neonatal purpura
Introduction
Introduction to neonatal purpura Neonatal purpura, the incidence of more than 2 to 7 days after birth, bleeding is characterized by slow and continuous exudation. The disease refers to a hemorrhagic disease in the neonatal period. It cannot be regarded as an independent disease. The cause is complicated. It is due to the lack of vitamin K in the newborn and is a blood coagulation disorder caused by insufficient synthesis of blood coagulation factors in the liver. The incidence of neonatal purpura is more than 2 to 7 days after birth, and bleeding is characterized by slow, continuous exudation. Often vomiting or tar-like stools, followed by umbilical cord, skin and subcutaneous tissue bleeding. The latter often occurs in areas other than oppression, such as the heel, ankle, and the main part. basic knowledge The proportion of sickness: 0.01% - 0.03% Susceptible people: children Mode of infection: non-infectious Complications: intracranial hemorrhage
Cause
Neonatal purpura
Self-cause (35%):
The autologous cause of neonatal purpura refers to the deficiency of vitamin K caused by malabsorption or poor development of the body. Due to congenital causes, the blood platelet content in neonates is reduced, and the symptoms of oozing purpura are prone to occur.
Causes of the disease (25%):
Secondary hemorrhagic disease in newborns caused by other diseases. Such as neonatal thrombocytopenia, neonatal platelet synthesis disorders, neonatal severe liver damage, neonatal vitamin K absorption disorders.
Pathogenesis
It is known that blood coagulation factors II, VII, IX, and X are all synthesized in the liver, and vitamin K must be involved. Therefore, these factors are also called vitamin K-dependent factors. The neonatal period is sterile in the intestine and cannot produce vitamin K. A small amount of food can be extracted from the food, and the liver function is not yet mature. Vitamin K-dependent blood coagulation factors II, VII, IX, and X are significantly lower within a few days of birth, and a transient "physiological" decline is caused, causing temporary Low prothrombinemia, if prothrombin activity falls below 15% to 20% of the normal value 2 to 7 days after birth, bleeding occurs, most of which manifests as gastrointestinal bleeding.
Prevention
Neonatal purpura prevention
Pregnant women who use anticoagulants, salicylic drugs, or a large number of oral antibiotics are suspected of having vitamin K deficiency. Vitamin K34 mg/d should be given to pregnant women before birth, for 3 to 5 days to prevent it, and to try to feed the baby early. In order to promote the formation of intestinal flora, in order to facilitate the synthesis of vitamin K.
Complication
Neonatal cyanosis complications Complications intracranial hemorrhage
Occasionally intracranial hemorrhage, other organ tissues can also be involved, bleeding will occur when the prothrombin activity drops below 15% to 20% of the normal value, most of which manifest as gastrointestinal bleeding.
Symptom
Neonatal purpura symptoms common symptoms skin bleeding plaque oil intracranial hemorrhage repeated hematemesis scalp scarring
The incidence is mostly within 2 to 7 days after birth. The bleeding is characterized by slow, continuous exudation, often hematemesis or tar-like stools, followed by umbilical cord, skin and subcutaneous tissue hemorrhage, the latter often occurs outside the vulnerable to stress. With the phlegm and the head and other parts, mainly ecchymosis, occasional intracranial hemorrhage, other organ tissues can also be affected, the amount of bleeding varies from person to person.
Vitamin K deficiency bleeding can also occur when vitamin K is insufficiently ingested and chronic diarrhea causes intestinal vitamin K synthesis disorders.
Examine
Examination of neonatal purpura
There is clotting time, prothrombin time is prolonged, but platelets and bleeding time are normal.
Laboratory inspection
(1) The beam arm test is positive or negative, but the routine examination of hemostasis function is normal.
(2) In a small number of patients, platelets are abnormal in ADP and adrenaline-induced aggregation, and the adhesion rate to the bead column is reduced.
Diagnosis
Diagnosis and diagnosis of neonatal purpura
diagnosis
According to clinical manifestations, the characteristics of skin lesions and the characteristics of laboratory tests can be diagnosed.
Differential diagnosis
Infants with bleeding between 2 and 7 days after birth should be excluded from other diseases such as:
1. Umbilical bleeding should be excluded from the umbilical cord ligation.
2. Congenital hemorrhagic disease: hemophilia caused by factor VIII deficiency, congenital thrombocytopenic purpura, congenital fibrin deficiency.
