Health
Department of Health and Human Services

Bleeding conditions in neonates

Key messages

  • Newborns who are well or sick may bleed for a variety of reasons.
  • A detailed history and complete examination is essential.
  • Treatment depends on the cause of bleeding and clinical condition of the neonate.

Page contents: Clinical presentation of neonatal bleeding | Differential diagnosis of neonatal bleeding | Laboratory investigations | Management of neonatal bleeding | More information

Neonates are susceptible to bleeding for various reasons. Take a detailed history, physical examination and determine whether the neonate is 'well' or 'sick'. Reasons for bleeding in neonates include:

Clinical presentation of neonatal bleeding

Bleeding in neonates may present with:

Particular points in the history include:

Image of neonate with petechiae
Newborn with petechiae on the face and thorax Source: newborns.stanford.edu

Differential diagnosis of neonatal bleeding

Physical examination will determine whether the neonate is 'well' or 'sick'. This is very useful as the differential diagnosis is different in the two circumstances.

Causes of bleeding in a 'well' neonate:

Causes of bleeding in a 'sick' neonate:

Bleeding at a single site is more likely to have an anatomic or structural component.

Major bleeding from any primary cause may induce a secondary DIC, which may mask the original pathology.

Laboratory investigations

First line tests include:

The results should be interpreted in the context of normal laboratory values for gestation and postnatal age.

Interpretation of laboratory investigations in a bleeding neonate

Isolated prolonged APTT, consider:

Isolated prolonged PT, consider:

Combined prolonged APTT and PT+/- low fibrinogen, consider

Normal APTT, PT, platelet count, fibrinogen, consider

Other points to consider:

Management of neonatal bleeding

Management depends on the cause of bleeding and clinical condition of the neonate. Specific management includes:

DIC

Vitamin K deficiency

Inherited factor deficiency

Related information

More information

Clinical

Consult a paediatric haematologist at the Royal Children’s Hospital if in doubt. Tel (03) 9345 5522.

Further reading

Christensen, MD : Hematologic problems of the neonate. W.B. Saunders Company , first edition; 2000.

Simon J Stanworth, Thrombocytopenia, bleeding, and use of platelet transfusions in sick neonates.

Ash Education book December 8, 2012 vol 2012 no 1, 512-516