Spontaneous hæmorrhages may develop during the first few days of life from sepsis, syphilis, Buhl’s disease, hæmophilia, and true melæna neonatorum. The fragile condition of the blood vessels, the great changes in the blood and circulation after birth, as well as constitutional dyscrasias, are etiological factors of importance. All the causes are not as yet known.
Fig. 126.—Method of strapping an umbilical hernia.
The blood may come from the umbilicus, the mucous membranes of the eyes, nose, mouth, stomach and intestines. It may be effused into the tissues beneath the skin, or into any organ of the body. Marked nosebleed is generally syphilitic in origin.
As a rule hæmorrhages in the newborn are most common in males, and strongly hereditary.
The tendency to bleed lasts only a few weeks, and if recovery takes place, it is permanent. In some cases, however, where hæmorrhage has developed in the brain, clots may form in important centers, and the child be permanently paralyzed in speech, sight, hearing, or intelligence.
Symptoms of hæmorrhage begin during the first week and almost never after the twelfth day. The appearance of blood is the earliest and the most definite sign. The bleeding may come first from the umbilicus, or from the stomach, or from the intestines (melæna neonatorum). The amount lost is small, but the oozing is continuous. The temperature may be high or subnormal, and may or may not be due to the hæmorrhage. The skin is pale, the pulse feeble, prostration marked, and weight is lost rapidly. Convulsions are not infrequent.
The diagnosis of the condition is simple. It is only necessary to be certain that the blood is really effused, and not a temporary or accidental event such as the regurgitation of swallowed blood. Black tarry stools will show blood if placed in water.
The prognosis is not good. About two-thirds of these babies die.
The treatment is to stop the hæmorrhage by ligature, suture, or compression if possible and to alter the character of the blood by adding to its fibrin content. This is brought about, if at all, by the administration of coagulose, coagulen ciba, or by transfusion from an adult—preferably the father.