents it.

## What you must remember

- **Affected factors:** vitamin K-dependent clotting factors II, VII, IX and X, plus the anticoagulant proteins C and S.
- **Early form:** bleeding within 24 hours of birth, usually linked to maternal drugs such as anticonvulsants or warfarin.
- **Classic form:** bleeding on days 2 to 7, often from the umbilical stump, gut, skin or nose.
- **Late form:** bleeding from 2 weeks to 6 months, most often in exclusively breastfed infants, with intracranial haemorrhage the dominant risk.
- **Investigation:** prolonged prothrombin time with normal platelet count and fibrinogen, and a fall in prothrombin time after vitamin K confirms the diagnosis.
- **Prophylaxis:** a single 1 mg intramuscular dose at birth in a term infant, with a lower dose for smaller babies per protocol.
- **Oral route:** repeated oral doses are used where injection is refused, but they are less reliable for preventing late disease.

## A stepwise approach to a bleeding newborn

A bleeding newborn with a prolonged prothrombin time needs quick recognition, correction and a check for intracranial injury. The steps below follow the usual sequence on neonatal units, though the exact doses and blood products are set by local protocol.

1. **Recognise the pattern:** note the timing, the site of bleeding and whether the case is early, classic or late, since each has a different risk profile.
2. **Check coagulation:** a prolonged prothrombin time with a normal platelet count and fibrinogen points to vitamin K deficiency.
3. **Exclude other causes:** check for platelet disorders, disseminated intravascular coagulation and liver disease, which can mimic the picture.
4. **Give vitamin K:** administer vitamin K1 intravenously or intramuscularly, with a slow intravenous infusion to reduce the risk of anaphylaxis.
5. **Replace factors if bleeding is severe:** fresh frozen plasma and packed red cells are given as the clinical picture demands.
6. **Image if intracranial bleeding is suspected:** cranial ultrasound or CT is used, with neurological support and monitoring.
7. **Confirm the response:** a fall in prothrombin time after vitamin K supports the diagnosis of vitamin K deficiency.

## Where the exam tries to catch you

Vitamin K deficiency bleeding questions test the timing of each form, the prophylactic dose and the drug and route choices.

- **Trap:** calling the late form rare and skipping prophylaxis for breastfed babies. — **Correct:** late disease is most common in exclusively breastfed infants, which is why prophylaxis is given to every newborn.
- **Trap:** using vitamin K to treat a low platelet count. — **Correct:** vitamin K corrects clotting factor deficiency, so it helps vitamin K deficiency bleeding but not thrombocytopenia.
- **Trap:** giving intravenous vitamin K as a rapid push. — **Correct:** the dose is given slowly, because rapid intravenous administration carries a risk of anaphylaxis.

## Frequently asked questions

### Why is vitamin K deficiency common in newborns?

Vitamin K deficiency is common in newborns because vitamin K crosses the placenta poorly, breast milk contains little of it and the gut is not yet colonised to synthesise it. These factors leave clotting factor levels low at birth. Prophylactic vitamin K at birth corrects this deficiency.

### What are the three forms of vitamin K deficiency bleeding?

The three forms of vitamin K deficiency bleeding are early, classic and late. Early bleeding occurs within 24 hours and is usually linked to maternal drugs, classic bleeding appears on days 2 to 7, and late bleeding occurs from 2 weeks to 6 months. Late disease carries the highest risk of intracranial haemorrhage.

### Which infants are at highest risk of late vitamin K deficiency bleeding?

Exclusively breastfed infants who did not receive prophylaxis are at highest risk of late vitamin K deficiency bleeding. Infants with malabsorption or cholestasis are also at raised risk. Prophylactic vitamin K at birth prevents most of these cases.

### What is the standard prophylactic dose of vitamin K for newborns?

The standard prophylactic dose of vitamin K for a term newborn is a single 1 mg intramuscular injection given at birth. Smaller babies receive a lower dose according to unit protocol. Oral regimens need repeated doses and are less reliable at preventing late disease.