NEONATAL DEATH OF THE MOTHER TREATED BY METHYLPHENOBARBITONE DUE TO EARLY MASSIVE PULMONARY HAEMORRHAGE PROBABLY CAUSED BY VITAMIN K DEFICIENCY

Abstract

Prikazano je zrelo donošeno novorođenče koje je neposredno po porodu očitovalo masivno plućno krvarenje koje se ponovilo u dobi od 8 sati, nakon čega je dijete umrlo. Krvarenja je vjerojatno uzrokovano nedostatkom vitamina K zbog liječenja majke epileptičarke metilfenobarbitonom (Phemiton) u trudnoći, što je ona zatajila i u trudnoći i dolaskom u rodilište. S obzirom na brzi tijek zbivanja i masivno krvarenje, nije ustanovljeno postojanje koagulopatije, no prestanak krvarenja neposredno po porodu nakon primjene vitamina K može svjedočiti o njegovom nedostatku. Tek smo nakon smrti novorođenčeta od majke saznali da se četiri godine liječi metilfenobarbitonom u dozi od 400 mg dnevno. Poznato je da liječenje antiepilepticima može u novorođenčeta izazvati sekundarni rani oblik hemoragijske bolesti, koja se može manifestirati kao intrakranijalno, intratorakalno, intraabdominalno i krvarenje na mjestu insercije skalp elektrode, dok plućno krvarenje kao u našega bolesnika izuzetno je rijetko. Važno je da se u trudnoći provede prevencija ranog oblika hemoragijske bolesti novorođenčeta primjenom vitamina K majci od 36. tjedna nadalje, te da se odmah po porodu u novorođenčeta učine koagulacijski testovi koje se onda mora na odgovarajući način zbrinuti bilo primjenom vitamina K ili svježe smrznute plazme.A case of a very mature well-developed newborn which manifested massive pulmonary hemorrhage immediately after birth is presented. The hemorrhage repeated within 8 hours and the child died. The hemorrhage was probably caused by a vitamin K deficit due to the fact that his epileptic mother had been treated with methylphenobarbitone (Phemiton) during pregnancy. She had kept it secret during pregnancy and on admission to maternity hospital. Considering the rapid course of events and massive hemorrhage, a coagulopathy was not discovered, but as the bleeding stopped immediately following birth after vitamin K had been administered it can be a sign of its deficit. Not before the newborn’s death did we learn from the mother that for four years she had been treated with methylphenobarbitone taking a 400 mg dosage daily. It is well-known that the anti-epileptic drug treatment can, in newborns, cause a secondary early form of hemorrhagic disease, which can be manifested intracranially, intrathoracally, intra-abdominally and as a bleeding at the place of scalp electrode insertion. Pulmonary hemorrhage, like in our patient, appears exceptionally rarely. In order to prevent an early hemorrhage disease in pregnancy it is important to administer vitamin K to mother from 36th week onward, and to make coagulation tests immediately after birth. The child must be then cared for accordingly either by vitamin K or fresh frozen plasma administration