Vitamin K supplementation to prevent hemorrhagic morbidity and mortality of newborns in India and China.

BACKGROUND: Vitamin K deficiency bleeding (VKDB) can cause prolonged and bleeding (intracranial hemorrhage) among newborns, which can be life-threatening or lead to long-term morbidity. The aim of this review article is to reiterate empirical evidence to support the argument that vitamin K should be mandatory for newborns in India and China, as well as in other countries with a high burden of neonatal deaths. DATA SOURCES: Studies were integrated from the PubMed/MEDLINE database search, as well as related literature available elsewhere. RESULTS: Both India and China have been slow in adopting an effective program for administering vitamin K injections to newborns to prevent VKDB-related morbidity and mortality. VKDB cases in China and India have shown inadequate attention to routine use of vitamin K by injection. CONCLUSIONS: While no reliable data are publicly available, the issue of VKDB is at last receiving some attention from the Chinese public health system as well as the Indian government. In both countries, routine vitamin K administration to newborns would prove to be a cost-effective intervention to reduce preventable neonatal morbidity and mortality. VKDB is a global neonatal care issue, including countries where parental resistance is preventing babies from defense against this life-threatening condition.

Late hemorrhagic disease of the newborn.

BACKGROUND: Late hemorrhagic disease of the newborn (HDN) may occur without an underlying disorder or as a secondary manifestation of an underlying disorder. It may be seen in fully breast-fed infants without a routine supplementation of vitamin K. In contrast, idiopathic late HDN is defined as HDN without the presence of any risk factor, such as gastroenteritis or use of antibiotics. Severe hemorrhagic symptoms frequently occur. METHODS: Between March 1987 and May 1997, we evaluated 15 infants with idiopathic late HDN, who were diagnosed by detailed history, physical examination and laboratory findings. RESULTS: The age (mean +/- SD) at onset of symptoms was 62.4 +/- 33.9 days. All children were breast-fed infants and were born at term from healthy mothers. The delivery histories were uneventful. There was no history of vitamin K administration at birth. Signs and symptoms of the patients were convulsions (47%), feeding intolerance and poor sucking (47%), irritability (33%) and pallor (20%). In physical examination; there was bulging or full fontanel in 10 patients (67%), diminished or absent neonatal reflexes in nine patients (60%) and ecchymosis in three patients (20%). Before administration of vitamin K, prothrombin time (PT) was 76.1 +/- 43.0 s and partial thromboplastin time (PTT) was 123.4 +/- 68.8 s. Six to 12 h after administration of vitamin K, PT was 15.6 +/- 1.8 s and PTT was 33.4 +/- 1.0 s. Neurologic, gastrointestinal and skin hemorrhagic findings were found in 11 (73%), three (20%) and three patients (20%), respectively. There were both neurologic and skin bleeding symptoms in two patients. The mortality in the present study was 33%. CONCLUSIONS: Late HDN results in severe hemorrhage, especially hemorrhage in the central nervous system. Administration of vitamin K (1 mg, i.m.) at the birth can reduce these severe complications.

Late form of vitamin K deficiency bleeding in Germany.

BACKGROUND: The evaluation of the disease of vitamin K deficiency bleeding (VKDB). METHOD: 108 reported cases between 1980 and 1990 from Germany. RESULTS: VKDB occurs preferentially (90%) in fully breastfed infants, males are affected nearly twice as often as females. The peak age is four weeks; the majority (79%) of the infants are between three and seven weeks old. 58% of the patients suffer from intracranial bleeding, which results in a total mortality rate of 19% and in neurological damage in 21%. Generally the VKDB occurred suddenly as no warning signs were noticed or they were so insignificant as not to be heeded. In at least 37% of the patients cholestasis was detected. The Quick value was pathologically low in every case. Vitamin K dependent factors were low and PIVKA was detectable, whereas vitamin K independent hemostatic parameters were normal or even elevated. The combination of low Quick value and normal fibrinogen as well as platelet level is a good diagnostic indicator which can be confirmed by administration of vitamin K, after which the Quick value will rise within 30 minutes. Vitamin K prophylaxis reduces the incidence of VKDB from 5.13 per 100,000 births to a tenth of that; single dose oral prophylaxis reduces the risk by a factor of 3.3 and a single parenteral dose by 14.3. Parenteral prophylaxis is more effective in patients with hepatobiliary disorders. Patients who suffered VKDB despite having received vitamin K prophylaxis are older at onset (without prophylaxis 32 days, with oral prophylaxis 37 days, and with parenteral prophylaxis 63 days) and have less intracranial bleeding (35%) than patients who received none (62%). CONCLUSION: Late form of VKDB is a rare but serious disease which can be prevented by VK-prophylaxis.

Vitamin K prophylaxis in the neonate by the oral route and its significance in reducing infant mortality and morbidity.

PIP: Vitamin K in oral drops and intramuscular injection given at birth to Thai infants were compared to determine whether these routes and doses would influence prothrombin complex activity, mortality or morbidity at 0.5, 1 and 2 months of age. The infants were 321 normal fullterm babies born at Bangkok Adventist Hospital in 1983, exclusively breastfed during the study. Prothrombin complex (PC) was measured by the Owren capillary thrombotest method using a reagent from Nyegaard Co., Oslo. Vitamin K was given in single 1 or 2 mg oral doses, or 1 mg im, within 12 hours of delivery. Judging by the number of PC deficient children, the 1 mg im and 2 mg oral doses of vitamin K maintained clotting factors best at 2 months of age. All formulations were significantly better than no treatment at 1 month at age. No toxicity or side effects were seen. Vitamin K deficiency is a known cause of bleeding disorders, particularly fatal and handicapping intracranial hemorrhage in newborns, in developing countries where injections cannot be given by midwives. These inexpensive oral pediatric drops may provide a practical form of primary health care for routine vitamin K prophylaxis in newborns.^ieng

Primary causes of perinatal mortality. Autopsy study of 100 cases.

Many previous reports on perinatal mortality mix primary and secondary causes of death, exclude such important causes as necrotizing enterocolitis and intrauterine growth retardation, and do not break down causes of extrinsic perinatal hypoxia. To avoid these criticisms, a slight modification was made of the list of causes of death used by the Perinatal Mortality Committee of Quebec Province, Canada. The methodology and results of 100 consecutive autopsies are described. Respiratory distress syndrome (31%), congenital anomalies (28%), and extrinsic perinatal hypoxia (17%) were the three commonest causes. Maternal, placental, or labor and delivery problems were associated with about half the cases of extrinsic perinatal hypoxia. In one case of unexplained death, sudden infant death syndrome may be considered as a possibility.