TY - JOUR
T1 - Fetal intracranial hemorrhage and maternal vitamin K deficiency induced by total parenteral nutrition A case report
AU - Lee, Subeen
AU - Kim, Hyun Mi
AU - Kang, Juyeon
AU - Seong, Won Joon
AU - Kim, Mi Ju
N1 - Publisher Copyright:
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2022/1/7
Y1 - 2022/1/7
N2 - Rationale: Fetal brain hemorrhage is rare. It is caused mainly by maternal trauma or fetal coagulation disorder, but in some cases, vitamin K deficiency may be the cause. Patient concerns: We describe the case of a pregnant woman with bowel obstruction who was susceptible to vitamin K deficiency due to oral diet restriction, decreased intestinal absorption, and limited intravenous vitamin K supplementation. Diagnosis: After 18 days of intermittent total parenteral nutrition, acute onset of severe fetal brain hemorrhage developed. Interventions: After acute onset of fetal brain hemorrhage, the patient underwent an emergency cesarean section at 25 + 3 weeks of gestation due to fetal non-reassuring fetal monitoring. Outcomes: The Apgar score at birth was 0/0, and despite cardiopulmonary resuscitation, neonatal death was confirmed. After the baby was delivered, we checked the maternal upper abdominal cavity and found a massive adhesion in the small bowel to the abdominal wall near the liver and stomach with an adhesion band. The adhesion band, presumably a complication of previous hepatobiliary surgery, appeared to have caused small bowel obstruction. Adhesiolysis between the small bowel and abdominal wall was performed. Lessons: This case demonstrates that even relatively short-term total parenteral nutrition can cause severe fetal brain hemorrhage. Vitamin K supplementation is required for mothers who are expected to be vitamin K deficient, especially if they are on total parenteral nutrition for more than 3 weeks.
AB - Rationale: Fetal brain hemorrhage is rare. It is caused mainly by maternal trauma or fetal coagulation disorder, but in some cases, vitamin K deficiency may be the cause. Patient concerns: We describe the case of a pregnant woman with bowel obstruction who was susceptible to vitamin K deficiency due to oral diet restriction, decreased intestinal absorption, and limited intravenous vitamin K supplementation. Diagnosis: After 18 days of intermittent total parenteral nutrition, acute onset of severe fetal brain hemorrhage developed. Interventions: After acute onset of fetal brain hemorrhage, the patient underwent an emergency cesarean section at 25 + 3 weeks of gestation due to fetal non-reassuring fetal monitoring. Outcomes: The Apgar score at birth was 0/0, and despite cardiopulmonary resuscitation, neonatal death was confirmed. After the baby was delivered, we checked the maternal upper abdominal cavity and found a massive adhesion in the small bowel to the abdominal wall near the liver and stomach with an adhesion band. The adhesion band, presumably a complication of previous hepatobiliary surgery, appeared to have caused small bowel obstruction. Adhesiolysis between the small bowel and abdominal wall was performed. Lessons: This case demonstrates that even relatively short-term total parenteral nutrition can cause severe fetal brain hemorrhage. Vitamin K supplementation is required for mothers who are expected to be vitamin K deficient, especially if they are on total parenteral nutrition for more than 3 weeks.
KW - Bowel obstruction
KW - Early vitamin K supplementation
KW - Fetal brain hemorrhage
KW - Total parenteral nutrition
KW - Vitamin K deficiency
UR - http://www.scopus.com/inward/record.url?scp=85123396472&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000028434
DO - 10.1097/MD.0000000000028434
M3 - Article
C2 - 35029889
AN - SCOPUS:85123396472
SN - 0025-7974
VL - 101
SP - E28434
JO - Medicine (United States)
JF - Medicine (United States)
IS - 1
ER -