Vitamin K Deficiency Bleeding and Early Infant Male Circumcision in Africa

Abstract

BACKGROUND Early infant (1–60 days of life) male circumcision is being trialed in Africa as a human immuno-deficiency virus prevention strategy. Postcircumcision bleeding is particularly concerning where most infants are breastfed, and thus these infants are at increased risk of vitamin K deficiency bleeding. CASE During a circumcision trial, one infant bled for 90 minutes postprocedure. After discovering he had not received standard prophylactic vitamin K, we gave 2 mg phytomenadione (vitamin K1) intramuscularly; bleeding stopped within 30 minutes. CONCLUSION Vitamin K’s extremely rapid action is not commonly appreciated. Neonatal vitamin K has been shown to be cost-effective. To increase availability and promote awareness of its importance, especially in low-resource settings where blood products and transfusions are limited, vitamin K should be included in the World Health Organization’s Model List of Essential Medicines for Children.

Single-Arm Evaluation of the AccuCirc Device for Early Infant Male Circumcision in Botswana

“…Bleeding resolved approximately 30 minutes after administration of 2 mg phytomenadione (vitamin K1) intramuscularly. A complete case report describing the event has been previously published [27]. …”

Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen clamp in Rakai, Uganda

“…A 40 mg acetaminophen suppository was provided 30 min before the procedure, and infants were given a 24% sucrose solution as a pacifier if needed. Infants aged <14 days were given a preoperative injection of 1 mg Vitamin K (s.c.) to avoid bleeding . The infants were swaddled with knees restrained on a strap board, the perineum cleaned, and the penis swabbed three times with povidone iodine.…”

Efficacy of knowledge and competence‐based training of non‐physicians in the provision of early infant male circumcision using the Mogen clamp in Rakai, Uganda

“…Most safety studies have been conducted during routine service provision, and not during training. Complications included missed contraindications , inadequate pain control, loss of anatomical landmarks with use of anaesthetic cream , cosmetic problems , and bleeding . A systematic review noted a higher likelihood of such complications with increasing infant age .…”