Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention |
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Authors: | P Renzulli P Tuchschmid G Eich S Fanconi M G Schwöbel |
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Institution: | (1) Department of Surgery, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland, Tel.: 0041/1/266 71 11, Fax.: 0041/1/266 71 71, CH;(2) Department of Paediatric Radiology, University Children's Hospital, Zurich, Switzerland, CH;(3) Department of Paediatrics, Intensive Care Unit, University Children's Hospital, Zurich, Switzerland, CH;(4) Department of Paediatric Surgery, University Children's Hospital, Zurich, Switzerland, CH;(5) Department of Paediatrics, Section of Paediatric Haematology, University Children's Hospital, Zurich, Switzerland, CH |
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Abstract: | Vitamin K deficiency bleeding within the first 24 h of life is caused in most cases by maternal drug intake (e.g. coumarins,
anticonvulsants, tuberculostatics) during pregnancy. Haemorrhage is often life-threatening and usually not prevented by vitamin
K prophylaxis at birth. We report a case of severe intracranial bleeding at birth secondary to phenobarbital-induced vitamin
K deficiency and traumatic delivery. Burr hole trepanations of the skull were performed and the subdural haematoma was evacuated.
Despite the severe prognosis, the infant showed an unexpected good recovery. At the age of 3 years, neurological examinations
were normal as was the EEG at the age of 9 months. CT showed close to normal intracranial structures.
Conclusion This case report stresses the importance of antenatal vitamin K prophylaxis and the consideration of a primary Caesarean
section in maternal vitamin K deficiency states and demonstrates the successful management of massive subdural haemorrhage
by a limited surgical approach.
Received: 4 July 1997 and in revised form: 30 October 1997 / Accepted: 7 November 1997 |
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Keywords: | Vitamin K deficiency bleeding Phenobarbital Cerebral haemorrhage Surgery |
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