日本未熟児新生児学会雑誌　第26巻第1号　117～123頁（2014年）

日本未熟児新生児学会雑誌　26(1)：117-123；2014　

受付日：平成25．03．26

受理日：平成25．09．10

栄養摂取不良の母体から出生し早発型ビタミンK欠乏による頭蓋内出血を来した双胎の1児例

A Twin Infant with Vitamin K Deficiency Secondary to Poor Maternal Intake Presenting as Fetal Onset Severe Intracranial Bleeding

＊1社会医療法人母恋日鋼記念病院　小児科，＊2手稲渓仁会病院　小児科1，＊3北海道大学病院　周産母子センター，＊4北海道大学大学院　医学研究科　小児科学分野

＊1Department of Pediatrics, Nikko Memorial Hospital, ＊2Department of Pediatrics, Teine Keijinkai Hospital, ＊3Maternity and Perinatal Care Center, Hokkaido University Hospital, ＊4Department of Pediatrics, Hokkaido University School of Medicine

森川俊太郎＊1＊4・恩田哲雄＊1・早坂　格＊1＊3・小杉山清隆＊1＊2・長　和俊＊3

Shuntaro MORIKAWA＊1＊4，Tetsuo ONDA＊1，Itaru HAYASAKA＊1＊3, Kiyotaka KOSUGIYAMA＊1＊2，Kazutoshi CHO＊3

Key Words：vitamin K，vitamin K deficiency bleeding（VKDB），intracranial hemorrhage，newborn

　母体の栄養摂取不良に起因したと考えられるビタミンK（VK）欠乏により，胎児期に重篤なビタミンK欠乏性出血症（VKDB）を来した症例を経験した。症例は40歳代の母より出生した在胎34週6日，2絨毛膜2羊膜の双胎。母体は妊娠30週から著明な嘔気・嘔吐のため経口摂取困難な状態が続いていた。第1 子に突然の胎児機能不全を認めたため緊急帝王切開が施行された。重症新生児仮死で出生した第1子は出生前に頭蓋内出血を発症しており，出生後の速やかなVK投与にもかかわらず重篤な神経学的後遺症を残した。母体と第2子にも止血能の低下を認めたが，速やかなVK投与によりともに後遺症なく回復した。PIVKA-IIは母体，双胎両児ともに異常高値であった。
　栄養摂取不良の妊婦と胎児はVK欠乏の存在を疑う必要がある。

　We report the case of fetal extensive intracranial bleeding due to severe vitamin K deficiency, which was caused by maternal severe loss of dietary intake.
　A 40-year-old woman was admitted to our hospital due to impending premature delivery. Her pregnancy was dichorionic diamniotic twins. She showed severe loss of dietary intake since 30 weeks of gestation. Because one fetus presented with sudden nonreassuring fetal status at 34 weeks of gestation, caesarean section was performed. This firstborn male showed severe asphyxia and cranial ultrasonography showed extensive intracranial hemorrhage which presumably occurred in utero. The twins and their mother showed extremely high Protein Induced by Vitamin K Absence（PIVKA）-II, suggesting severe vitamin K（VK）deficiency. Although the second-born infant and their mother were successfully treated with vitamin K supplementation, the first-born infant has remained severe neurological complication.
　This case indicates malnourished pregnant should be carefully evaluated for VK deficiency.