Prophylactic Dosing of Vitamin K to Prevent Bleeding

Witt, Mauri; Kvist, Nina; Jørgensen, Marianne Hørby; Hulscher, Jan B F; Verkade, Henkjan J.; also,

doi:10.1542/peds.2015-4222

Cited by 29 publications

(26 citation statements)

References 19 publications

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“…No clinical trials have been conducted to evaluate the effect of vitamin K prophylaxis on late-onset VKDB. However, epidemiological studies from various countries have suggested that the incidence of late-onset VKDB has significantly been reduced owing to the implementation of vitamin K prophylaxis programs [47,62,65,66] (Table 4). PO vitamin K administration has been the primary method of prophylaxis in several countries, and the incidence of late-onset VKDB has varied: 1.6 per 100,000 infants in the UK [67], 1.9 in Japan [68], 5.1 in Sweden [69], and 6.4 in Switzerland [70] (Table 6).…”

Section: Prevention Of Vkdb In Infancy and Prophylaxis Guidelinesmentioning

confidence: 99%

Vitamin K Deficiency Bleeding in Infancy

Araki

Shirahata

2020

Nutrients

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Vitamin K is essential for the synthesis of few coagulation factors. Infants can easily develop vitamin K deficiency owing to poor placental transfer, low vitamin K content in breast milk, and poor intestinal absorption due to immature gut flora and malabsorption. Vitamin K deficiency bleeding (VKDB) in infancy is classified according to the time of presentation: early (within 24 h), classic (within 1 week after birth), and late (between 2 week and 6 months of age). VKDB in infancy, particularly late-onset VKDB, can be life-threatening. Therefore, all infants, including newborn infants, should receive vitamin K prophylaxis. Exclusive breastfeeding and cholestasis are closely associated with this deficiency and result in late-onset VKDB. Intramuscular prophylactic injections reduce the incidence of early-onset, classic, and late-onset VKDB. However, the prophylaxis strategy has recently been inclined toward oral administration because it is easier, safer, and cheaper to administer than intramuscular injection. Several epidemiological studies have shown that vitamin K oral administration is effective in the prevention of VKDB in infancy; however, the success of oral prophylaxis depends on the protocol regimen and parent compliance. Further national surveillance and studies are warranted to reveal the optimal prophylaxis regimen in term and preterm infants.

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Section: Prevention Of Vkdb In Infancy and Prophylaxis Guidelinesmentioning

confidence: 99%

Vitamin K Deficiency Bleeding in Infancy

Araki

Shirahata

2020

Nutrients

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“…A single dose of either oral or intramuscular injection of vitamin K at birth is insufficient to suppress PIVKA-II at 3 months of age [ 113 ] and additional oral supplementation beyond the postnatal period is needed in order to prevent biochemical evidence of vitamin K deficiency [ 114 , 115 ]. However, the current North American guideline for vitamin K prophylaxis in healthy term infants remains a single dose of 1 mg of phylloquinone by intramuscular injection at birth [ 116 ].…”

Section: Fat Soluble Vitaminsmentioning

confidence: 99%

Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities

et al. 2017

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Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard. Almost all micronutrients display a decrease in their serum levels in critically ill children, resulting in an increased risk of deficiency in this setting. While vitamin D deficiency is a well-known phenomenon in critical illness and can predict a higher need for intensive care, serum concentrations of many trace elements such as iron, zinc, and selenium decrease as a result of tissue redistribution in response to systemic inflammation. Despite a decrease in their levels, supplementation of micronutrients during times of severe illness has not demonstrated clear benefits in either survival advantage or reduction of adverse outcomes. For many micronutrients, the lack of large and randomized studies remains a major hindrance to critically evaluating their status and clinical significance.

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“…A recent study in patients with biliary atresia questioned the efficacy of this new regimen and suggested that the risk had remained unchanged [ 29 ]. The aim of this study is to determine the consequences of a sixfold increase in the oral prophylactic vitamin K dose (150 μg) on the overall incidence of late VKDB and late intracranial VKDB in the Netherlands in comparison with the former oral prophylactic dose of 25 μg.…”

Section: Introductionmentioning

confidence: 99%

Increasing the dose of oral vitamin K prophylaxis and its effect on bleeding risk

et al. 2019

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Vitamin K prophylaxis in infancy aims to prevent life-threatening vitamin K deficiency bleeding (VKDB). The Dutch prophylactic oral daily regimen was increased sixfold from 25 to 150 μg because of a high failure rate. To evaluate the efficacy of this new regimen, incidences of intracranial VKDB under both regimens were compared using both general and targeted surveillance. Late VKDB in the general pediatric population was identified by the Netherlands Pediatric Surveillance Unit, between 1 October 2014 and 31 December 2016. Additionally, infants with intracranial vitamin K deficiency bleeding were identified using the Dutch Pediatric Intensive Care Evaluation registry. The incidence of intracranial VKDB as assessed by general and targeted surveillance decreased from 1.6 per 100,000 (95% CI, 0.4–5.1) to 1.3 per 100,000 (95% CI, 0.5–3.2) and from 3.1 per 100,000 live births (95% CI, 1.9–5.0) to 1.2 per 100,000 live births (95% CI, 0.6–2.3), respectively. Median time between consecutive cases in the latter increased from 24 to 154 days ( p < 0.001). Conclusion : A sixfold increase in oral vitamin K prophylaxis was associated with a surprisingly modest reduction in the incidence of intracranial VKDB, indicating that factors other than the dose need addressing to improve efficacy. What is Known: • The efficacy of intramuscular vitamin K prophylaxis is threatened by an increasing number of parents opting out. • Oral prophylaxis represents an attractive and less invasive alternative but is inferior, especially in infants with malabsorption of vitamin K due to cholestasis. What is New: • Increasing the daily oral dose of vitamin K sixfold had a surprisingly modest effect on the incidence of late vitamin K deficiency bleeding. • This finding indicates that factors other than the dose must play an important role. Electronic supplementary material The online version of this article (10.1007/s00431-019-03391-y) contains supplementary material, which is available to authorized users.

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Prophylactic Dosing of Vitamin K to Prevent Bleeding

Cited by 29 publications

References 19 publications

Vitamin K Deficiency Bleeding in Infancy

Vitamin K Deficiency Bleeding in Infancy

Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities

Increasing the dose of oral vitamin K prophylaxis and its effect on bleeding risk

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