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Perrone S, De Bernardo G, Lembo C, Dell'Orto V, Giordano M, Beretta V, Petrolini C, Gambini L, Toni AL, Parigi G, Fontanarosa I, Natale MP, D'Amato G, Sordino D, Buonocore G. Vitamin K insufficiency and the prophylaxis strategy in term healthy infants: A multicentre study. Eur J Clin Invest 2024; 54:e14141. [PMID: 38071415 DOI: 10.1111/eci.14141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND/AIM Late vitamin K deficiency bleeding (VKDB) during early infancy is a serious problem worldwide. Vitamin K (VK) deficiency commonly occurs in newborns who are exclusively breastfed. Protein Induced by VK Absence (PIVKA-II) has been identified as an early indicator of subclinical VK deficiency in neonates, surpassing prothrombin time. To assess PIVKA-II levels at 48 h, 1 and 3 months of age in full-term newborns who were exclusively breastfed and received varying VKDB prophylaxis regimens. METHODS A prospective observational study was conducted in four hospitals, enrolling 105 newborns. PIVKA-II levels were measured using a sandwich-type enzyme-linked immunosorbent assay. RESULTS At 48 h of age, there was no significant difference in PIVKA-II concentrations between newborns who received intramuscular administration of 1 mg of phylloquinone (VK1) and those who received oral administration of 2 mg of VK1 at birth. At 1 and 3 months of life, infants who received any supplementation regimen between 2 and 14 weeks exhibited significantly lower PIVKA-II concentrations compared to infants who received only 1 mg of intramuscular VK1 at birth. The prophylaxis involving a dose of 1 mg of intramuscular VK1 at birth followed by oral administration of 150 μg/day of VK1 from the 2nd to the 14th week of life showed the lowest PIVKA-II blood concentrations. CONCLUSIONS Oral supplementation of VK1 after discharge significantly reduced PIVKA-II concentrations in exclusively breastfed term infants. These findings suggest the importance of oral VK1 supplementation in exclusively breastfed infants during their first 3 months of life to avoid the risk of VK insufficiency.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Giuseppe De Bernardo
- Division of Pediatrics Neonatology and NICU, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Chiara Lembo
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Valentina Dell'Orto
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Virginia Beretta
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Chiara Petrolini
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Lucia Gambini
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | | | | | | | | | | | - Desiree Sordino
- Department of Emergency, NICU, A.O.R.N. Santobono-Pausillipon, Naples, Italy
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Sameshima T, Ashina M, Fukuda T, Kido T, Abe S, Watanabe Y, Sato I, Yano Y, Tanimura K, Nagase H, Nozu K, Fujioka K. Range of protein induced by vitamin K absence or antagonist-II levels in neonates at birth. Sci Rep 2024; 14:921. [PMID: 38195988 PMCID: PMC10776853 DOI: 10.1038/s41598-024-51674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 01/11/2024] Open
Abstract
Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is avitamin K (VK) deficiency indicator in neonates. However, PIVKA-II detection frequency in neonatal blood at birth and the correlation between PIVKA-II and gestational age are unclear. We retrospectively analyzed infants admitted to our institution between June 1, 2018, and March 31, 2022, whose clinical and PIVKA-II data were available, and classified them into preterm and term infant groups. Overall incidence of PIVKA-II-positive cases (≥ 50 mAU/mL) was 42.8%, including 0.6% apparent VK deficiency (≥ 5000 mAU/mL), 3.1% experimental VK deficiency (1000-4999 mAU/mL), and 10.7% latent VK deficiency (200-999 mAU/mL) cases. Incidence of PIVKA-II-positive cases was significantly higher in the term group than in the preterm group (49.4% vs. 29.7%, p < 0.001). Gestational age correlated with PIVKA-II levels (r2 = 0.117, p < 0.0001). Median serum PIVKA-II levels and incidence of PIVKA-II-positive cases (≥ 50 mAU/mL, 16.4%) were lower at 5 days after birth than at birth, possibly reflecting the postnatal VK prophylaxis impact. Only one infant was diagnosed with VK deficiency bleeding (PIVKA-II levels, at birth: 10,567 mAU/mL; at day 5: 2418 mAU/mL). Thus, serum PIVKA-II levels after birth weakly correlated with gestational age. VK deficiency was more common in term infants than in preterm infants.
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Affiliation(s)
- Tomohiro Sameshima
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mariko Ashina
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takuya Fukuda
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takumi Kido
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Abe
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuko Watanabe
- Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Itsuko Sato
- Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Yoshihiko Yano
- Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Three Different Regimens for Vitamin K Birth Prophylaxis in Infants Born Preterm: A Randomized Clinical Trial. J Pediatr 2022; 255:98-104. [PMID: 36343740 DOI: 10.1016/j.jpeds.2022.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the efficacy of 3 different vitamin K birth prophylaxis regimens in infants born premature. STUDY DESIGN This was an open-label, parallel-group, randomized clinical trial conducted in a tertiary neonatal care unit in India. Infants born very preterm (≤32 weeks) and/or with very low birth weight (≤1500 g) were included. In each arm, 25 babies were enrolled. Babies were randomized to receive 1.0 mg, 0.5 mg, or 0.3 mg intramuscular (IM) vitamin K1 at birth. Protein induced by vitamin K absence - II (PIVKA-II) levels were assessed at birth, and on days 5 and 28, along with the frequency of death, bleeding manifestations, intraventricular hemorrhage, necrotizing enterocolitis, bilirubin levels, and duration of phototherapy. The primary outcome was comparison of PIVKA-II levels on day 5 of life. RESULTS All the 3 regimens resulted in similar proportion of vitamin K subclinical sufficiency (PIVKA-II < 0.028 AU/mL) infants on day 5 (1 mg - 100%; 0.5 mg - 91.7%; 0.3 mg - 91.7%, P = .347), with no significant difference in median (IQR) PIVKA-II levels (AU/mL): 1 mg 0.006 (0.004, 0.009); 0.5 mg 0.008 (0.004, 0.009); 0.3 mg 0.006 (0.003, 0.009), P = .301. However, on day 28, there was a significant decrease in the proportion of vitamin K-sufficient infants in the 0.3-mg IM group (72.7%) compared with the 1.0-mg (100%) or 0.5-mg (91.3) groups. The 1.0-mg group had significantly greater bilirubin levels and duration of phototherapy. None of the other clinical outcomes were statistically different. CONCLUSIONS Both 1-mg and 0.5-mg IM vitamin K birth prophylaxis resulted in high sufficiency on follow-up, compared with 0.3 mg. The current recommendation of 0.5-1 mg IM vitamin K birth prophylaxis for infants born preterm, needs to be continued. TRIAL REGISTRATION CTRI/2022/02/040396.
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Negash BT, Alelgn Y. Prevalence and factors associated with vitamin K prophylaxis utilization among neonates in rural Ethiopia in 2016. BMC Pediatr 2022; 22:361. [PMID: 35739491 PMCID: PMC9229479 DOI: 10.1186/s12887-022-03428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal Mortality Ratio (NMR) could not be reversed sufficiently in Ethiopia in the last couple of years. Neonatal bleeding is one of the major causes of neonatal deaths. Administration of vitamin K prophylaxis at birth is the proven strategy to reduce neonatal death which can be caused by vitamin K deficiency bleeding. Although World Health Organization (WHO) recommends universal supplementation of vitamin K prophylaxis for all neonates at birth, many neonates could not get it in many resource poor countries. Despite its importance, information is scarce about uptake of vitamin K prophylaxis in Ethiopia in 2016. Therefore, this study aimed to identify prevalence and factors associated with vitamin K prophylaxis utilization among neonates in Ethiopia in 2016. METHODS Secondary data analysis of EDHS 2016 was done to assess prevalence and predictors of vitamin K prophylaxis among neonates in Ethiopia five years before EDHS 2016. Multi-stage cluster sampling was used in EDHS 2016. Sample weight and complex analysis were used to minimize bias. Bivariate and multivariable logistic regression analyses were carried out to identify factors associated with vitamin K prophylaxis. Finally, adjusted odds ratio with 95% confidence interval was calculated and P-value less than 0.05 taken as the cuff of point for declaration of the statistical significant association. RESULTS Prevalence of vitamin K prophylaxis among neonates in Ethiopia in 2016 was found to be 4710(65.5%) in this study. Factors like: Institutional delivery (AOR = 2.2, 95%CI: 1.8, 2.7), neonates from richest family (AOR = 2.1, 95%CI: 1.6, 2.7), neonates from richer household (AOR = 1.4, 95%CI: 1.1, 1.8), starting of antenatal care from 3-6 months of gestational age (AOR = 2.9, 95%CI: 2.3, 3.6) were factors positively associated with vitamin K prophylaxis in Ethiopia. CONCLUSION AND RECOMMENDATION Compared with expected world health organization recommendation of universal supplementation vitamin K prophylaxis, vitamin K utilization is lower among neonates in this study. Hence, it is recommended that strengthen early antenatal care initiation and improving community awareness about vitamin K prophylaxis are the key interventions to improve its uptake. Furthermore, improving institutional delivery might increase uptake of vitamin K prophylaxis.
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Affiliation(s)
- Berhan Tsegaye Negash
- Department of Midwifery,Collage of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia.
| | - Yitateku Alelgn
- Department of Midwifery,Collage of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Sriwichai W, Collin M, Avallone S. Partial disintegration of vegetable cell wall during cooking improves vitamin K1 (Phylloquinone) bioaccessibility in in vitro digestion. INT J VITAM NUTR RES 2021; 91:439-450. [PMID: 34134516 DOI: 10.1024/0300-9831/a000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vegetables rich in vitamin K consumption could prevent bleeding and maintain bone status. The aims of the present work were to investigate i) the effect of household cooking (i.e., boiling for 5 min at 100 °C in distilled water and stir-frying for 3 min at 180 °C in hot canola oil) on phylloquinone bioaccessibility of five rich phylloquinone leafy vegetables, namely Water spinach (Ipomoea aquatic Forssk), Amaranth (Amaranthus blitum subsp. oleraceus L.), Chinese broccoli (Brassica alboglabra), Pak choi (Brassica rapa L.) and Drumstick (Moringa oleifera Lam.), and ii) the structural changes of these leaves before and after in vitro gastro-intestinal digestion. All the experiments were realized in triplicate for each vegetable. The amounts of phylloquinone in leafy vegetables were noticeable in almost all species and ranged from 94 to 182 μg/100 g DM. Their cell wall polysaccharide contents greatly varied from 4.3 to 8.4 g for 100 g. The content in bioaccessible phylloquinone was low in raw leaves (<25 μg/100 g DM) as well as its bioaccessibility (<15%). Leaf pectin content impaired phylloquinone bioaccessibility using principal component analysis. Boiling and stir-frying significantly improved the bioaccessibility of phylloquinone in leaves by a factor of three to twelve and two to seven respectively (p<0.05). These variations were associated with changes in leaf structure. Palisade and spongy cells appeared ruptured and disorganized after stir-frying. Given the estimated bioaccessibility of phylloquinones, the consumption of 500 g of cooked wet leaves per day would cover phylloquinone needs of an individual adult average body weight.
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Affiliation(s)
- Wichien Sriwichai
- Faculty of Agro-Industry, Department of Innovation and Technology of Product Development, King Mongkut's University of Technology North Bangkok, Prachinburi, Thailand
| | - Myriam Collin
- Institut de Recherche pour le Développement, UMR DIADE 2, IRD/CIRAD F2F-Palmiers, IRD, Montpellier, France
| | - Sylvie Avallone
- UMR QualiSud, Université de Montpellier, CIRAD, Institut Agro, Université d'Avignon, Université de la Réunion, Montpellier, France
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Holley SL, Green K, Mills M, Detterman C, Rappold MF, Thayer S. Educating Parents on Vitamin K Prophylaxis for Newborns. Nurs Womens Health 2020; 24:283-293. [PMID: 32778394 DOI: 10.1016/j.nwh.2020.05.005] [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] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Vitamin K is important in the clotting cascade, and vitamin K prophylaxis is important in preventing vitamin K deficiency bleeding (VKDB) in newborns. Breastfed newborns have been found to be particularly vulnerable to VKDB. Although oral vitamin K is available, there is no version for newborns approved by the U.S. Food and Drug Administration (FDA), and if a dose is missed, the risk of VKDB may more than double. Therefore, an injection is recommended by the American Academy of Pediatrics to prevent VKDB in newborns. Nurses often administer the newborn vitamin K injection, and they play a key role in educating parents and helping them make informed decisions about vitamin K prophylaxis for their newborns.
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Seasonal and meteorological associations of vitamin K-dependent coagulation factors in 1-month-old infants: assessment of Normotest values. Blood Coagul Fibrinolysis 2020; 31:233-236. [PMID: 32004199 DOI: 10.1097/mbc.0000000000000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: We aimed to determine the presence of seasonal and meteorological associations of the activity of vitamin K-dependent coagulation factors to explain the seasonal variation in vitamin K deficiency-related bleeding. Seasonal and monthly changes in Normotest values in 1759 healthy 1-month-old infants were retrospectively accessed, and the impact of meteorological parameters on Normotest values was analyzed. Normotest values peaked in winter and were the lowest in summer, with statistically significant differences among the seasonal values (P < 0.001). Comparing monthly variations, the values peaked in January and were the lowest in August (P < 0.001). Only the average daily air temperature significantly correlated with the Normotest values on multiple linear regression (P < 0.001) and with low Normotest values on multiple logistic regression analysis (odds ratio, 1.023; P = 0.002). Seasonal and monthly variations in Normotest values were observed in 1-month-old infants, possibly due to fluctuations in daily air temperature.
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Delvin E, Harrington DJ, Levy E. Undernutrition in childhood: Clinically based assessment tools and biological markers: Where are we and where should we go? Clin Nutr ESPEN 2019; 33:1-4. [PMID: 31451244 DOI: 10.1016/j.clnesp.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/31/2022]
Abstract
Despite its association with poor clinical outcomes and increased hospital costs, as of today undernutrition still goes undetected in paediatric hospitals. The reported prevalence of undernutrition in paediatric patients varies considerably. This disparity is partly due to the diversity of methods for its detection and assessment, as well as to the lack of consensus regarding its definition. Several methods, based on varied combinations of morphology characteristics, estimated nutritional intakes and medical conditions have been developed during the last 25 years. However, these tools suffer from poor sensitivity and selectivity particularly in acute conditions. Also while having their own merit, these tools mainly view malnutrition from the energy standpoint, disregarding assessment of specific micronutrients such as minerals and vitamins. In this position paper we make the point that in the era of personalized medicine, present technology offers the possibility of going beyond the traditional nutritional tools for assessing patients' status, and propose the measurement of selected micronutrients and allied metabolic markers in nutritional workup schemes adapted to each clinical condition.
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Affiliation(s)
- E Delvin
- Sainte-Justine UHC Research Centre, Canada; Department of Biochemistry and Molecular Medicine, Université de Montréal, Montréal, Canada.
| | - D J Harrington
- Nutristasis Unit, Viapath, St Thomas Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - E Levy
- Sainte-Justine UHC Research Centre, Canada; Department of Nutrition, Université de Montréal, Montréal, Canada
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Coffey PS, Gerth-Guyette E. Current perspectives and practices of newborn vitamin K administration in low and middle income countries. RESEARCH AND REPORTS IN NEONATOLOGY 2018; 8:45-51. [PMID: 33488138 PMCID: PMC7745116 DOI: 10.2147/rrn.s154652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background Vitamin K prophylaxis can prevent vitamin K deficiency bleeding (VKDB), and current global recommendations support universal prophylactic use in newborns. Data about access to and use of vitamin K in low and middle income countries (LMIC) are scarce. To address this gap, we explored current perspectives and practices of newborn vitamin K administration in LMIC in order to better understand the barriers to more widespread coverage of this lifesaving preventative treatment. Methods We conducted an online survey of stakeholders involved in newborn health. We sent the survey via e-mail to 109 individuals who were based primarily in LMIC and 23 responses were received, resulting in a response rate of 21%. Respondents were generally health or development professionals from sub-Saharan Africa and Asia. Results Incidence rates at the country level were mostly unknown or not supported by adequate data. Many respondents (17/23) indicated that vitamin K prophylaxis is included in their national newborn care guidelines and policies, while 12 respondents indicated that administration at birth was widely practiced. Around half of respondents reported that health workers were trained in the diagnosis and treatment of VKDB. The most frequently cited barriers to more widespread vitamin K prophylaxis were (in rank order) high rates of home birth (which preclude injections that must be given by skilled health workers), lack of access to and availability of vitamin K, perception that vitamin K prophylactic treatment is not a priority among health workers, lack of vitamin K formulations appropriate for infants, cultural practices suggesting that injection at birth is not acceptable to parents, and vitamin K not being included in national guidelines and policies. There was no consensus as to the ideal formulation, respondents preferring both the current intramuscular (IM) injection and oral formulation. Reported product attributes of IM and oral formulations are summarized. Conclusion Prophylactic administration of vitamin K to newborns is relatively well integrated into policy at the global and country levels, but its practice is underutilized. Barriers to use are access, supply chain logistics, provider attitudes, and restrictions on the use of injections by providers at the community level. Technology innovation may offer some promise to mitigate these barriers, although advocacy and health system strengthening might be more likely to yield improved coverage. Further investigation using in-depth bottleneck analysis at the country level could help identify specific health system improvements.
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Tursunov D, Yoshida Y, Yrysov K, Sabirov D, Alimova K, Yamamoto E, Reyer JA, Hamajima N. Estimated costs for treatment and prophylaxis of newborn vitamin K deficiency bleeding in Tashkent, Uzbekistan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:11-20. [PMID: 29581610 PMCID: PMC5857497 DOI: 10.18999/nagjms.80.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vitamin K deficiency bleeding (VKDB) is a preventable cause of infant mortality and long-term morbidity through the world. This study aimed to demonstrate the costs of VKDB treatment estimated from the hospital records in Tashkent, Uzbekistan, as well as the prophylaxis costs for mass vitamin K medication. Subjects were 50 patients with no operation and 50 patients who had received a brain operation, consecutively enrolled from 180 cases diagnosed at Republican Research Center of Emergency Medicine in 2014. In that year, an additional 22 VKDB patients were found in Tashkent; the incidence of VKDB was 478/100,000 among 42,225 newborns. The prophylaxis costs for all newborns in Tashkent were estimated under a plausible condition. The average age at admission was 43.2 days among 100 patients (67 boys and 33 girls) with birth weight from 2,600 g to 3,800 g (3,105 g on average). The great majority of patients (92.0%) were breastfed; 89.5% in boys and 97.0% in girls. Average treatment cost per VKDB patient was 365 USD for the operated and 285 USD for the non-operated. Total expenses of the 202 patients were estimated to be 64,603 USD. A single prophylaxis was estimated to cost 1.24 USD, totaling 52,359 USD for the prophylaxis of 42,225 newborns. Since the reduction of VKDB incidence through prophylaxis is considered to be higher than 78.5% (52,359/64,603), provision of prophylaxis services would reduce the total costs of VKDB treatment in Uzbekistan, where prophylaxis is not provided.
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Affiliation(s)
- Doniyorjon Tursunov
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Republican Research Centre of Emergency Medicine, Department of Pediatrics, Tashkent, Uzbekistan
| | - Yoshitoku Yoshida
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keneshbek Yrysov
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dilmurad Sabirov
- Republican Research Centre of Emergency Medicine, Department of Pediatrics, Tashkent, Uzbekistan
| | - Khilola Alimova
- Republican Research Centre of Emergency Medicine, Department of Pediatrics, Tashkent, Uzbekistan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Joshua A Reyer
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
This review of hematology in Africa highlights areas of current practice and the immediate needs for development and clinical research. Acute hematological practice is dominated by anemia, sickle cell disease, and the need to provide a safe and rapidly available supply of blood. There is a growing need for specialist services for bleeding and coagulation, hematological malignancy, and palliative care. There are many areas of practice where straightforward measures could yield large gains in patient care. There is an urgent need for good clinical research to describe the epidemiology, natural history, and management of hematological diseases in Africa.
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Affiliation(s)
- Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar-es-Salaam, Tanzania
| | - David J Roberts
- Radcliffe Department of Medicine, University of Oxford, National Health Service Blood and Transplant, John Radcliffe Hospital, Oxford OX3 9BQ, UK.
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