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Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev 2023; 3:CD000352. [PMID: 36884026 PMCID: PMC9994459 DOI: 10.1002/14651858.cd000352.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned hospital birth in many places does not reduce mortality and morbidity but increases the frequency of interventions and complications. Euro-Peristat (part of the European Union's Health Monitoring Programme) has raised concerns about iatrogenic effects of obstetric interventions, and the World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women's own capability to give birth and negatively impacts their childbirth experience. This is an update of a Cochrane Review first published in 1998, and previously updated in 2012. OBJECTIVES To compare the effects of planned hospital birth with planned home birth attended by a midwife or others with midwifery skills and backed up by a modern hospital system in case a transfer to hospital should turn out to be necessary. The primary focus is on women with an uncomplicated pregnancy and low risk of medical intervention during birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP, and conference proceedings), ClinicalTrials.gov (16 July 2021), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. Cluster-randomised trials, quasi-randomised trials, and trials published only as an abstract were also eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted study authors for additional information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included one trial involving 11 participants. This was a small feasibility study to show that well-informed women - contrary to common beliefs - were prepared to be randomised. This update did not identify any additional studies for inclusion, but excluded one study that had been awaiting assessment. The included study was at high risk of bias for three out of seven risk of bias domains. The trial did not report on five of the seven primary outcomes, and reported zero events for one primary outcome (caesarean section), and non-zero events for the remaining primary outcome (baby not breastfed). Maternal mortality, perinatal mortality (non-malformed), Apgar < 7 at 5 minutes, transfer to neonatal intensive care unit, and maternal satisfaction were not reported. The overall certainty of the evidence for the two reported primary outcomes was very low according to our GRADE assessment (downgraded two levels for high overall risk of bias (due to high risk of bias arising from lack of blinding, high risk of selective reporting and lack of ability to check for publication bias) and two levels for very serious imprecision (single study with few events)). AUTHORS' CONCLUSIONS: This review shows that for selected, low-risk pregnant women, the evidence from randomised trials to support that planned hospital birth reduces maternal or perinatal mortality, morbidity, or any other critical outcome is uncertain. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be just as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new RCTs. As women and healthcare practitioners may be aware of evidence from observational studies, and as the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives collaboratively conclude that there is strong evidence that out-of-hospital birth supported by a registered midwife is safe, equipoise may no longer exist, and randomised trials may now thus be considered unethical or hardly feasible.
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Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Abstract
Intramuscular administration of vitamin K for prevention of vitamin K deficiency bleeding (VKDB) has been a standard of care since the American Academy of Pediatrics recommended it in 1961. Despite the success of prevention of VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. This increase in incidence of VKDB is attributable to parental refusal as well as lowered efficacy of alternate methods of administration. The aim of this statement is to discuss the current knowledge of prevention of VKDB with respect to the term and preterm infant and address parental concerns regarding vitamin K administration.
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Affiliation(s)
- Ivan Hand
- Department of Pediatrics, NYC Health + Hospitals Kings County, Brooklyn, New York.,Department of Pediatrics, SUNY-Downstate College of Medicine, Brooklyn, New York
| | - Lawrence Noble
- NYC Health + Hospitals Elmhurst, Elmhurst, New York.,Department of Pediatrics, Dell Medical School at the University of Texas-Austin, Austin, Texas
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas-Austin, Austin, Texas
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Fiesack S, Smits A, Rayyan M, Allegaert K, Alliet P, Arts W, Bael A, Cornette L, De Guchtenaere A, De Mulder N, George I, Henrion E, Keiren K, Kreins N, Raes M, Philippet P, Van Overmeire B, Van Winckel M, Vlieghe V, Vandenplas Y. Belgian Consensus Recommendations to Prevent Vitamin K Deficiency Bleeding in the Term and Preterm Infant. Nutrients 2021; 13:nu13114109. [PMID: 34836364 PMCID: PMC8621883 DOI: 10.3390/nu13114109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Simon Fiesack
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (S.F.); (K.K.)
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (A.S.); (M.R.); (K.A.)
- Neonatal Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Maissa Rayyan
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (A.S.); (M.R.); (K.A.)
- Neonatal Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (A.S.); (M.R.); (K.A.)
- Department of Pharmacy and Pharmaceutical Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC, 3011 Rotterdam, The Netherlands
| | - Philippe Alliet
- Department of Paediatrics, Jessa Hospital, 3500 Hasselt, Belgium; (P.A.); (M.R.)
| | - Wim Arts
- Department of Paediatrics, ZOL Genk, 3600 Genk, Belgium;
| | - An Bael
- Department of Pediatrics, ZNA Queen Paola Children’s Hospital, Faculty of Medicine UA, 2020 Antwerp, Belgium;
| | - Luc Cornette
- Department of Neonatology, AZ Sint-Jan, 8000 Brugge, Belgium;
| | | | - Nele De Mulder
- Vrije Universiteit Brussel (VUB), UZ Bussel, KidZ Health Castle, 1090 Brussels, Belgium;
| | | | - Elisabeth Henrion
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, 5000 Namur, Belgium;
| | - Kirsten Keiren
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (S.F.); (K.K.)
| | - Nathalie Kreins
- Neonatal Intensive Care Unit, CHC MontLégia, 4000 Liège, Belgium;
| | - Marc Raes
- Department of Paediatrics, Jessa Hospital, 3500 Hasselt, Belgium; (P.A.); (M.R.)
| | | | | | - Myriam Van Winckel
- Department of Paediatrics, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Vinciane Vlieghe
- Neonatal Intensive Care Unit, Queen Fabiola Children’s University Hospital, Université Libre de Bruxelles, 1020 Bruxelles, Belgium;
| | - Yvan Vandenplas
- Department of Pediatrics, ZNA Queen Paola Children’s Hospital, Faculty of Medicine UA, 2020 Antwerp, Belgium;
- Vrije Universiteit Brussel (VUB), UZ Bussel, KidZ Health Castle, 1090 Brussels, Belgium;
- Correspondence: ; Tel.: +32-475748794
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Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications. This is an update of a Cochrane review first published in 1998. OBJECTIVES To assess the effects of planned hospital birth compared with planned home birth in selected low-risk women, assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2012) and contacted editors and authors involved with possible trials. SELECTION CRITERIA Randomised controlled trials comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. DATA COLLECTION AND ANALYSIS The two review authors as independently as possible assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS Two trials met the inclusion criteria but only one trial involving 11 women provided some outcome data and was included. The evidence from this trial was of moderate quality and too small to allow conclusions to be drawn. AUTHORS' CONCLUSIONS There is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women. However, the trials show that women living in areas where they are not well informed about home birth may welcome ethically well-designed trials that would ensure an informed choice. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new randomised controlled trials.
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Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen,Copenhagen K, Denmark. @gmail.com
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[Prophylactic vitamin K for vitamin K deficiency bleeding of the newborn]. FARMACIA HOSPITALARIA 2010; 35:148-55. [PMID: 21111646 DOI: 10.1016/j.farma.2010.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 05/17/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The administration of vitamin K immediately after birth has shown a significant decrease in the incidence of newborn bleeding, but there is not enough evidence to determine the most appropriate method of administration. The objective of this review is to determine the effectiveness of orally administered vitamin K compared to the intramuscular route in the prevention of hemorrhagic disease of newborn (HDN). METHODS We conducted a systematic review of the main databases (Medline, Embase and Cochrane, among others) without limitation by date, language or type of study. Selected studies evaluated the efficacy and safety of vitamin K. Excluded were studies in pregnant women in preterm infants or patients with pathology. The validity of these studies was assessed by CASPe tools for systematic reviews and clinical trials. RESULTS Only two studies evaluated clinical aspects. They showed a reduction in the incidence of bleeding in the newborn after intramuscular prophylaxis with vitamin K. With regard to the oral route, different studies examined the effectiveness of vitamin K by determining biochemical parameters (factor X, prothrombin time and index, vitamin K1 in plasma and prothrombin antigen, among others) with inconclusive results regarding the route of administration and the number of doses. CONCLUSIONS There is sufficient evidence to support the effectiveness of a single intramuscular dose of vitamin K to prevent the classic form of HDN. With regard to late HDN and oral route, the results are inconclusive because the studies used biochemical indicators of effectiveness, which can not be correlated with the actual coagulation status of the newborn due to lack of scientific evidence.
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Abstract
BACKGROUND Vitamin K deficiency can cause bleeding in an infant in the first weeks of life. This is known as Hemorrhagic Disease of the Newborn (HDN). HDN is divided into three categories: early, classic and late HDN. Early HDN occurs within 24 hours post partum and falls outside the scope of this review. Classic HDN occurs on days one to seven; common bleeding sites are gastrointestinal, cutaneous, nasal and from a circumcision. Late HDN occurs from week 2-12; the most common bleeding sites are intracranial, cutaneous, and gastrointestinal. Vitamin K is commonly given prophylactically after birth for the prevention of HDN, but the preferred route is uncertain. OBJECTIVES To review the evidence from randomized trials in order to determine the effectiveness of vitamin K prophylaxis in the prevention of classic and late HDN. Main questions are: Is one dose of vitamin K, given after birth, able to significantly reduce the incidence of classic and late HDN? Is there a significant difference between the oral route and the intramuscular route in preventing classic and late HDN? Are multiple oral doses of vitamin K, given after birth, able to significantly reduce the incidence of classic and late HDN? SEARCH STRATEGY The standard search strategy of the Cochrane Neonatal Review Group was used. SELECTION CRITERIA All trials using random or quasi-random patient allocation, in which methods of vitamin K prophylaxis in infants were compared to each other, placebo or no treatment, were included. DATA COLLECTION AND ANALYSIS Data were extracted independently by each author and were analysed with the standard methods of the Cochrane Collaboration and its Neonatal Review Group, using relative risk, risk difference and weighted mean difference. MAIN RESULTS Two eligible randomized trials, each comparing a single dose of intramuscular vitamin K with placebo or nothing, assessed effect on clinical bleeding. One dose of vitamin K reduced clinical bleeding at 1-7 days, including bleeding after circumcision, and improved biochemical indices of coagulation status. Eleven additional eligible randomized trials compared either a single oral dose of vitamin K with placebo or nothing, a single oral with a single intramuscular dose of vitamin K, or three oral doses with a single intramuscular dose. None of these trials assessed clinical bleeding. Oral vitamin K improved biochemical indices of coagulation status at 1-7 days. There was no evidence of a difference between the oral and intramuscular route in effects on biochemical indices of coagulation status. A single oral compared with a single intramuscular dose resulted in lower plasma vitamin K levels at two weeks and one month, whereas a 3-dose oral schedule resulted in higher plasma vitamin K levels at two weeks and at two months than did a single intramuscular dose. REVIEWER'S CONCLUSIONS A single dose (1.0 mg) of intramuscular vitamin K after birth is effective in the prevention of classic HDN. Either intramuscular or oral (1.0 mg) vitamin K prophylaxis improves biochemical indices of coagulation status at 1-7 days. Neither intramuscular nor oral vitamin K has been tested in randomized trials with respect to effect on late HDN. Oral vitamin K, either single or multiple dose, has not been tested in randomized trials for its effect on either classic or late HDN.
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Affiliation(s)
- Renee M Puckett
- Academic Medical CenterPediatrics, H3‐144P.O. Box 22700AmsterdamNetherlands
| | - Martin Offringa
- Academic Medical CenterPediatrics, H3‐144P.O. Box 22700AmsterdamNetherlands
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Abstract
BACKGROUND A meta-analysis of observational studies have suggested that planned home birth may be safe and with less interventions than planned hospital birth. OBJECTIVES The objective of this review was to assess the effects of planned home birth compared to hospital birth on the rates of interventions, complications and morbidity as determined in randomised trials. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: September 1999. SELECTION CRITERIA Controlled trials comparing planned hospital birth to planned home birth in selected women, assisted by an experienced home birth practitioner, and backed up by a modern hospital system in case transfer should be necessary. DATA COLLECTION AND ANALYSIS Trial quality was assessed and data were extracted by one reviewer and checked by the other reviewer. Study authors were contacted for additional information. MAIN RESULTS One study involving 11 women was included. The trial was of reasonable quality, but was too small to be able to draw conclusions. REVIEWER'S CONCLUSIONS There is no strong evidence to favour either planned hospital birth or planned home birth for low risk pregnant women.
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Affiliation(s)
- O Olsen
- The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, dept. 7112, Copenhagen, Denmark, DK-2100 O.
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9
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Abstract
Newborn babies are born vitamin K deficient; however, the deficiency is not sufficiently severe to cause a vitamin K deficiency coagulopathy and haemorrhagic disease of the newborn (HDN). Severe vitamin K deficiency can develop quickly in breast-fed newborns and can result in the appearance of classic HDN during the first week of life or late HDN during the first 2 months of life. Both forms of the disease can be severe, causing brain damage and death. Classic and late HDN are prevented by the intramuscular administration of vitamin K at birth. Oral prophylaxis prevents classic HDN but is ineffective in preventing late HDN. Despite proven effectiveness of intramuscular vitamin K prophylaxis there have been concerns about the need for, and safety of, this therapy. This review provides evidence that there is need for intramuscular vitamin K prophylaxis for all babies in order to eradicate haemorrhagic disease of the newborn and concludes that there is no evidence that this therapy is harmful.
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Affiliation(s)
- A Zipursky
- Department of Pediatrics, Hospital for Sick Children, and University of Toronto, Ontario, Canada
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Behera MK, Kulkarni SD. VITAMIN 'K' DEFICIENCY HAEMORRHAGIC DISEASE OF NEW-BORN AND PRESENT CONTROVERSIES. Med J Armed Forces India 1998; 54:143-145. [PMID: 28775450 PMCID: PMC5531388 DOI: 10.1016/s0377-1237(17)30506-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Vitamin K deficiency haemorrhagic disease of newborn (HDN) is a well known entity and presents in 3 different clinical forms - early, classical and late. The coagulopathy is due to deficiency of vitamin K dependent procoagulant factors II, VII, IX, X. In the event of vitamin K deficiency Protein Induced in Vitamin K Absence (PIVKA) arc in excess and its estimation is very helpful in diagnosis even after starting the treatment. The bleeding defects are usually corrected within few hours after administration of vitamin K. All newborn babies require vitamin K prophylaxis. Oral route is effective like parenteral route but require higher and more doses. Intra muscular route is safe and does not increase the risk of childhood cancer. All breast fed babies with diarrhoea, malabsorption require another dose of vitamin K in postneonatal period to prevent late vitamin K deficiency bleeding.
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Affiliation(s)
- M K Behera
- Classified Specialist (Paediatrics), Command Hospital (Eastern Command), Alipore, Calcutta, West Bengal 700027
| | - S D Kulkarni
- PMO Central Air Command, Bamrauli, Allahabad, UP 211012
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Abstract
BACKGROUND Because of the risk of hemorrhagic disease of the neonate secondary to vitamin K deficiency, it is generally agreed that neonates should be given vitamin K. There is however, no consensus concerning the route of administration, dose, number of doses, or dose frequency. It was therefore necessary to determine patterns of vitamin K administration in France. POPULATION AND METHODS Routine vitamin K administration was studied in 1993 by questionnaires sent to all maternity units in France. RESULTS Six hundred and forty of the 1,086 questionnaires could be analysed. Vitamin K was never prescribed in 0.3% of maternity units and was given only to high risk neonates in 3%. In healthy neonates receiving milk formulas, the route of administration (oral or IM) agreed with the recommendations of the French Committee of Pediatric Nutrition. In contrast, breast-fed infants were given IM vitamin K in only 19% of the maternité units whereas regular weekly doses were prescribed in only 56%. In premature infants, IM doses were prescribed in only 46% of cases and repeated weekly doses in 34%. The dose generally prescribed (5 mg orally or IM) was not the recommended dose. Among the available products, oral or parenteral vitamin K Roche was the most frequently prescribed. CONCLUSION New recommendations for the use of vitamin K in the perinatal period in France are necessary.
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Affiliation(s)
- E Autret
- Service de pharmacologie clinique, hôpital Bretonneau, Tours, France
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Choo KE, Tan KK, Chuah SP, Ariffin WA, Gururaj A. Haemorrhagic disease in newborn and older infants: a study in hospitalized children in Kelantan, Malaysia. ANNALS OF TROPICAL PAEDIATRICS 1994; 14:231-7. [PMID: 7825997 DOI: 10.1080/02724936.1994.11747722] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This is a retrospective study of the epidemiology, clinical features, laboratory findings, treatment and outcome of haemorrhagic disease in 42 Kelantanese infants who were admitted to Hospital Universiti Sains Malaysia during a 2-year period (1987-1988). Classical haemorrhagic disease of the newborn was the commonest presentation (48%), followed by early onset (29%) and late onset (24%) disease. Home deliveries accounted for 81% of the affected infants. Most of these babies were not given vitamin K at birth in contrast to those delivered in hospitals. All except one infant were breastfed. The six commonest presenting clinical features were pallor, jaundice, umbilical cord bleeding, tense fontanelle, convulsions and hepatomegaly. All the infants had prolonged prothrombin and partial thromboplastin times which were corrected by administration of vitamin K. Subdural haemorrhage was the commonest form of intracranial haemorrhage, followed by subarachnoid haemorrhage. The overall case fatality rate was 14%. The results of this study once again emphasize the value of vitamin K prophylaxis in the newborn.
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Affiliation(s)
- K E Choo
- Department of Paediatrics, Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan
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Tulchinsky TH, Patton MM, Randolph LA, Meyer MR, Linden JV. Mandating vitamin K prophylaxis for newborns in New York State. Am J Public Health 1993; 83:1166-8. [PMID: 8342729 PMCID: PMC1695173 DOI: 10.2105/ajph.83.8.1166] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
New York State's infant deaths and hospitalizations attributed to hemorrhagic disease of the newborn and other neonatal hemorrhagic conditions were reviewed. In 65% of 34 deaths reviewed, vitamin K was not documented as given or was given only after the onset of hemorrhage. Vitamin K was not included in standing orders in any of 22 hospitals contacted. As a result of this review, vitamin K prophylaxis was made a mandatory newborn care procedure in the State Public Health Code.
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Affiliation(s)
- T H Tulchinsky
- School of Public Health, State University of New York, Albany
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Lulseged S. Haemorrhagic disease of the newborn: a review of 127 cases. ANNALS OF TROPICAL PAEDIATRICS 1993; 13:331-6; discussion 337-8. [PMID: 7506879 DOI: 10.1080/02724936.1993.11747666] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A review of 127 infants with haemorrhagic disease of the newborn (HDN) is presented. The case definition of HDN used in the selection of patients was bleeding during the 1st week of life in a newborn with normal platelet count, normal peripheral blood smear and complete clinical response to parenteral vitamin K. Equivocal cases with respect to cause of bleeding were excluded. The eligible cases consisted of 0.9% of all admissions to the unit and the male:female ratio was 1.8:1. Most were from families of low economic status and poor educational background. Omission of vitamin K prophylaxis and exclusive breastfeeding were the commonest antecedents. The mean (SE) gestation and admission weight were 39.3 (0.2) weeks and 2981 (78) g, respectively. One hundred and two (80.3%) had classical HDN with a mean (SE) age at onset of 63 (4.4) hours. Gastro-intestinal bleeding was the commonest observation. Thirty-three infants (26%) died, most of them from exsanguination. There is a need for well designed work to determine the magnitude of the problem, including that of late-onset HDN, the antecedent risk factors, the preferred route for administering prophylactic vitamin K and a clear policy guideline on prevention of the disease.
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Affiliation(s)
- S Lulseged
- Department of Paediatrics and Child Health, Ethio-Swedish Children's Hospital, Addis Ababa, Ethiopia
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Cornelissen EA, Kollée LA, De Abreu RA, van Baal JM, Motohara K, Verbruggen B, Monnens LA. Effects of oral and intramuscular vitamin K prophylaxis on vitamin K1, PIVKA-II, and clotting factors in breast fed infants. Arch Dis Child 1992; 67:1250-4. [PMID: 1444522 PMCID: PMC1793939 DOI: 10.1136/adc.67.10.1250] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A randomised clinical trial was conducted to establish the effects of oral and intramuscular administration of vitamin K at birth on plasma concentrations of vitamin K1, proteins induced by vitamin K absence (PIVKA-II), and clotting factors. Two groups of about 165 healthy breast fed infants who received at random 1 mg vitamin K1 orally or intramuscularly after birth were studied at 2 weeks and 1 and 3 months of age. Although vitamin K1 concentrations were statistically significantly higher in the intramuscular group, blood coagulability, activities of factors VII and X and PIVKA-II concentrations did not reveal any difference between the two groups. At 2 weeks of age vitamin K1 concentrations were raised compared with reported unsupplemented concentrations and no PIVKA-II was detectable. At 3 months vitamin K1 concentrations were back at unsupplemented values and PIVKA-II was detectable in 11.5% of infants. Therefore, a repeated oral prophylaxis will be necessary to completely prevent (biochemical) vitamin K deficiency beyond the age of 1 month.
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Affiliation(s)
- E A Cornelissen
- Department of Paediatrics, University of Nijmegen, The Netherlands
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Hathaway WE, Isarangkura PB, Mahasandana C, Jacobson L, Pintadit P, Pung-Amritt P, Green GM. Comparison of oral and parenteral vitamin K prophylaxis for prevention of late hemorrhagic disease of the newborn. J Pediatr 1991; 119:461-4. [PMID: 1880663 DOI: 10.1016/s0022-3476(05)82064-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- W E Hathaway
- Department of Pediatrics, University of Colorado School of Medicine, Denver
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Andrew M. An approach to the management of infants with impaired haemostasis. BAILLIERE'S CLINICAL HAEMATOLOGY 1991; 4:251-89. [PMID: 1912662 DOI: 10.1016/s0950-3536(05)80161-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Jørgensen FS, Felding P, Vinther S, Andersen GE. Vitamin K to neonates. Peroral versus intramuscular administration. ACTA PAEDIATRICA SCANDINAVICA 1991; 80:304-7. [PMID: 2035325 DOI: 10.1111/j.1651-2227.1991.tb11853.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a randomized study of 300 infants, the effect of 1 mg of peroral vitamin K given at birth was compared to the same dose given as an intramuscular injection. The combined activity of coagulation factor II + VII + X taken after 48 and before 72 hours after delivery served as the primary endpoint. Prothrombin (antigen) and PIVKA II (acarboxyprothrombin) were also measured. All infants were observed for events of bleeding until discharge from the hospital, normally on the fifth day. No significant differences between the groups in any of the biochemical markers were observed. The 95% confidence limits of the differences were very narrow for all factors. No cases of bleeding were observed. We conclude that administration of 1 mg peroral vitamin K is as efficient as intramuscular administration of the same dose in the prevention of classical hemorrhagic disease of the newborn.
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Affiliation(s)
- F S Jørgensen
- Department of Gynecology and Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
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Blanchette V, Doyle J, Andrew M. Haematological investigation in neonates. BAILLIERE'S CLINICAL HAEMATOLOGY 1990; 3:1019-54. [PMID: 2271791 DOI: 10.1016/s0950-3536(05)80145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Vitamin K has regained paediatric interest due to a recurrence of bleeding caused by deficiency of the vitamin in newborns and young infants. Increasing awareness of these clinical problems, the development of new methods for the detection of vitamin K deficiency and the direct measurement of vitamin K in tissues have stimulated research. Much new data obtained from these studies has proved helpful to the understanding of vitamin K deficiency in infancy. For example low concentrations of vitamin K have been found in fetal and neonatal livers. The implications of these findings with respect to manifest vitamin K deficiency and to new methods for detection of subclinical vitamin K deficiency are discussed. Breast-feeding is a major risk factor for classical haemorrhagic disease of the newborn and for late onset bleeding due to vitamin K deficiency in young infants. The interdependencies between breast-feeding and vitamin K deficiency are discussed on the basis of new data obtained from direct measurement of vitamin K in maternal milk. The review further focuses on pathophysiological concepts of bleeding due to vitamin K deficiency in infancy and current concepts of vitamin K prophylaxis.
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Affiliation(s)
- R von Kries
- Zentrum für Kinderheilkunde, Universität Düsseldorf, Abteilung für Allgemeine Pädiatrie, Neonatologie und Gastroenterologie, Federal Republic of Germany
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Felding C, Jul E. Maternal prophylactic vitamin K treatment and response in cord plasma of coagulation factor (II, VII, X) activity. Pediatr Hematol Oncol 1988; 5:77-80. [PMID: 3152955 DOI: 10.3109/08880018809031256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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von Kries R, Kreppel S, Becker A, Tangermann R, Göbel U. Acarboxyprothrombin concentration [corrected] after oral prophylactic vitamin K. Arch Dis Child 1987; 62:938-40. [PMID: 3435609 PMCID: PMC1778562 DOI: 10.1136/adc.62.9.938] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The effect of prophylaxis with oral vitamin K (1 mg vitamin K1 given with the first feed) on the rate of detection of acarboxyprothrombin (PIVKA II) and factor II clotting concentration [corrected] were analysed. Introducing such prophylaxis reduced the rates of detection of PIVKA II concentration [corrected] on day 5 from 48% to zero. None of the babies given prophylaxis had factor II clotting concentration [corrected] below 40%, compared with 34 of 95 babies not given prophylaxis. This study has important implications in the prophylaxis of both classical and late onset haemorrhagic disease of the newborn.
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Affiliation(s)
- R von Kries
- Department of Paediatrics, University of Düsseldorf, Federal Republic of Germany
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Ishii E, Ueda K. Thrombotest values and effect of vitamin K administration for infants. Arch Dis Child 1987; 62:540-1. [PMID: 3606196 PMCID: PMC1778372 DOI: 10.1136/adc.62.5.540-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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25
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Abstract
To determine the most effective way of preventing intracranial hemorrhage due to vitamin K deficiency in infants, we first performed a comparative study using Normotest on the effects of several regimens for the oral administration of vitamin K2. Based on the results, we gave vitamin K2 orally, 2 mg, at birth, and then, 4 mg, at 1 week of age (on discharge from the newborn nursery) to all infants except premature and low-birth-weight infants born in Nagasaki Prefecture, Japan. Since then, as the number of infants with vitamin K2 prophylaxis increased, patients with intracranial hemorrhage due to vitamin K deficiency decreased in number, and no patient was found in 1984. The incidence of this disease in infants with vitamin K prophylaxis was 1/68,500, which was one-twentieth of that (1/3,500 live births) before the period when most neonates received vitamin K prophylaxis. From the results, we concluded that the oral administration of vitamin K2 at birth and 1 week of age prevents this disease.
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Affiliation(s)
- T Matsuzaka
- Department of Pediatrics, School of Medicine, Nagasaki University, Japan
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