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Azar JM, Lambert R, Maffei FA, Thomas TA. Late-onset vitamin K deficiency presenting as haemorrhagic shock and severe multi-system organ failure. BMJ Case Rep 2024; 17:e261126. [PMID: 39122381 PMCID: PMC11409245 DOI: 10.1136/bcr-2024-261126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
Vitamin K is an essential dietary cofactor required for the synthesis of active forms of vitamin K-dependent procoagulant proteins. Vitamin K deficiency, particularly late-onset deficiency occurring between 1 week and 6 months of age, can cause a life-threatening bleeding disorder. An exclusively breastfed, full-term, 6-week-old infant male presented with severe haemorrhagic shock and multi-system organ failure related to caregiver refusal of intramuscular vitamin K after birth. Coagulation studies were normalised within 8 hours of intramuscular vitamin K administration. An increasing number of caregivers are refusing intramuscular vitamin K which has led to a rise in the incidence of vitamin K deficiency bleeding. Health policy organisations around the world emphasise the benefits of intramuscular vitamin K and risks of refusal, particularly in exclusively breastfed infants who are at higher risk due to low vitamin K levels in breast milk. This case highlights the multi-system severity of this life-threatening yet preventable disorder.
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Affiliation(s)
- Justin M Azar
- Janet Weis Children's Hospital, Danville, Pennsylvania, USA
- Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Richard Lambert
- Janet Weis Children's Hospital, Danville, Pennsylvania, USA
- Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Frank Anthony Maffei
- Janet Weis Children's Hospital, Danville, Pennsylvania, USA
- Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Tessy A Thomas
- Janet Weis Children's Hospital, Danville, Pennsylvania, USA
- Pediatrics, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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Rogers TP, Fathi O, Sánchez PJ. Neonatologists and vitamin K hesitancy. J Perinatol 2023; 43:1067-1071. [PMID: 36707666 DOI: 10.1038/s41372-023-01611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 11/03/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Hemorrhagic disease of the newborn, more aptly termed "Vitamin K Deficiency Bleeding (VKDB)," has long been recognized as a cause of significant morbidity and mortality in early infancy. A single intramuscular dose of vitamin K administered at birth has virtually eliminated VKDB, and this prophylactic regimen has been recommended by the American Academy of Pediatrics since 1961. Although most newborns in the United States receive vitamin K at birth, a growing number of parents are hesitant about this intervention, citing concerns about harm from the injection, preservatives contained in the medication, and clashes with personal belief systems. Ultimately, there is distrust in the medical establishment as many of these parents also opt out of newborn ophthalmic prophylaxis and importantly, childhood vaccinations, establishing a dangerous public health precedent that will lead to resurgence of vaccine-preventable diseases. Various shared decision making models and educational efforts can assist newborn health care professionals in addressing these parental concerns so that VKDB can be effectively prevented in all newborns.
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Affiliation(s)
- Timothy P Rogers
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA
| | - Omid Fathi
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA
| | - Pablo J Sánchez
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA.
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA.
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Shaw MA, Liu A. Take the Shot: A Review of Vitamin K Deficiency. Pediatr Ann 2023; 52:e42-e45. [PMID: 36779880 DOI: 10.3928/19382359-20230102-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Vitamin K is essential for the process of coagulation. In its absence, severe and sometimes fatal bleeding events can occur, especially in newborns. Vitamin K prophylaxis at birth has been shown to prevent morbidity and mortality associated with vitamin K deficiency bleeding (VKDB) and is recommended by multiple organizations including the American Academy of Pediatrics and the World Health Organization. Pediatricians should feel comfortable explaining the risks and benefits of vitamin K prophylaxis to families and should be equipped to recognize signs of VKDB, especially given increasing rates of parental refusal. This article aims to improve understanding of VKDB, including prevention, early recognition, and treatment. [Pediatr Ann. 2023;52(2):e42-e45.].
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Sellers A, Lew A, Tudyk M, Nakagawa TA, Sochet AA. Hemorrhagic Disease of the Newborn: A Case Series Illustrating Preventable Harm. J Pediatr Health Care 2023; 37:67-73. [PMID: 36117074 DOI: 10.1016/j.pedhc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/20/2022] [Indexed: 01/31/2023]
Abstract
Newborns are susceptible to postnatal Vitamin K deficiencies from limited placental transfer, gastrointestinal absorption, and bioavailability in breast milk and formula preparations. For over 50 years, the American Academy of Pediatrics has recommended prophylactic vitamin K to prevent hemorrhagic disease in newborns. Yet, public skepticism contributes to increasing refusal rates. We present three cases of vitamin K-dependent bleeding following parental refusal of postnatal prophylaxis. Two patients experienced intracranial hemorrhage with resultant neurological devastation and mortality, respectively. The third child presented with symptomatic hematuria. Perinatal providers must partner with families and advocate vitamin K prophylaxis to limit unnecessary morbidity and mortality.
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Affiliation(s)
- Austin Sellers
- Austin Sellers, MS, Institue of Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Alicia Lew
- Alicia Lew, MD, Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL
| | - Miriam Tudyk
- Miriam Tudyk, MD, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Thomas A Nakagawa
- Thomas A. Nakagawa, MD, Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL
| | - Anthony A Sochet
- Anthony A. Sochet, MD, MSc, Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL; Anthony A. Sochet, MD, MSc, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Yörük S, Güler D. Factors associated with pediatric vaccine hesitancy of parents: a cross-sectional study in Turkey. Hum Vaccin Immunother 2021; 17:4505-4511. [PMID: 34665993 DOI: 10.1080/21645515.2021.1953348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Aim: This study aims to determine the prevalence and associated factors of vaccine hesitancy in females with children aged 12 months to 6 years who receive service from the antenatal class of a tertiary hospital in Turkey.Method: The study group includes 370 parents receiving service from a tertiary hospital. The data collection tools of the study were a descriptive data form and the Parent Attitudes about Childhood Vaccines survey.The data were analyzed using chi-square analysis and logistic regression analysis.Results: In our study, the prevalence of vaccine hesitancy was determined as 13.8% and vaccine refusal prevalence as 4.8%. In univariate analysis, vaccine hesitancy was found to be significantly higher in mothers with a university education, who got pregnant with treatment, who were not trained about pediatric vaccines in the antenatal follow-up, who followed anti-vaccine groups on social media, and who did not use vitamin D and iron supplements regularly or never used for their child. Vaccine hesitancy was significantly higher in parents who stated that their information sources of vaccines were not scientific, who were worried about vaccine ingredients (aluminum, mercury, pig gelatine) and who used alternative medicine practices (p < .05). In multivariate analysis, the risk of vaccine hesitancy increases 3.05 times in pregnancies with treatment, 3.74 times in those who did not use vitamin D or iron preparations, 3.01 times in those who followed anti-vaccine groups on social media,2.93 times in parents who were worried about the vaccine ingredients.Conclusion: Our findings suggest that the prevalence of vaccine hesitancy and risk factors should be monitored closely in the following years.
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Affiliation(s)
- Selda Yörük
- School of Health, Department of Midwifery, Balıkesir University, Balikesir, Turkey
| | - Döndü Güler
- Training And Research Hospital, Sakarya University, Sakarya, Turkey
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Shah S. Children and the American Rescue Plan: countering COVID-19 vaccine hesitancy during a global pandemic. Pediatr Res 2021; 90:237-239. [PMID: 34035429 PMCID: PMC8147585 DOI: 10.1038/s41390-021-01590-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023]
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Brumberg HL, Shah SI. Introduction: Perinatal health services: Impacting individual, organizational, and societal approaches towards optimizing family health. Semin Perinatol 2020; 44:151237. [PMID: 32268943 DOI: 10.1016/j.semperi.2020.151237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Heather L Brumberg
- Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States.
| | - Shetal I Shah
- Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
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