Routine administration of vitamin K to newborns (Feb 1, 2018)

Question 1

How does hemorrhagic disease of the newborn present?

Answer 1

GI hemorrhage, ecchymosis, intracranial hemorrhage

Question 2

is there sig complications after 420,000 IM vitamin K injections

Answer 2

no

Question 3

When vit K is given, is classic hemorrhagic disease of the NB present?

Answer 3

no

Question 4

When does late hemorrhagic disease of the NB occur?

Answer 4

3 - 8 weeks

Question 5

In what population does hemorrhagic disease of the NB occur?

Answer 5

exclusively BF infants

Question 6

When did Germany, Britain, Sweden and Australia see late hemorrhagic disease of the NB?

Answer 6

When they switched IM to po admin of vit K

Question 7

is oral or IM admin of VIt K more effective?

Answer 7

IM, but repeated doses or oral have also been suggested.

Question 8

What protein appears in the blood after absence of adequate Vit K

Answer 8

PIVKA-II (appears in absence of vit K

Question 9

When does PIVKA-II (protein seen in the blood in the absence of adequate Vit K) disappear?

Answer 9

by five days after oral admin of 1.0mg of Vit K at birth

Question 10

Is there a difference of oral vs IM vit K at 5 days post birth?

Answer 10

no

Question 11

At 4 - 6wk which infants show biochem signs of vit K deficiency (po vs IM)

Answer 11

19% of infants given 2.0mg of Vit K po, compared to 5.5% of infants given 1.0mg IM

Question 12

What is the failure rate (occurrence of late HDNB) after IM admin (German study)? What about po? (per 100,000 infants)

Answer 12

0.25 per 100,000 infants (compared with 1.4 per 100,000 after po)

Question 13

What is the relative risk of HDNB of those receiving po vs IM Vit K post birth?

Answer 13

13.82

Question 14

what are the reasons behind the increased benefit with IM admin of Vit K vs po?

Answer 14

unclear (possibly storage with slow release)

Question 15

Why doesn’t IM admin provide complete protection from HDNB in BF infants?

Answer 15

po intake of Vit K low (in breastmilk)

Question 16

Bleeding in the first 6 months of life, what should physicians think about

Answer 16

vit k deficiency

Question 17

What are three categories of infants at high risk for HDNB?

Answer 17

1. FTT 2. Liver Dx 3. long term diarrhea 4. exclusively BF

Question 18

what percent of infants with late HDNB have serious intracranial hemorrhages?

Answer 18

50%

Question 19

when are repeated oral doses of vit K used?

Answer 19

parents who refuse IM admin following birth

Question 20

What is the Vit K recommendation by the cps for infants <1500g?

Answer 20

0.5mg Vit K1 IM within first 6h after birth, following stabilization for maternal (fam) baby interaction

Question 21

What is the Vit K recommendation by the cps for infants >1500g?

Answer 21

1.0mg VitK1 IM within first 6h after birth, following stabilization and appropriate opportunity for maternal (fam) baby interaction

Question 22

For parents who refuse IM injections what should physicians recommend?

Answer 22

po dose of 2.0mg vit K1 at time of first feeding.

Question 23

What is the oral product used?

Answer 23

parental form (same as IM)

Question 24

When should po admin of vit K be repeated?

Answer 24

2 - 4 weeks and 6 - 8 wks of age