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Intracranial Hemorrhage Associated With Vitamin K–deficiency Bleeding in Patients With Biliary Atresia: Focus on Long-term Outcomes

Alatas, Fatima S.; Hayashida, Makoto; Matsuura, Toshiharu; Saeki, Isamu; Yanagi, Yusuke; Taguchi, Tomoaki

Journal of Pediatric Gastroenterology and Nutrition: April 2012 - Volume 54 - Issue 4 - p 552–557
doi: 10.1097/MPG.0b013e3182421878
Original Articles: Hepatology and Nutrition

Background and Aim: The prophylactic oral administration of vitamin K to newborns has markedly reduced the incidence of vitamin K deficiency (VKD); however, intracranial hemorrhage (ICH) is still one of the complications found in biliary atresia (BA) patients and is associated with VKD bleeding. Therefore, we aimed to investigate the incidence and long-term outcome of ICH in patients with BA who previously received prophylactic vitamin K during the neonatal period.

Methods: Eighty-eight consecutive infants with BA were treated and followed up at Kyushu University Hospital from 1979 to 2009. The clinical records and imaging study results were retrospectively reviewed in the infants with BA who presented with ICH.

Results: ICH occurred in 7.95% of patients with BA. The onset of ICH occurred at 47 to 76 days after birth, before the patients underwent surgery for BA (9–37 days after the onset of ICH). Coagulopathy was found upon admission in all of the cases with available data and improved after intravenous administration of vitamin K. A craniotomy was required in 2 cases before the surgery for BA. During the 22 to 278 months of follow-up, some neurologic sequelae persisted in 5 of 7 cases. Follow-up head computed tomography scans showed a low-density area in the left hemisphere in 5 cases.

Conclusions: Although vitamin K prophylaxis had been given during the neonatal period, ICH-associated VKD bleeding was still found in 7.95% of patients with BA. Persistent neurologic sequelae were found in 5 of 7 cases, with low-density area in the left hemisphere.

Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Address correspondence and reprint requests to Makoto Hayashida MD, PhD, Department of Pediatric Surgery, Reproductive and Developmental Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan (e-mail:

Received 20 February, 2011

Accepted 26 September, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN