Controversies Concerning Vitamin K and the Newborn

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 1001-1002
Author(s):  
Keyword(s):  
Vitamin K ◽  
Standard Of Care ◽  
Repeated Administration ◽  
Similar Efficacy ◽  
Hemorrhagic Disease ◽  
Vitamin K Deficiency ◽  
Oral Vitamin ◽  
Vitamin K Prophylaxis ◽  
K Deficiency ◽  
Risk Of Cancer

Vitamin K deficiency may cause unexpected bleeding (0.25% to 1.7% incidence) during the first week of life in previously healthy-appearing neonates (classic hemorrhagic disease of the newborn [HDN]). The efficacy of neonatal vitamin K prophylaxis (either oral or parenteral) in the prevention of classic HDN is firmly established. It has been the standard of care since the recommendation by the Committee on Nutrition was adopted as policy by the American Academy of Pediatrics in 19611 Late HDN, a syndrome defined as unexpected bleeding due to severe vitamin K deficiency in infants aged 2 to 12 weeks, occurs primarily in exclusively breast-fed infants who have received no or inadequate neonatal vitamin K prophylaxis. In addition, infants who have intestinal malabsorption defects (cholestatic jaundice, cystic fibrosis, etc) may also present with late HDN. The rate of late HDN (often manifested by sudden central nervous system hemorrhage) ranges from 4.4 to 7.2 per 100 000 births based on reports from Europe and Asia. When a single dose of oral vitamin K has been used as neonatal prophylaxis, the rate has decreased to 1.4 to 6.4 per 100 000 births. Parenteral neonatal vitamin K prophylaxis prevents the development of late HDN, with the rare exception of infants with severe malabsorption syndromes. Oral regimens that have a similar efficacy as parenteral vitamin K in prevention of late HDN include the repeated administration of oral vitamin K1 (Germany) or K2 (Japan) at birth, 1 week, and 2 to 4 weeks. In 1990 Golding et al2 reported a study of a 1970 birth cohort in Britain in which they noted an unexpected association between childhood cancer and pethidine given in labor and the neonatal administration of vitamin K. Subsequently, Golding and others3 conducted a case-control study designed to examine the risk of cancer associated with intramuscular vitamin K administration among infants born in two hospitals in Avon between 1965 and 1987 and diagnosed with cancer between 1971 and 1989.

scholarly journals Belgian Consensus Recommendations to Prevent Vitamin K Deficiency Bleeding in the Term and Preterm Infant

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4109
Author(s):  
Simon Fiesack ◽  
Anne Smits ◽  
Maissa Rayyan ◽  
Karel Allegaert ◽  
Philippe Alliet ◽  
...  
Keyword(s):  
Vitamin K ◽  
Healthcare Providers ◽  
Vitamin K Deficiency ◽  
Oral Vitamin ◽  
Prophylactic Regimen ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
Dosing Regimens ◽  
Parental Refusal ◽  
K Deficiency

Neonatal vitamin K prophylaxis is essential to prevent vitamin K deficiency bleeding (VKDB) with a clear benefit compared to placebo. Various routes (intramuscular (IM), oral, intravenous (IV)) and dosing regimens were explored. A literature review was conducted to compare vitamin K regimens on VKDB incidence. Simultaneously, information on practices was collected from Belgian pediatric and neonatal departments. Based on the review and these practices, a consensus was developed and voted on by all co-authors and heads of pediatric departments. Today, practices vary. In line with literature, the advised prophylactic regimen is 1 or 2 mg IM vitamin K once at birth. In the case of parental refusal, healthcare providers should inform parents of the slightly inferior alternative (2 mg oral vitamin K at birth, followed by 1 or 2 mg oral weekly for 3 months when breastfed). We recommend 1 mg IM in preterm <32 weeks, and the same alternative in the case of parental refusal. When IM is perceived impossible in preterm <32 weeks, 0.5 mg IV once is recommended, with a single additional IM 1 mg dose when IV lipids are discontinued. This recommendation is a step towards harmonizing vitamin K prophylaxis in all newborns.

scholarly journals INTRACEREBRAL BLEEDING IN LATE HEMORRHAGIC DISEASE OF THE NEWBORN

2019 ◽  
pp. 1-2
Author(s):  
Jayashree Nadkarni
Keyword(s):  
Vitamin K ◽  
Task Force ◽  
Current Status ◽  
Hemorrhagic Disease ◽  
Current Guideline ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
New Born ◽  
K Deficiency

1 Vitamin K Ad Hoc Task Force. Controversies concerning vitamin K and the newborn. Pediatrics 1993; 91: 1001-1003. 2. Isarangkura PB, Pintadit P, Tejavej A, Siripoonya P. Chulajata C, Green GM. Vitamin K prophylaxis in the neonate by oral route and its significance in reducing infant mortality and morbidity. J Med Assoc Thai 1986; 69: 56-61. 3. Ijland MM, Pereira RR, Cornelissen EA. Incidence of late vitamin K deficiency bleeding in new-borns in the Netherlands in 2005: Evaluation of the current guideline. Eur J Paediatr 2008; 167: 165-169. 4. Waseem M. Vitamin K and hemorrhagic disease of new-borns. South Med J 2006; 99: 1199. 5. Lane PA, Hathaway WE. Vitamin K in infancy. J Pediatr 1985; 106: 351-359. 6. Singh M. Vitamin K during infancy: Current status and recommendations.Indian Pediatr 1997; 34: 708-712. 7. Bor O, Akgun N, Yakut A, et al. Late hemorrhagic disease of the new-born.Paediatr Int 2000; 42: 64-66. 8. D?Souza IE, Rao SD. Late hemorrhagic disease of new-born. Indian Paediatr 2003; 40: 226-229. 9. Flood VH, Galderisi FC, Lowas SR, et al. Hemorrhagic disease of the new-born despite vitamin K prophylaxis at birth. Paediatr Blood Cancer 2008; 50: 1075-1077. 10. Zengin E, Sarper N, Türker G, et al. Late haemorrhagic disease of the new- born. Ann Trop Paediatr 2006; 26: 225-231. 11. Sutor AH, Dagres N, Niederhoff H. Late form of vitamin K deficiency bleeding in Germany. KlinPediatr 1995; 207: 89-97

scholarly journals Neonatal Prophylaxis: Prevention of Vitamin K Deficiency Haemorrhage and Neonatal Ophthalmia / Neonatalna Profilaksa: Preprečevanje Krvavitev Zaradi Pomanjkanja Vitamina K in Neonatalne Oftalmije

2015 ◽  
Vol 54 (3) ◽  
pp. 184-193 ◽  
Author(s):  
Anita Jug Došler ◽  
Petra Petročnik ◽  
Ana Polona Mivšek ◽  
Teja Zakšek ◽  
Metka Skubic
Keyword(s):  
Vitamin K ◽  
Health Professionals ◽  
Descriptive Statistics ◽  
Vitamin K Deficiency ◽  
Oral Vitamin ◽  
Gluteal Muscle ◽  
Eye Infections ◽  
K Deficiency ◽  
Routine Procedures ◽  
Written Informed Consent

Abstract Introduction. The aim of the study was to explore two aspects of neonatal prophylaxis: the application of the vitamin K injection to the newborns and the prophylaxis against chlamydial and gonococcal eye infections, comparing Slovenian and Croatian practices. Methods. A causal non-experimental method of quantitative empirical approach was used. The data was collected by means of predesigned questionnaires. The questionnaires were sent to 14 Slovenian and 32 Croatian birth hospitals. The data wasanalysed with descriptive statistics and the Kullback test. Results. Vitamin K is applied to all newborns in 9 (out of 14) Slovene and 22 (out of 32) Croatian birth hospitals that returned the questionnaire. The prophylaxis against chlamydial gonococcal eye infections is applied to all newborns in 9 Slovene and 16 Croatian birth hospitals that offered answers to the questionnaire. The majority of Slovene and Croatian birth hospitals perform these procedures in the first hour after birth. The majority of Slovene birth hospitals still apply vitamin K in the gluteal muscle, whereas the majority of Croatian birth hospitals usually use the thigh as an injection site. In Slovenia, 1 % Targesin is used for the prophylaxis against chlamydial and gonococcal eye infections, whereas in Croatia the prevailing medicine is Erythromycin. Conclusions. The possibility of oral vitamin K application should be offered to parents, and pain management in practice should be discussed. The form of written informed consent could be offered to parents. Health professionals should provide intimacy and exclude routine procedures in the first couple of hours after birth. However, more research is needed as delayed administration might be related to lower efficacy and, as a consequence of that, the safety of newborns is questionable.

Fatal Intracranial Hemorrhage in a Normal Infant Secondary to Vitamin K Deficiency

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 562-564
Author(s):  
PETER A. LANE ◽  
WILLIAM E. HATHAWAY ◽  
JOHN H. GITHENS ◽  
RICHARD D. KRUGMAN ◽  
DONNA A. ROSENBERG
Keyword(s):  
Vitamin K ◽  
Correct Diagnosis ◽  
Fatal Case ◽  
Male Infant ◽  
Hemorrhagic Disease ◽  
Normal Infant ◽  
Vitamin K Deficiency ◽  
Hospital Emergency Room ◽  
History Of ◽  
K Deficiency

Since the initiation of routine vitamin K prophylaxis in newborns, the incidence of hemorrhagic disease of the newborn has been dramatically decreased. Recently there have been suggestions in the literature that prophylaxis may be unnecessary.1-4 We report here a fatal case of vitamin K deficiency in an otherwise healthy 1-month-old who did not receive prophylaxis. This case is illustrative because the child was initially thought to have suffered nonaccidental trauma. In addition, the correct diagnosis was confirmed, retrospectively, after vitamin K administration, with new assays for vitamin K-deficient prothrombin. CASE REPORT This 4-week-old male infant was seen at a community hospital emergency room with a one-day history of irritability, poor feeding, and decreased responsiveness without fever.

scholarly journals Intracranial Hemorrhage Caused by Vitamin K Deficiency Beyond Neonatal Period

2017 ◽  
Vol 37 (1) ◽  
pp. 104-107 ◽  
Author(s):  
Sudhir Adhikari ◽  
Eva Gauchan ◽  
Tejesh Malla ◽  
Brijesh Sathian ◽  
Kalipatanam Seshagiri Rao
Keyword(s):  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Neonatal Period ◽  
National Policy ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
Clinical Presentations ◽  
Intracranial Bleed ◽  
K Deficiency

Vitamin K deficiency bleeding (VKDB) can manifest as intracranial hemorrhage (ICH) and is still prevalent in poor resource countries. Infants aged one to twelve months with the diagnosis of ICH from 1st July 2011 to 30th June 2016 were included. There were 16 cases of ICH attributed to vitamin K deficiency. Clinical presentations were anemia16 (100%), bulged fontanel 13(81.3%), seizures 10(62.5%), vomiting 8(50%) and fever 9(56.3%). Mean INR at admission was 8.575±7.267 and 1.868±0.838 after three doses of vitamin K administration. Sites of intracranial bleed were parenchymal 5(31.3%), subdural 4(25%), extradural 2(12.5%), ventricular 2(12.5%). In 3(18.8%) of cases bleeding was more extensive involving more than one site. Mortality was 4(25%) and 3(18.8%) had abnormal neurological findings at discharge. There is an urgent need for national policy for vitamin K prophylaxis at birth.

scholarly journals Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review

2016 ◽  
Vol 36 (S1) ◽  
pp. S29-S35 ◽  
Author(s):  
M J Sankar ◽  
A Chandrasekaran ◽  
P Kumar ◽  
A Thukral ◽  
R Agarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin K ◽  
Vitamin K Deficiency ◽  
Vitamin K Deficiency Bleeding ◽  
Vitamin K Prophylaxis ◽  
K Deficiency

THE VITAMIN K DEFICIENCY IN INFANCY IN JAPAN -- THE SECOND NATIONWIDE SURVEY

1987 ◽  
Author(s):  
T Nagao ◽  
Y Hanawa ◽  
K Sawada ◽  
I Tsukimoto ◽  
I Ikeda ◽  
...  
Keyword(s):  
Vitamin K ◽  
Nationwide Survey ◽  
Near Miss ◽  
Screening Tests ◽  
Hemorrhagic Disease ◽  
Vitamin K Deficiency ◽  
K Deficiency ◽  
Hemorrhagic Tendency ◽  
Bile Duct Atresia ◽  
Nation Wide Survey

Questionnaires were sent to 1,218 hospitals with more than 200 beds, in order to know the incidence of hemorrhagic disease due to vitamin K deficiency in infancy beyond 2 weeks after birth, during 4 and a half years, i.e. from January 1981 to June 1985. Out of the 534 cases reported, 407 had no obvious reasons for vitamin K deficiency: "idiopathic vitamin K deficiency in infancy". Other 68 cases had bleedingepisodes due to vitamin K deficiency associated with hepatobiliary lesions (e.g.congenital bile duct atresia), chronic diarrhea, long term antibiotic therapy and so on: "secondary vitamin K deficiencyin infancy". The third group consisting of 59 cases was so called "near miss" type, in which hemorrhagic tendency was discovered at the time of mass screening tests for vitamin K deficiency or by chance withoutany clinical hemorrhage. In the idiopatic group, 345 cases (84.8%) developed their bleeding episodes between 21 and 59 days of age, and 368 cases (90.4%) were wholly breast-fed. Intracranial hemorrhage was seen in 338 cases (83.0%) of this group. In most cases of this series (97.3%),no vitamin K was supplemented after birth. Administration of vitamin K is an urgent routine procedure during the first one or two months of life for all newbornbabies, although the incidence of the idiopathic vitamin K deficiency in infancyhas not decreased significantly comparedto the results of the first nation-wide survey (Jan. 1978 - Dec. 1980). This study was sponsored by the Ministry of Health and Welfare of Japan.

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