Trends and Morbidities Associated with Hemorrhagic Disease of Newborn (HDN): Analysis of the US National Data

Background: HDN is a bleeding disorder due to physiologically low concentration of vitamin K in early infancy. Healthy newborns are at risk of developing severe hemorrhages due to low concentrations of vitamin K–dependent clotting factors. Prophylaxis by administration of vitamin K at birth prevents HDN.
In recent years, there is an increasing trend for parental refusal for vitamin K prophylaxis resulting in HDN. There is a significant knowledge gap of the impact of non-administration of vitamin K and HDN in the USA. We aimed to describe outcomes from a large cohort of infants born in the USA presenting with HDN and its complications, using Healthcare Cost and Utilization Project (HCUP) database

Objective: To describe the frequency trends for HDN in neonates with gestational age (GA) ≥ 33 weeks for the years 2012-2017 and describe their risk factors and outcomes

Methods: Data was compiled from de-identified HCUP data from the Agency for Healthcare Research and Quality for the years 2012 to 2017 using International classification of diseases 9 & 10 coding. All live births with GA ≥ 33 weeks and postnatal age <28 days with diagnosis of HDN were included. Incidence of HDN, demographic characteristics and co-morbidities were identified. Cochrane Armitage test was used for trend analysis. P values were calculated using appropriate statistical tests

Results: A total of 23,689,011 infants were included in the study. Of them, 1665 infants (7 per 100,000 live births) had HDN over the study period. HDN incidence has increased over the years (p < 0.001)) (Figure 1). Majority of the infants with HDN were of term GA, caucasian race, male, with birth weight >2500 grams (Table 1). Intracranial and pulmonary hemorrhages occured in 6% and 5.4% of infants, respectively (Table 2). About 19% of infants required mechanical ventilation for ≤96 hours and 25% for >96 hours; 12% of infants had hypotension, suggesting large proportion of them required intensive care support. Mortality rate was 15.6%. Median (range) length of stay in hospital was 12 (271) days and cost of hospitalization was $ 96055 (429045).

Conclusion: There is an increasing trend in the incidence of HDN over the years 2012-2017 across the USA. Mortality rate (15.6%) and costs of hospitalization remain high in this group. Many infants had intracranial bleeding, which has implications for long term neurodevelopment