A hemorrhagic disorder can occur during the neonatal period. Intracranial hemorrhage is the most severe complication and occurs mainly after breech deliveries. Subarachnoid and subdural hemorrhages are the most common of these intracranial hemorrhages.

This disorder is more frequent and severe in neonates born to mothers receiving antiepileptic drugs (AEDs). This is thought to be the result of AEDs crossing the placenta and lowering vitamin K levels in the newborn. It occurs with the enzyme-inducing agents phenytoin, carbamazepine, phenobarbital, primidone, and ethosuximide, and even in women with epilepsy who are taking no AEDs. Among the new AEDs, lamotrigine, oxcarbazepine, tiagabine, and topiramate are mild inducers of liver enzymes.

Prophylactic treatment consists of vitamin K administered to the mother from the 36th week of gestation (given orally as 10 mg daily), and 1 mg administered intramuscularly or intravenously to the newborn at birth.7,59

Adapted from: Sepkuty JP and Kaplan PW. Hematologic and pulmonary disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;209–228. 
With permission from Elsevier (www.elsevier.com). 

Reviewed by: Steven C. Schachter, MD on 4/2004
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