Prophylactic Effect of Intramuscular, Oral, and Maternal Administration of Vitamin K on Hemorrhagic Disease of the Newborn

PURPOSE: Vitamin K deficiency is associated with hemorrhagic disease of the newborn. Late hemorrhagic disease is often intracranial and may be fatal. Many countries recommend vitamin K prophylaxis after birth to prevent this hazard of vitamin K deficiency. Nevertheless, there are still controversies concerning the best way of providing effective prophylaxis. A recent article by Golding and colleagues has questioned the safety of the routine use of intramuscular vitamin K for the newborn. These authors reported a significantly increased rate of childhood cancer in infants who received intramuscular prophylaxis. So we compared the prophylactic effect of intramuscular, oral, and maternal administration of vitamin K on hemorrhagic disease of the newborn. METHODS: A total of 60 newborns, delivered spontaneously vaginally, in the Masan Fatima hospital from March to June, 1996, were enrolled. Neonated with intrapartum anoxia, liver disease or hereditary coagulation factor deficiencies, who received antibiotics were excluded. Mothers receiving any medication known to interferes with vitamin K metabolism(such as antiepileptics, antibiotics and anticonvulsions) were excluded. The newborns were randomly allocated to one of the four groups. A group was not supplied. B group received 1mg of vitamin K1 intramusculary, C group received 2mg of vitamin K1 orally. D group was given 20mg of vitamin K1 orally to their mothers at least 2days(range 2 to 7) before birth. Blood samples were collected from 48hrs to 72hrs after birth. PIVKA-II level was measured by enzyme-linked immunosorbent assay (EITEST-MONOP, Eisai Ltd), using a monospecific monoclonal antibody against PIVKA-II. The results obtained are expressed in arbitrary unit (AU) : 1AU corresponds to 1micro gram of purified prothrombin. (healthy adults have less than 0.13AU/ml). PT, PTT were measured simultaneously. RESULTS: 1) PIVKA-II was detected in 4 of 15 infants in group A, who were not supplied. None was detected in other groups. So PIVKA-II detection rate was significantly decreased in other groups compared with group A(p<0.05). 2) PT(sec) values were 12.74+/-0.91, 12.58+/-0.89, 12.36+/-1.04, 12.16+/-0.90 respectively, and there was no significant difference between groups. 3) PTT(sec) values were 52.41+/-13.26, 38.39+/-10.04, 42.67+/-7.01, 39.77+/-10.48 respectively and there was significant shortening in other groups compared with group A (p<0.05). CONCLUSION: Not only intramuscular administration but oral and maternal administration of vitamin K have prophylactic effect on hemorrhagic disease of the newborn. Prophylactic effect on the late hemorragic disease of the newborn requires further extensive study and evaluation.

A Study on the Change of Serum Immunoglobulin and T-cell Count in Nephrotic Syndrome & Various Meningitides

A study was conducted on T-cell function, utilizing active & total T-lymphocyte count according to Minowata method, and B-cell function, using irrgnunoe4ctrophoresjp. Total 41 children (10 with nephrotic syadrome, 26 with meningitides, & 5 with frequent pneumonia) were entered into study group, all of them were admitted to our pediatric department during 11 months period from November, 1978 to September, 1979, As control, 22 healthy children were chosen, divided into various age groups. Following results were obtained: 1. T-cell count on normal children (total 59.4+/-0. 6, active 27.2+/-0.9%) were slightly less than that of normal adult (total 68. 2+/-0. 8, active 33. 0+/-1.9%), P value being<0.01. 2. In most cases of severe tuberculous meningitis (stage III), active T-cell count was severely depressed. However, changes of immunoglobulin & T-cell count in the other meningitides & frequent pneumonia patients were variable & inconsistant. 3. In nephrotic syndrome patients, total T-cell count was decreased in 50%, active T-cell count in 70%, and serum immunoglobulin was also decreased in 90% (9 out of 10 patients).

Relationship Between Neonatal Hypocalcemia and Q-oTc Interval

A study has been conducted to see the relationship between Q-oTc interval and neonatal hypocalcemia study group consists of 75 Newborns(full-Term 57, premature 18), whose conditions were Known to be susceptable to the development of hypocalcemia and all of them were admitted to the newborn service of Kyungpook National University Hospital during 6 months period from February to August, 1978. Following results were obtainod: 1. Overall incidence of hypocalcemia was 32%, with highest rate of 70% occurring in high-risk premature group, and 3 out of 4 cases with sever hypocalcemia, defined as serum calcium level below 5mg% were noted inpremature group. There was no sexual difference. 2. cardinal sympotoms were irritability and convulsion,. Convlsion was seen in all cases with severe hypocalcemiam compared to 41% with serum calcium level above 5mg%, subtle type of seizure was the commoest form, occurring in 8 cases, followed by generalized tonic type and multifocal type 3. O-oTc interval was prolonged in 83.4% of hypocalcemia and Q-Tc interval only in 37.5%, There was statistically significant correlation between Q-oTc and serum calcium level, showing = -0.41(P<0.01) in premature and = -0.47(P<0.01)in full term. In summary, we recommend Q-oTc interval as a quick and reliable screening test to detect hypocalcemia in newborn period.