Free Materials Protect Babies from Life-threatening Bleeding Talk to Expectant Parents about the Benefits of the Vitamin K Shot for Newborns Espaol (Spanish) | Print Download and print this fact sheet [PDF - 247 KB, 2 Pages] We . Background Vitamin K is necessary for synthesis of factors II (prothrombin), VII, IX, and X Vitamin K is undetectable in cord blood Lactobacillus (primary gut flora in breastfed babies) does not synthesize vitamin K Breastmilk contains only small amounts of vitamin K (1 - 9 mcg/L); formula (53-66 mcg/L) Problem Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585350/ [Accessed 6th April 2018], NHS Choices. Total and differential phylloquinone (vitamin K1) intakes of preterm infants from all sources during the neonatal period. Acta Paediatr Scand 1991;80(10):9668. 2003;112:191. PubMedGoogle Scholar. None of the studies have ever been able to find that link again. The amount of medicine that you take depends on the strength of the medicine. Unlike many other nutrients, vitamin K doesn't pass through the placenta very easily. You can have a medication abortion up to nine weeks of pregnancy. Farm Hosp. Pediatrics. CDC. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). We create our articles with NCT antenatal teachers, postnatal leaders and breastfeeding counsellors, as well as academics and representatives from relevant organisations and charities. Correspondence to It's rarer than early-onset or classical VKDB, occurring in 1 in 14,000 to 1 in 25,000 babies. Cases of VKDB seem to be increasing. They're weighed and measured. Adults and teenagersThe usual dose is 2.5 to 25 mg, rarely up to 50 mg, injected under the skin. In this article, we looked at existing recommendations and supporting evidence on the effectiveness of vitamin K given after birth in preventing the haemorrhagic disease of the newborn (HDN). Newborn babies normally have low levels of this vitamin until a few days after birth. This protein disappears by day five of life following PO administration of 1.0 mg of vitamin K at birth [25] and there appears to be no difference in these levels by day 5, whether vitamin K was administered PO or IM [26]. Brain bleeding happens in about half of all babies who develop VKDB, and it can lead to brain damage or death. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. You may be trying to access this site from a secured browser on the server. Bleeding can also occur in other parts of the body, such as the brain (causing one type of stroke). Publication charges for this article have been funded by the Friede Springer endowed professorship for Global Child Health at the Witten Herdecke University, Germany. Early-onset: This begins within the first 24 hours after birth. ChildrenThe usual dose is 5 to 10 mg, injected into a muscle or under the skin, one or two times a day. Vitamin K injections remain the best preventive measure for reducing the risk of haemorrhagic disease of the newborn. Although it was published prior to 2010, we decided to include this review in this summary as this is the backbone evidence supporting the existing recommendations from both the WHO and PrevInfad. PIVKA-II levels after prophylactic vitamin K. Arch Dis Child 1987;62:93840. Incomplete oral prophylaxis have been detected in newborns with HDN receiving the oral regimen [6, 16, 18]. Classic HDN happens when babies dont get enough vitamin K through breast milk. Take this medicine only as directed by your doctor. J Pediatr 1991;119(3):4614. The reasons for additional benefits with IM delivery are not clear, but may pertain to better storage and slow release. Another study looked at the incidence of HDN in breastfed infants with biliary atresia who received one of the three following regimens of prophylactic vitamin K according to their country and date of birth: (oral 25g group) 1mg orally at birth followed by 25g orally daily from week 2 to week 13 of life was given to infants born in the Netherlands from 1991 to 2011, (oral 150g group) 1mg orally at birth followed by 150g orally daily from week 2 to week 13 of life was given to infants born in the Netherlands from 2011 to 2015, (2mg IM group) single dose of 2mg IM at birth was given to infants born in Denmark from 2000 to 2014 [15]. Elimination half-life of vitamin K1 in neonates is longer than is generally assumed: Implications for the prophylaxis of haemorrhaghic disease of the newborn. Pediatrics. The main advantage of a vitamin K injection given through the intramuscular route in the thigh is that your baby will only need one dose (Puckett and Offringa, 2000). Air Force 1 x Tiffany & Co. Air Force 1 1982 . Article World Health Organization. Early-onset and classical VKDB occur in 1 in 60 to 1 in 250 newborns. The pharmacokinetic differences may relate to the lack of sustained vitamin K release from the muscle depot following IV administration, leading to more expedient clearance. (See Box Warning.) Systematic review of evidence to date suggests that a single intramuscular (IM) injection of vitamin K at birth effectively prevents VKDB. Phytonadione is a man-made form of vitamin K, which occurs naturally in the body. 2010;4:CD002776. Also, given the higher risk for late VKDB after a single PO dose of vitamin K administered post-birth, compared with vitamin K administered IM, and the 50% chance that infants with late VKDB will experience serious intracranial hemorrhage [27], delivering vitamin K by the IM route seems prudent. Your baby will need to have vitamin K after they are born to prevent a rare bleeding disorder called haemorrhagic disease of the newborn (HDN) (Puckett and Offringa, 2000). Vitamin K can be given by mouth if preferred, but oral doses arent as effective. Their noses are suctioned out and their vital signs are tested. (1991) Haemorrhagic disease of the newborn in the British Isles: two year prospective study. Learn all about alcohol - includes standard drink size, health risks and effects, how to keep track of your drinking, binge drinking, how long it takes to leave the body, tips to lower intake. From the PrevInfad workgroup (Spanish Association of Primary Care Pediatrics), we found recommendations on vitamin K prophylaxis for haemorrhagic disease of the newborn, last updated in April 2010. The hemorrhagic disease of the newborn. Google Scholar. Canadian Paediatric Society, Fetus and Newborn Committee. Prophylactic dosing of vitamin K to prevent bleeding. The early disease occurs within the first 24 h of life and cannot be prevented by prophylactic administration of vitamin K to the newborn. Greer FR, Marshall SP, Foley AL, Suttie JW. The Puckett 2000 Cochrane review looked at the effectiveness of vitamin K prophylaxis in the prevention of classic and late HDN, but clinical bleeding was only assessed as an outcome for classical HDN. PubMed Vitamin K does not cross the placenta to the developing baby, and the gut does not have any bacteria to make vitamin K before birth. (Pukett and Offringa, 2000). There are no randomized trials comparing the oral and intramuscular route of administration of prophylactic vitamin K in newborns. statement and A mixed micelle formulation for oral delivery of vitamin K may be better absorbed, but one study showed that a higher incidence of vitamin K deficiency occurred when the vitamin was delivered PO, even in this formulation, compared with IM delivery [28]. Administering one intramuscular (IM) dose of vitamin K (0.5 mg for infants weighing 1,500 g or 1.0 mg for infants weighing >1,500 g) routinely to all newborns within the first 6 hours post-birth and following initial stabilization and appropriate maternal/newborn interaction, is now the recommended best practice. The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. The usual dose is 0.5 to 1 mg, injected into a muscle or under the skin, right after delivery. Paediatr Perinat Epidemiol 1992;6(1):713. Witt M, Kvist N, Jrgensen H, Hulscher JB, Verkade HJ. You can have a surgical abortion from around six weeks of pregnancy onwards. Before the initiation of universal vitamin K prophylaxis, a study randomizing half of the male infants in a newborn nursery to receive vitamin K administration demonstrated a sixfold increase in postcircumcision bleeding 8 in the untreated group. In countries where PO administration was the primary form of prophylaxis, the incidence of late VKDB varied: from 1.6 per 100,000 infants (in the UK), 1.9 (Japan), 5.1 (Sweden) to 6.4 (Switzerland) [19][22]. However, although the program was in place to give the injections, most parents did not get any information about the injection and why it was given. Another study looked at the effect of oral and IM on the combined activity of coagulation factor II, VII and X, prothrombin antigen and PIVKA II, with no significant differences between the two administration routes [13]. A: Vitamin K is used by the body to form clots and to stop bleeding. Mayo Clinic on Incontinence - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Vitamin K (Class) (Oral Route, Parenteral Route). In summary, the reported successes of using PO vitamin K prophylaxis in neonates [29] are consistently outweighed by data supporting the preferential use of IM over PO vitamin K in newborns. Pediatr Int 2011;53(6):897901. McNinch AW, Tripp JH. Google Scholar. volume21, Articlenumber:350 (2021) Researchers found this was because of the use of high doses (50 mg) of vitamin K2. The oral route is not appropriate for newborns with biliary atresia. CMAJ 1989;140(1):134. 2016;63(1):1239. CAS https://doi.org/10.1016/j.farma.2010.09.001. Abstract Newborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk. Euro J Clin Pharmocol 1996;49(5):4213. Looking at surveillance data from European countries, it seems that there is no significant difference between the IM and the oral regimens for preventing classical and late HDN, provided that the oral regimen is duly completed. This is called "vitamin K deficiency" and means that a baby has low levels of vitamin K. Without enough vitamin K, babies cannot make the substances used to form clots, called 'clotting factors.' Comparison of oral and parenteral vitamin K prophylaxis for prevention of late hemorrhagic disease of the newborn. Biochemical indices of vitamin K status were measured at birth, at 5 days and after 2 weeks of achieving full enteral feeds (>150 mL/kg/day). If your baby has a vitamin K deficiency, they might bruise or bleed for no apparent reason (CDC, 2017). Eur J Pediatr. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1671305/ [Accessed 6th April 2018], MMWR (Morb Mortal Wkly Rep). Skin colour thats paler than usual, or pale gums in darker-skinned babies. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Content on this website is provided for information purposes only. The benefits of routine vitamin K administration have been demonstrated historically, but the most effective mode of delivery is yet to be fully determined [12]. Pediatrics. Vitamin K injections have been routinely given in Australia for over 20 years, with no ill effects at the time of the injection, or later. Classic VKDB rarely occurs in newborns who have received parenteral vitamin K at birth [12]. 2020;145(6):20202. Croucher C, Azzopardi D. Compliance with recommendations for giving vitamin K to newborn infants. 2013;98(1):417. concluded that while data from older studies suggest that IM may be more effective than the multiple oral doses of vitamin K for preventing late HDN, the more recent data from surveillance systems does not seem to support a significant difference between the IM and the oral route for preventing late HDN [16]. Last updated on Sep 6, 2022. Privacy Policy. BMJ. There were no statistically significant differences neither between 0.2mg IV nor 0.5mg IM on the same outcomes. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. If youve heard people talk about Vitamin K but are feeling a bit clueless, heres the information youll need. There are no randomized trials comparing the oral and intramuscular route of administration of prophylactic vitamin K in newborns. Late HDN occurs when they are between two and 12 weeks old (Puckett and Offringa, 2000). Your privacy choices/Manage cookies we use in the preference centre. Oral prophylaxis compared to placebo also reduced incidence of late HDN, although effect was probably lower (reduction by 97 and 80% for IM versus placebo and oral versus placebo respectively, from one study) and no pooled estimate was performed. Some of these infants may also have had underlying disorders that affected vitamin K metabolism [23]. J Pediatr 1995;127(2):3014. Clarke P, Mitchell SJ, Wynn R, et al. Another systematic review was identified, with the literature search conducted up to 2008, including the studies included in the Puckett 2000 systematic review and four additional studies that were published after 2000 [13]. Recommendations for management of common childhood conditions: evidence for technical update of pocket book recommendations. Babies' intestines don't have very many bacteria yet, so their bodies can't make enough vitamin K. Newborns who don't get a Vitamin K shot and are low on the vitamin are are at risk of vitamin K deficiency bleeding (VKDB). By supporting the PO route for administering vitamin K and a formulation designed for parenteral use, the CPS recommendations of 1988 aimed to secure all the apparent benefits of vitamin K for newborns without incurring unnecessary pain [4][13]. Babies who get early HDN have it within 24 hours of birth. This statement was reviewed by the Community Paediatrics and Drug Therapy and Hazardous Substances Committees of the Canadian Paediatric Society. This content does not have an English version. https://doi.org/10.1186/s12887-021-02701-4, Defined preventive interventions for children under five years of age: evidence summaries for primary health care in the WHO European region, https://doi.org/10.1186/s12887-021-02638-8, https://apps.who.int/iris/bitstream/handle/10665/259269/WHO-MCA-17.07-eng.pdf;jsessionid=CF264F9448EAE361B5BE63F6B8BD284B?sequence=1, https://apps.who.int/iris/bitstream/handle/10665/44774/9789241502825_eng.pdf?sequence=1, http://previnfad.aepap.org/monografia/vitamina-k, https://www.cdc.gov/ncbddd/vitamink/index.html, https://doi.org/10.1016/j.farma.2010.09.001, https://doi.org/10.1007/s00431-019-03391-y, https://doi.org/10.1097/MPG.0000000000001232, https://doi.org/10.1136/archdischild-2011-301029, https://www.ohchr.org/en/professionalinterest/pages/crc.aspx, https://bmcpediatrics.biomedcentral.com/articles/supplements/volume-21-supplement-1, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. For injection dosage form: For problems with blood clotting or increased bleeding: Adults and teenagersThe usual dose is 2.5 to 25 mg, rarely up to 50 mg, injected under the skin. BMJ 1994;308(6933):8945. Do not double doses. However, maternal supplementation with 5 mg daily increases milk vitamin K levels and can improve vitamin K status in breastfed infants who also receive intramuscular vitamin K shortly after birth. Skin-to-skin care for procedural pain in neonates (Review). One clinical guideline on postnatal care from the National Institute for Health and Care Excellence (NICE) gives recommendations on prophylactic administration of vitamin K and was therefore included. The early disease occurs within the first 24h of life and cannot be prevented by prophylactic administration of vitamin K to the newborn. The World Health Organization (WHO) European Region is developing a new pocket book for primary health care for children and adolescents in Europe. Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn. Cochrane Database Syst Rev 2000;(4):CD002776. It can also happen inside the body where parents can't see it. Prevention and management of procedural pain in the neonate: An update. Three trials compared a single dose of oral vitamin K versus placebo or no supplement and showed a significant reduction in the detection of PIVKA II at 3days of life, favouring vitamin K (RR 0.40 [95%CI 0.26 to 0.61] and RD -0.44 [95%CI 0.60 to 0.29]; 3 trials) [12]. Some centres administer intravenous (IV) vitamin K to preterm infants undergoing intensive care, to avoid the pain inflicted by injection. CMAJ 1988;139(2):12730. World Health Organization. Since 1961, the American Academy of Pediatrics (AAP) has recommended that a single 0.5 mg to 1.0 mg dose of vitamin K be administered intramuscularly (IM) to all newborns shortly after birth to prevent VKDB [3]. In the UK, youll be offered vitamin K as an injection for your baby. Keywords: HDNB; Newborn; Prophylaxis; Vitamin K; VKDB. The bleeding starts suddenly, and may not be recognized until it is too late. Paler skin or, in dark-skinned babies, pale gums, Bruising easily, especially around the face and head, Bloody stool or black, dark, sticky stool, A yellow tint to the white parts of the eyes 3 weeks or more after birth, Seizures, irritability, excessive vomiting or sleeping too much. Pediatrics 2006;118(6):e165766. Semin Thromb Hemost 1995;21(3):31729. Health providers should consider the possibility of vitamin K deficiency at an early stage when evaluating any case of bleeding that occurs in the first six months of life. It has a molecular weight of 450.70. Health care providers should advise parents that: For preterm infants undergoing intensive care, limited data suggest that a single IV dose of 0.2 mg at birth may not be as protective against late VKDB as a 0.2 mg or 0.5 mg dose of vitamin K delivered IM. 2015;7(10):830820. Acta Paediatr 1996;85(10):11379. BMC Pediatrics Among infants who had not received vitamin K prophylaxis at birth, the incidence of HDN was estimated at 35 (10.5 to 80) per 100,000 live births, being lower in high income countries at 8.8 (5.8 to 17.8) per 100,000 live births [2]. 1 Estimates of the incidence of early VKDB (without vitamin K prophylaxis) range from 0.25% to 1.7%. Pregnancy, Childbirth, Postpartum and Newborn CARE: A guide for essential practice. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. It's also more effective for preventing HDN. To do so may cause serious unwanted effects, such as blood clotting problems. Raith W, Fauler G, Pichler G, Muntean W. Plasma concentrations after intravenous administration of phylloquinone (vitamin K[1]) in preterm and sick neonates. Read more about our editorial review process. https://doi.org/10.1136/archdischild-2011-301029. This brochure is based on the Joint statement and recommendations on vitamin K administration to newborn infants to prevent vitamin K deficiency bleeding in infancy, that was re-issued by the National Health . The classical form presents between the days 1 and 7. This page was lastreviewed inApril 2018. Hathaway WE, Isarangkura PB, Mahasandana C, et al. To prevent early VKDB, the CPS previously recommended administering PO vitamin K to expectant mothers who are taking medications, notably antiepileptics, which impair vitamin K metabolism [4]. The most reliable and direct way to give Vitamin K injection to a newborn is via an injection. The dose may be repeated, if needed. Thromb Res 2000;99(5):46772. Puckett RM, Offringa M. Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. Schubiger G, Tonz O, Gruter J, Shearer MJ. Pediatrics 1993;91(5):10013. 1 Estimates of the incidence of late VKDB from Europe and Asia range from 10 . DESCRIPTION Phytonadione is a vitamin, which is a clear, yellow to amber, viscous, odorless or nearly odorless liquid. I agree to NCT contacting me in the following ways: https://www.cdc.gov/ncbddd/vitamink/facts.html, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1671305/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585350/, https://www.nhs.uk/conditions/pregnancy-and-baby/what-happens-straight-after-the-birth/#vitamin-k-for-newborn-babies, https://www.nice.org.uk/guidance/cg37/evidence/full-guideline-485782237, http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD002776/full, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862383/#bib5, https://www.scientificamerican.com/article/more-parents-nixing-anti-bleeding-shots-for-their-newborns/, Birth and Beyond Community Support Programme (BBCS). The large number of newborn infants required to conduct a strong prospective study comparing the efficacy of IM versus PO vitamin K (with and without repeated doses) makes it unlikely that such a study will be carried out. Yes, vitamin K shots are very safe. The bacteria in your baby's intestines will also start making vitamin K once they're eating solid foods. Without enough vitamin K, small cuts can go on bleeding for a very long time and big bruises can happen from small injuries. Variations, taking into account individual circumstances, may be appropriate. No document was identified from the US Preventive Services Task Force (USPSTF) published recommendations or recommendations in progress. Twenty-seven years of experience with oral vitamin K1 therapy in neonates. All newborns should receive vitamin K prophylaxis, as it has been proven that oral and intramuscular prophylactic vitamin K given after birth are effective for preventing classical HDN. In a newborn baby, some vitamin K comes through the placenta but at times this is not enough. VKDB is fairly rare, so many parents aren't aware of how dangerous the effects of this disease can be. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Babies have very little vitamin K in their bodies at birth. PO vitamin K appears to be less effective, however, with higher failure rates compared with IM vitamin K [6][19][21]. Answer: Most babies who develop vitamin K deficiency bleeding do not have any known birth trauma, injury, or illness. However, while clinical decisions should always be based on the best evidence available, potential for harm to the infant must also be considered. When it comes to content, our aim is simple: every parent should have access to information they can trust. are born using forceps, ventouse or caesarean section, have liver problems or were poorly at birth. Available from: https://apps.who.int/iris/bitstream/handle/10665/259269/WHO-MCA-17.07-eng.pdf;jsessionid=CF264F9448EAE361B5BE63F6B8BD284B?sequence=1. Arch Dis Child. For more than 20 years, all newborn babies have been given vitamin K at birth, by injection. Ardell S, Offringa M, Ovelman C, Soll R. Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates (Review). Most babies get an injection of vitamin K in the upper thigh. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. In one small study of 14 preterm infants [36], a single 0.3 mg/kg 0.1 mg/kg dose of IV vitamin K achieved plasma levels at 24 and 120 hours similar to that achieved by PO or IM doses of 1.5 mg [37]. American Academy of Pediatrics, Committee on Nutrition. (2006) Routine postnatal care of women and their babies. Question: What is Vitamin K? Late (2 to 12 weeks and up to 6 months of age) VKDB, which occurs almost exclusively in breastfed infants, is a serious condition that manifests predominantly as intracranial hemorrhage [2]. Vitamin K compounds and the water-soluble analogues: Use in therapy and prophylaxis in pediatrics. When some concern about its safety was published in an international journal, there was a considerable outcry - not so much about its safety (it was quickly shown to be both safe and effective), but about the fact that parents were not given information about the need for the injection, or given the opportunity to make an informed decision about an injection given to their baby. Clark FI, James EJ. PubMed The full contents of the supplement are available at https://bmcpediatrics.biomedcentral.com/articles/supplements/volume-21-supplement-1. Follow your doctor's orders or the directions on the label. Their recommendation is based on a review of surveillance systems in four countries (Australia, Germany, the Netherlands, and Switzerland), which suggested that administering vitamin K PO was less effective than by the IM route and may be associated with higher incidence of failure [6]. Classic VKDB is associated with low intake of vitamin K, and late VKDB with chronic malabsorption and low vitamin K intake [2]. As such trials are unlikely to be conducted, the efficiency of the different regimens is assessed by national surveillance, with the risk of underreporting the true incidence of HDN. Children should always be closely supervised near animals and taught how to behave safely around pets. Pain experienced during the neonatal period may have long-term effects [10][11]. von Kries R. Vitamin K prophylaxis a useful public health measure? Preterm infants are at higher risk for VKDB, due to hepatic immaturity, delayed gut colonization with microflora and other factors. The systematic review on vitamin K prophylaxis for preventing HDN conducted by Sankar et al. Harden CL, Pennell PB, Koppel BS, et al. If you miss a dose of this medicine, take it as soon as possible. Parents do not have to allow their baby to have a vitamin K injection, but it is very strongly recommended that they do give permission for it. By screening titles and abstracts, and after exclusion of duplicates with studies already identified, we included two reviews, two cohort studies, and two position papers from the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and from the Canadian Agency for Drugs and Technologies in Health (CADTH). 2018 [cited 2019 Jun 27]. The search was conducted on the 10th of June 2019, by manual search and by using the search term vitamin K. The following information includes only the average doses of these medicines. When a newborn doesn't have enough vitamin K, it puts them at risk for something called vitamin K deficiency bleeding (VKDB). Oral vitamin K From two studies, 1mg of IM or subcutaneous vitamin K prophylaxis reduced incidence of late HDN when compared to placebo (RR 0.02; 95%CI 0.00 to 0.10). Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN committee on nutrition. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862383/#bib5 [Accessed 6th April 2018], Scientific American. Late HDN is linked to babies not absorbing vitamin K because of liver disease or not getting enough vitamin K in their feeds. Newborn babies are given vitamin K injections to prevent a serious disease called haemorrhagic disease of the newborn (HDN). PubMed The major disadvantage is that it's invasive and can cause pain and a small bruise where the injection was given. This site complies with the HONcode standard for trustworthy health information: verify here. From older trials and surveillance data, it seems that there is no significant difference between the intramuscular and the oral regimens for preventing classical and late HDN, provided that the oral regimen is duly completed. Approximately 0.25% to 1.7% of newborns who don't receive vitamin K at birth . Without adequate vitamin K intake, an induced protein (PIVKA-II) becomes measurable in blood. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Takahashi D, Shirahata A, Itoh S, Takahashi Y, Nishiguchi T, Matsuda Y. Vitamin K prophylaxis and late vitamin K deficiency bleeding in infants: Fifth nationwide survey in Japan. Blood in the babys poo it might look black, dark or sticky. BMJ 1991;303(6810):11059. We'll only contact you in the ways you want, and we'll keep your data safe. did not identify any additional trial through the literature search conducted up to 2013 [2]. Babies who are exclusively breastfed are at higher risk of developing VKDB because their vitamin K levels are low. 2019;178(7):103342. However, recommendations for vitamin K prophylaxis at birth for preterm infants vary widely in terms of dosage and routes of administration [35], and there is inadequate evidence to support any one clinical practice. Breast milk does give your baby a little bit of vitamin K. But it's not enough to prevent VKDB. 62(45):901-902. Cochrane Database Syst Rev. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We described the search methods, data collection and data synthesis in the second paper of this supplement (Jullien S, Huss G, Weigel R. Supporting recommendations for childhood preventive interventions for primary health care: elaboration of evidence synthesis and lessons learnt. We conducted a literature search up to the 10th of December 2019 by using key terms and manual search in selected sources. It is insoluble in water, soluble in chloroform and slightly soluble in ethanol. Some parents may ask for oral vitamin K instead of the shot. J Perinatol. Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, et al. Answer: Vitamin K is given to prevent a rare but possibly deadly brain bleed in the first 6 months of life. Part of ; American Academy of Neurology; American Epilepsy Society. Drug information provided by: Merative, Micromedex. Murdoch LA. If theyre formula-fed, it can be given in their bottle. WHO recommendations on newborn health. Privacy This puts them at risk for bleeding. Townsend CW. Pediatrics 1997;99(1):8892. Fertility and the reproductive system - male, Fertility and the reproductive system - female, Seeing a doctor, specialist or health professional, Abortion information translated into community languages. (Table1). (2014) More parents nixing anti-bleeding shots for their newborns. 1, 2 VKDB may present either in the first week of life (early VKDB) or between 2 and 12 weeks of life (late VKDB). Two RCTs (from the 1960s) comparing a single dose of IM vitamin K versus placebo or no intervention showed a reduction of clinical bleeding at one to seven days of life (relative risk [RR] 0.73; 95% confidence interval [CI] 0.56 to 0.96; and RD -0.02; 95%CI 0.04 to 0.00; one trial), and a reduction of bleeding after circumcision (RR 0.18; 95%CI 0.08 to 0.42; and risk difference [RD] -0.11; 95%CI 0.16 to 0.07; one trial) [12]. Infants who didn't get a vitamin K shot at birth are 81 times more likely to develop late-onset VKDB than babies who do get the shot. Clarke P, Mitchell SJ, Shearer MJ. (Suppl 1), 350 (2021). No clinical trial to date has evaluated the effect of vitamin K on late VKDB. Giving your baby a vitamin K injection soon after birth greatly reduces the chances of vitamin K deficiency bleeding (VKDB), a potentially life-threatening condition. When looking at higher (0.5mg) versus lower (0.2mg) dose of IM vitamin K, there were also no statistically significant differences with broad 95%CI for the same outcomes. J Pediatr 1960;56:3436. The bleeding can occur anywhere on the inside or outside of the body. Mayo Clinic does not endorse companies or products. J Pediatr 1985;106(3):3519. 2015. You may have heard about a study from the 1990s about a possible link between the vitamin K shot and developing childhood cancer. We summarized the main findings of systematic reviews with the certainty of the evidence as reported. Controversies concerning vitamin K and the newborn. Evidence assessing vitamin K prophylaxis in preterm infants is scarce. Few other studies looked at biochemical parameters without significant differences [13]. Within the American Academy of Pediatrics (AAP), Dr. Hand is a member of the Committee on Fetus and Newborn. 2011;35(3):14855. The common limitation of these studies is a weak clinical correlation between the biochemical indicators and abnormal bleeding in infants. This article is part of a series of reviews, which aim to summarize the existing recommendations and the most recent evidence on preventive interventions applied to children under 5 years of age to inform the WHO editorial group to make recommendations for health promotion in primary health care. Sadly, most babies with HDN show no warning signs before life-threatening bleeds but they might develop any of the following signs: Breastfedbabies are more prone to HDN than formula fed babies. https://doi.org/10.1007/s00431-019-03391-y. https://doi.org/10.1186/s12887-021-02701-4, DOI: https://doi.org/10.1186/s12887-021-02701-4. One epidemiological study, which included Australia, Germany, the Netherlands and Switzerland, confirmed that three doses PO of 1 mg vitamin K were less effective than IM vitamin K prophylaxis in neonates, although a daily PO dose of 25 micrograms (from week 1 to 13), after an initial PO dose of 1 mg, may be as effective [6]. PubMed Central Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Vitamin K is naturally found in human milk. Eur J Pediatr 1988;147(2):10612. Special thanks are due to members of the Maternity and Newborn Care Program Committee of the College of Family Physicians of Canada, who also reviewed this statement: William Ehman, Kate Miller, Sudha Koppula, Balbina Russillo, Amanda Pendergast, Michelle Abou-Khalil (resident rep), Kevin Desmarais and Heather Baxter. American Academy of Pediatrics, Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. The vitamin K from the injection is stored in your baby's liver and released slowly over months. The dose may be repeated after six to eight hours, if needed. Sankar M, Chandrasekaran A, Kumar P, Thukral A, Agarwal R, Paul V. Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review. Bleeding from the nose or umbilical cord. Epidemiological studies from a number of countries suggest that the incidence of late VKDB has been reduced significantly through implementation of vitamin K prophylaxis programs. Members: Mireille Guillot MD, Leonora Hendson MD, Ann Jefferies MD (past Chair), Thierry Lacaze-Masmonteil MD (Chair), Brigitte Lemyre MD, Michael Narvey MD, Leigh Anne Newhook MD (Board Representative), Vibhuti Shah MD, Liaisons: Radha Chari MD, The Society of Obstetricians and Gynaecologists of Canada; James Cummings MD, Committee on Fetus and Newborn, American Academy of Pediatrics; William Ehman MD, College of Family Physicians of Canada; Roxanne Laforge RN, Canadian Perinatal Programs Coalition; Chantal Nelson PhD, Public Health Agency of Canada; Eugene Ng MD, CPS Neonatal-Perinatal Medicine Section; Doris Sawatzky-Dickson RN, Canadian Association of Neonatal Nurses, Principal authors: Eugene Ng MD, Canadian Paediatric Society; Amanda Loewy MD, College of Family Physicians of Canada. When the bleeding occurs inside the body, it can be difficult to notice. Paediatr Child Health 2004;9(4):2358. This failure rate followed a single PO dose, compared with a rate of 0.25 per 100,000 infants following IM administration. Vitamin K deficiency bleeding in infants and children. The rationale for the substitution of the IM route by an alternative oral route has to be seen from the child rights convention perspective [21]. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/what-happens-straight-after-the-birth/#vitamin-k-for-newborn-babies [Accessed 6th April 2018], NICE. https://doi.org/10.1097/MPG.0000000000001232. McMillan D; Canadian Paediatric Society, Fetus and Newborn Committee. The dose may be repeated, if needed. They don't get much vitamin K from the mother during pregnancy. Their results demonstrated clearly that vitamin K prophylaxis effectively reduces VKDB of any severity in the first week of life [17][18]. Shah P, Herboso C, Aliwalas L, Shah V. Breastfeeding or breast milk for procedural pain in neonates (Review). In an infant, vitamin K deficiency can cause bleeding known as HDN or vitamin K deficiency bleeding (VKDB). This happens when a baby's blood can't make clots, and their body can't stop bleeding. The late onset HDN occurs between 7days and 6months of life, although it is more common between 14days and 3months of life, mainly in fully breastfed infants and typically with cutaneous, gastrointestinal or intracranial haemorrhage. von Kries R, Gobel U. Vitamin K prophylaxis and vitamin K deficiency bleeding (VKDB) in early infancy. One shot is all it takes to protect your baby from getting vitamin K deficiency bleeding. Implementing strategies that minimize the procedural pain associated with IM injections for all newborns is also recommended. McMillan DD, Grenier D, Medaglia A. Canadian Paediatric Surveillance Program confirms low incidence of hemorrhagic disease of the newborn in Canada. Google Scholar. https://doi.org/10.1542/peds.2015-4222. This bleeding is called haemorrhagic disease of the newborn (HDN). Further, a 1993 review from the AAP vitamin K Ad Hoc Task Force effectively dispelled concerns that IM administration of vitamin K was associated with childhood cancers such as leukemia [7]. By screening the titles and abstracts, we included one systematic review and none of the protocols. World Health Organization. It has been recommended by the American Academy of Pediatrics and routinely given to newborns in the US since the 1960s. For permission to reprint or reproduce multiple copies, please see our copyright policy. Ekelund H. Late haemorrhagic disease in Sweden 198789. Available from: https://apps.who.int/iris/bitstream/handle/10665/44774/9789241502825_eng.pdf?sequence=1, Palls AC. 2016;36(S1):S2935. Practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers. Vitamin K is needed by humans for blood clotting. 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