Authors:

Sofien Atitallahsofien.atitallah@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Farah Hassinebenhassine.farah@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Zouhour Trabelsiztrabelsi97@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Fethi KaddourKaddour.fethi@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Nada Missaouinada.missaoui.2018@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Msaddek Assidiassidi.msaddek@fmt.utm.tnPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Rania Ben Rabehraniabenrabeh@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Sonia Mazighsonia.mazigh202@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Olfa Bouyahiabouyahiao@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Salem Yahyaouiyahyaouisalem@yahoo.frPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Samir Boukthirsamirb.tun@gmail.comPediatric Department C, Bechir Hamza Children’s hospital, Tunis

Abstract:

Background: Late-onset Vitamin K Deficiency Bleeding (VKDB) is rare but serious, often presenting with intracranial hemorrhage in infants who had appeared healthy beforehand, occurring within the interval from 2 weeks to 6 months of life. It often presents with intracranial hemorrhage and may mimic non-accidental trauma, such as Shaken Baby Syndrome (SBS), posing diagnostic and ethical challenges.

Case Report: A 40-day-old, previously healthy, exclusively breastfed female infant presented with focal seizures. Cranial computed tomography revealed extensive intracerebral and subdural hemorrhages with midline shift. SBS was initially suspected. However, vitamin K prophylaxis had not been given at birth, and subsequent laboratory analysis demonstrated a significant prolongation of the prothrombin time with low concentrations of vitamin K–dependent coagulation factors II, VII, IX, and X. A diagnosis of late-onset VKDB was made. The patient received intravenous vitamin K and supportive care, including antiseizure medication. Coagulation parameters normalized rapidly, and the infant showed clinical improvement with no focal neurological deficits. Follow-up imaging showed partial resolution of hemorrhages.

Conclusion: This case highlights the importance of including late-onset VKDB in the differential diagnosis of unexplained seizures or intracranial hemorrhage in infants, particularly in exclusively breastfed infants. Prompt recognition and treatment are essential to prevent serious complications. Universal administration of vitamin K at birth remains a safe, effective, and necessary preventive strategy.

Keywords: Intracranial Hemorrhage, Late-onset, Neonatal Seizures, Shaken Baby Syndrome, Vitamin K Deficiency Bleeding

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