Delivering neonatal vitamin K prophylaxis: the continuing need for surveillance and vigilance

Shearer, Martin J.

doi:10.1136/archdischild-2019-318117

Cited by 4 publications

(11 citation statements)

References 5 publications

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“…As reliable estimates of VKDB-related burden are currently unavailable, systematic investigations should be initiated. Elsewhere in the world, VKDB surveillance programmes have helped in determining the VKDB-related burden and bolstering the VKDB prevention efforts (4,9,(31)(32)(33) . The feasibility, applicability and benefits of establishing such programmes in the Indian context should be explored.…”

Section: Discussionmentioning

confidence: 99%

“…Although newborn vitamin K 1 prophylaxis is regarded as a safe, reliable and cost-effective intervention against VKDB in many countries including India (2)(3)(4)10,11,17,34,35) , the challenges to implement it continue to exist (36) . Reports from developed countries have increasingly documented instances of parents refusing vitamin K 1 prophylaxis in their newborn children (7,9,33,(37)(38)(39) . The common reasons include cultural and religious beliefs (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…vitamin K 1 predisposes to cancer, etc.) and parental preference for 'alternative' and 'natural' lifestyle (33,(36)(37)(38)(39) . While these are globally relevant issues, a recent online survey brought to light some unique challenges that can hamper vitamin K 1 prophylaxis in lowand middle-income countries, viz., high rates of home deliveries, perception among health workers that neonatal vitamin K prophylaxis is not a priority and supply chain shortcomings (40) .…”

Section: Discussionmentioning

confidence: 99%

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Gaps in the coverage of vitamin K₁ prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Bora

2021

Public Health Nutr.

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Objective: Despite operational guidelines, anecdotal evidence suggests that newborn vitamin K1 prophylaxis is not practiced routinely in India. This study determined the coverage of vitamin K1 prophylaxis among newborns in the country. Design: Nationwide cross-sectional data on live births and newborns receiving vitamin K1 during the 2019–20 reporting period were abstracted from the Health Management Information System (HMIS). The coverage estimates of newborn vitamin K1 prophylaxis were derived nationally and also for individual states and union territories (UTs). Additionally, coverage heterogeneities were investigated using classifiers, viz. geography, socio-demographic index (SDI), special developmental categories and institutional birth rate (IBR). Setting: India Participants: 20,208,804 newborns documented with HMIS. Results: Vitamin K1 was administered to overall 62.36% newborns (95% CI: 62.34 to 62.38%). The Central zone (49.0%), low SDI states (54.39%), Empowered Action Group states (53.32%), and states with low IBRs (44.69%) had the lowest coverage amongst their respective groupings. Across the individual states and UTs, the coverage ranged widely from 22.18% (in Tripura) to 99.38% (in Puducherry), exhibiting considerable variability (coefficient of variation: 33.74%) and inequality (Gini coefficient: 0.17). While the coverage in 8 states/UTs (i.e., Arunachal Pradesh, Manipur, Nagaland, Tripura, Uttar Pradesh, Uttarakhand, Telangana, and Andaman & Nicobar Islands) was below 50%; only five states/UTs (i.e., Chandigarh, Gujarat, Goa, Puducherry, and Tamil Nadu) achieved above 90% coverage. Conclusion: Vitamin K1 prophylaxis was not practiced in more than one-third newborns in India. It calls for identifying the barriers, addressing the gaps and implementing newborn vitamin K1 prophylaxis more effectively throughout the country.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gaps in the coverage of vitamin K₁ prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Bora

2021

Public Health Nutr.

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“…The first observed decline in the administration of vitamin K was in the 1970s. This was due to the preference of only giving vitamin K to preterm babies, which was supported by a 1978 Editorial in the Lancet 17. Various UK newspapers published Golding’s suggested association between the administration of IM vitamin K and the increased risk of childhood cancer 8.…”

Section: Obstacles For Cliniciansmentioning

confidence: 99%

Fifteen-minute guide: Vitamin K administration in neonates: the challenges clinicians face

Haddick

Berry

Sweet³

2021

Arch Dis Child Educ Pract Ed

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“…Infants have low vitamin K stores due to poor placental transfer of vitamin K, low concentrations of vitamin K in breast milk, and possibly insufficient vitamin K from gut microbiota ( 1 ). As vitamin K is an essential nutrient required for blood clotting, newborns are at risk of a rare vitamin K deficiency bleeding (VKDB) disorder that occurs during the first 6 mo of life ( 2 ). Prophylactic administration of vitamin K at birth has successfully reduced incidence of VKDB ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Feeding Practice and Delivery Mode Are Determinants of Vitamin K in the Infant Gut: An Exploratory Analysis

Ellis

Wang

et al. 2022

Current Developments in Nutrition

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Background Infants have low stores of vitamin K at birth. Dietary intake of phylloquinone differs dramatically by infant feeding practice, but the contribution of microbially-produced vitamin K (menaquinones) to infant vitamin K status is not well-understood. Objective The objective of this study was to investigate determinants of infant fecal vitamin K profiles in mother-infant dyads at 6 weeks postpartum. Methods Fecal and breastmilk samples were collected from a subsample of breastfeeding (n = 23) or formula-feeding (n = 23) mother and infant dyads, delivered vaginally (n = 26) or by C-section (n = 20) in the STRONG Kids 2 cohort. Vitamin K concentrations in breastmilk and feces were analyzed by LC/MS and/or HPLC. Fecal bacterial metagenomes were analyzed to derive taxonomy and vitamin K biosynthetic genes. Multivariate linear modelling was used to assess effects of delivery and feeding modes on infant fecal vitamin K. Results Breastmilk contained 1.3 ± 0.2 ng/mL phylloquinone (PK), and formula was reported to contain 52 ng/mL PK. Fecal PK was 38-times higher (P<0.001) in formula-fed than breastfed infants. Infant fecal menaquinones (MKn) MK6, MK7, MK12, and MK13 were higher (P<0.001) in formula-fed than breastfed infants, whereas MK8 predominated in breastfed and was 5-times higher than formula-fed infants. Total MKn were greater (P<0.001) in vaginally delivered than C-section infants. Relative abundances of 33 bacterial species were affected by feeding mode, 2 by delivery mode, and 4 by both (P<0.05). Bacterial gene content of 5/12 vitamin K biosynthetic genes were greater (P<0.05) in breastfed vs formula-fed infants, and 1 differed by delivery mode. Conclusions Feeding practice and delivery mode influence bacterial vitamin K production in the infant gut. High concentrations of unmetabolized PK in feces of formula-fed infants suggests formula PK content exceeds the absorptive capacity of the infant gut.

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Delivering neonatal vitamin K prophylaxis: the continuing need for surveillance and vigilance

Cited by 4 publications

References 5 publications

Gaps in the coverage of vitamin K₁ prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Gaps in the coverage of vitamin K₁ prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Fifteen-minute guide: Vitamin K administration in neonates: the challenges clinicians face

Feeding Practice and Delivery Mode Are Determinants of Vitamin K in the Infant Gut: An Exploratory Analysis

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Delivering neonatal vitamin K prophylaxis: the continuing need for surveillance and vigilance

Cited by 4 publications

References 5 publications

Gaps in the coverage of vitamin K1 prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Gaps in the coverage of vitamin K1 prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Fifteen-minute guide: Vitamin K administration in neonates: the challenges clinicians face

Feeding Practice and Delivery Mode Are Determinants of Vitamin K in the Infant Gut: An Exploratory Analysis

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Product

Resources

About

Gaps in the coverage of vitamin K₁ prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System

Gaps in the coverage of vitamin K₁ prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System