Title Hemoragijska bolest novorođenčeta Title (english) Hemorrhagic disease of newborn Author Barbara Parabić Mentor Nada Sindičić Dessardo (mentor)Committee member Ruža Grizelj (predsjednik povjerenstva)Committee member Marija Jelušić (član povjerenstva)Committee member Nada Sindičić Dessardo (član povjerenstva)Granter University of Zagreb Defense date and country 2024-07-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Hemoragijska bolest novorođenčeta (HBN) stečena je bolest koja se javlja tijekom cijelog dojenačkog razdoblja. S obzirom na dob djeteta u kojem se javlja, razlikuju se tri oblika HBN: rani, klasični i kasni. Rani oblik nastaje u prva 24 sata života djeteta, klasični nastaje nakon 24 sata do 7. dana života djeteta, a kasni od 8. dana života djeteta do navršenih 12 mjeseci života djeteta. Rani oblik HBN najčešće se javlja u novorođenčadi čije su majke tijekom trudnoće uzimale lijekove iz skupine antiepileptika, varfarin i njegove derivate, lijekove iz skupine tuberkulostatika ili antibiotike dulje od 14 dana. Klinička prezentacija najčešće
uključuje kefalhematom, intraabdominalno, intratorakalno i intrakranijalno krvarenje. Klasični oblik HBN češće se javlja u rizične novorođenčadi i novorođenčadi u koje je odgođeno započeto dojenje. Klinička slika često uključuje kožna krvarenja, epistaksu, krvarenje iz pupka, a može se prezentirati i intraabdominalnim te intrakranijalnim krvarenjem. Kasni oblik HBN češće se javlja u novorođenčadi koja prima antibiotik, koja ima malapsorpciju vitamina K ili proljev dulje od 7 dana. U kliničkoj se slici u više od 50% slučajeva javlja intrakranijalno krvarenje. Svi oblici HBN uspješno se preveniraju neselektivnom primjenom vitamina K1 intramuskularno novorođenčadi 1-2 sata nakon porođaja. Vitamin K liposolubilan je vitamin koji služi kao kofaktor u reakcijama gama-karboksilacije koagualcijskih proteina u jetri. Koagulacijski proteini ovisni o vitaminu K su faktori II, VII, IX, X, protein C i protein S koji gama-karboksilacijom glutaminskih ostataka poprimaju svoj aktivni oblik. Njihova se aktivnost indirektno procjenjuje jednostavnim laboratorijskim testovima koji uključuju testove trombinskog vremena, protrombinskog vremena i aktiviranog parcijalnog tromboplastinskog vremena. Intramuskularna primjena vitamina K1 dokazano smanjuje učestalost hemoragijske
bolesti novorođenčeta te se stoga smatra zlatnim standardom u prevenciji iste. U slučaju da roditelji odbijaju intramuskularnu profilaksu vitaminom K1 i nakon što im je objašnjen razlog primjene iste i svi rizici vezani uz njeno neprovođenje, istu je potrebno primijeniti peroralno u 3 doze. Roditeljima je potrebno naglasiti da se višekratnim peroralnim davanjem vitamina K ne postiže jednako učinkovita profilaksa pa je pritom i veća učestalost kasnog oblika HBN.
Abstract (english) Hemorrhagic disease of newborn (HDN) is an acquired disease that occurs during the entire period of infancy. Considering the time of its occurrence, three forms of HDN are distinguished: early, classic and late. The early form occurs in the first 24 hours of the child's life, the classic form occurs after 24 hours of the child's life until the 7th day of the child's life,
and the late form occurs from the 8th day of the child's life until the child reaches 12 months of age. The early form of HDN most often occurs in newborns whose mothers took drugs from the group of antiepileptics, warfarin and its derivatives, drugs from the group of tuberculostatics or antibiotics during pregnancy for more than 14 days. Clinical presentation most often includes cephalhematoma, intra-abdominal, intrathoracic and intracranial bleeding. The classic form of HDN occurs more often in high-risk newborns and newborns in whom breastfeeding has been delayed. The clinical picture often includes bleeding into the skin, epistaxis, umbilical cord bleeding, and can also be presented with intra-abdominal and intracranial bleeding. The late form of HDN occurs more often in newborns receiving antibiotics, who have malabsorption of vitamin K or diarrhea for more than 7 days. In the clinical picture, intracranial bleeding occurs in more than 50% of cases. All forms of HDN are successfully prevented by non-selective administration of vitamin K1 intramuscularly to all newborns 1-2 hours after birth. Vitamin K is a liposoluble vitamin that serves as a cofactor in gamma-carboxylation reactions of coagulation proteins in the liver. Coagulation proteins dependent on vitamin K are factors II, VII, IX, X, protein C and protein S which acquire their active form by gamma-carboxylation of glutamine residues. Their activity is indirectly assessed by simple laboratory tests, which include tests for thrombin time, prothrombin time and activated partial thromboplastin time. Intramuscular administration of vitamin K1 has been proven to reduce the incidence of hemorrhagic disease in newborns and is therefore considered the gold standard in its prevention. In the case that the parents refuse intramuscular prophylaxis with vitamin K1 and after the reason for its use and all the risks associated with its non-implementation have been explained
to them, it must be administered orally in 3 doses. It is necessary to emphasize to parents that repeated oral administration of vitamin K does not achieve equally effective prophylaxis and the frequency of the late form of HDN is also higher.
Keywords
hemoragijska bolest novorođenčeta
vitamin K
primarna prevencija
Keywords (english)
hemorrhagic disease of newborn
vitamin K
primary prevention
Language croatian URN:NBN urn:nbn:hr:105:482017 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-07-01 15:04:09
