Routine administration of vitamin K to newborns (Feb 1, 2018) Flashcards
How does hemorrhagic disease of the newborn present?
GI hemorrhage, ecchymosis, intracranial hemorrhage
is there sig complications after 420,000 IM vitamin K injections
no
When vit K is given, is classic hemorrhagic disease of the NB present?
no
When does late hemorrhagic disease of the NB occur?
3 - 8 weeks
In what population does hemorrhagic disease of the NB occur?
exclusively BF infants
When did Germany, Britain, Sweden and Australia see late hemorrhagic disease of the NB?
When they switched IM to po admin of vit K
is oral or IM admin of VIt K more effective?
IM, but repeated doses or oral have also been suggested.
What protein appears in the blood after absence of adequate Vit K
PIVKA-II (appears in absence of vit K
When does PIVKA-II (protein seen in the blood in the absence of adequate Vit K) disappear?
by five days after oral admin of 1.0mg of Vit K at birth
Is there a difference of oral vs IM vit K at 5 days post birth?
no
At 4 - 6wk which infants show biochem signs of vit K deficiency (po vs IM)
19% of infants given 2.0mg of Vit K po, compared to 5.5% of infants given 1.0mg IM
What is the failure rate (occurrence of late HDNB) after IM admin (German study)? What about po? (per 100,000 infants)
0.25 per 100,000 infants (compared with 1.4 per 100,000 after po)
What is the relative risk of HDNB of those receiving po vs IM Vit K post birth?
13.82
what are the reasons behind the increased benefit with IM admin of Vit K vs po?
unclear (possibly storage with slow release)
Why doesn’t IM admin provide complete protection from HDNB in BF infants?
po intake of Vit K low (in breastmilk)
Bleeding in the first 6 months of life, what should physicians think about
vit k deficiency
What are three categories of infants at high risk for HDNB?
- FTT 2. Liver Dx 3. long term diarrhea 4. exclusively BF
what percent of infants with late HDNB have serious intracranial hemorrhages?
50%
when are repeated oral doses of vit K used?
parents who refuse IM admin following birth
What is the Vit K recommendation by the cps for infants <1500g?
0.5mg Vit K1 IM within first 6h after birth, following stabilization for maternal (fam) baby interaction
What is the Vit K recommendation by the cps for infants >1500g?
1.0mg VitK1 IM within first 6h after birth, following stabilization and appropriate opportunity for maternal (fam) baby interaction
For parents who refuse IM injections what should physicians recommend?
po dose of 2.0mg vit K1 at time of first feeding.
What is the oral product used?
parental form (same as IM)
When should po admin of vit K be repeated?
2 - 4 weeks and 6 - 8 wks of age