A full-term exclusively breastfed boy born at home presents on day 4 with oozing from the umbilical stump and blood in the stool. PT is markedly prolonged, aPTT mildly prolonged, platelet count normal. The most likely cause is:

• A Disseminated intravascular coagulation from birth asphyxia
• B Maternal warfarin therapy crossing the placenta during labor
• C Congenital afibrinogenemia
• D Low vitamin K content of breast milk combined with a sterile neonatal gut ✓

Explanation

Classic hemorrhagic disease of the newborn occurs at days 2 to 7 because human milk contains little vitamin K and the sterile infant gut cannot synthesize menaquinones yet; prophylactic intramuscular vitamin K prevents it. DIC would consume platelets and fibrinogen, and afibrinogenemia would prolong both PT and aPTT severely with low fibrinogen, so options C and A do not fit the isolated factor II, VII, IX, X pattern.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.