Vitamin K deficiency: a case report and review of current guidelines.
Ital J Pediatr. 2018 Mar 14;44(1):36. doi: 10.1186/s13052-018-0474-0.
Marchili MR1, Santoro E2, Marchesi A3, Bianchi S3, Rotondi Aufiero L3, Villani A3.
VitaminDWiki
- To prevent Vitamin K Deficiency Bleeding many countries inject or give Vitamin K orally to all newborns
- Total doses range from 1 to 6 mg over several days - depend on country
- I wonder why ALL infants get Vitamin K injections/oral
- I wonder if this started when Vitamin K levels in maternal blood decreased ~40 years ago
- due to decreased Vitamin K in dairy products (low-fat, etc.)
- I wonder if K1 or K2 is used
- I wonder why they do not continue to look at Vitamin K levels in infants/toddlers
- I wonder why Vitamin K is given at birth to stop bleeding but Vitamin K is restricgted in elderly to prevent bleeding
- I wonder why Vitamin D is not also given to infants
- similar to East Germany 600,000 IU injections for many decades
- Henry Lahore - founder of VitaminDWiki
Download the PDF from VitaminDWiki
BACKGROUND:
Vitamin K, a fat soluble vitamin, is a necessary cofactor for the activation of coagulation factors II, VII, IX, X, and protein C and S. In neonatal period, vitamin K deficiency may lead to Vitamin K Deficiency Bleeding (VKDB).
CASE PRESENTATION:
We present the case of a 2 months and 20 days Caucasian male, presented for bleeding from the injections sites of vaccines. At birth oral vitamin K prophylaxis was administered. Neonatal period was normal. He was exclusively breastfed and received a daily oral supplementation with 25 μg of vitamin K. A late onset vitamin K deficiency bleeding was suspected. Intravenous Vitamin K was administered with complete recovery.
CONCLUSIONS:
Nevertheless the oral prophylaxis, our case developed a VKDB: it is necessary to revise the current guidelines in order to standardize timing and dosage in different clinical conditions.
PMID: 29540231 DOI: 10.1186/s13052-018-0474-0
References
- Lippi G, Franchini M. Vitamin K in neonates: facts and myths. Blood Transfus. 2011;6:4-9.
- American Academy of Pediatrics, Committee on Nutrition. Vitamin K compounds and their water soluble analogues: use in therapy and prophylaxis in pediatrics. Pediatrics. 1961;28:501-7.
- Autret-Leca E, Jonville-Bera AP. Vitamin K in neonates. Pediatr Drugs. 2001;3:1-8.
- Ozdemir MA, Karakukcu M, Per H, et al. Late-type vitamin K deficiency bleeding: experience from 120 patients. Childs Nerv Syst. 2012;28:247-51.
- American Academy of Pediatrics. Committee on Fetus and Newborn. Controversies concerning vitamin K and the newborn. Pediatrics. 2003;112: 191-2.
- Misirlioglu ED, Aliefendioglu D, Bademci G, Baydar Z, Kose G, Cakm FN. Intracranial hemorrhage due to vita- min k deficiency in infancy: clinical and radiological findings. J Neurosurg Sci. 2009;26(1):18-25.
- Haroon Y, Shearer MJ, Rahim S, et al. The content of phylloquinone (vitamin K1) in human milk, cows' milk and infant formula foods determined by high-performance liquid chromatography. J Nutr. 1982;112:1105-17.
- Russell R, Beard JL, Cousins R, et al. Vitamin K. In: IOM, editor. Institute of Medicine (US) panel on micronutrients. Dietary reference intakes for vitamin a, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press; 2001. p. 162-96.
- Greer FR. Vitamin K status of lactating mothers and their infants. Acta Paediatr Suppl. 1999;88:95-103.
- Van Winkle M, De Bruyne R, Van De Velde S, Van Biervliet S. Vitamin K, an update for the paediatrician. Eur J Pediatric. 2009;168:127-34.
- American Academy of Pediatrics. Committee on Nutrition. Vitamin K compounds and the water-soluble analougues: use in therapy and pophylaxis in pediatrics. Pediatrics. 1961:28501-507.
- National Institute for Health and Care Excellence. Postnatal care [Internet]. London: The Institute; 2015. Available from: https://www.nice.org.uk/ guidance/cg37/resources/guidance-postnatal-care-pdf. Cited 1 May 2015. (NICE clinical guideline)
- Dermott K, Bick D, Norman R, et al. Clinical guidelines and evidence review for post natal care: routine postnatal care of women and their babies Internet. London: The National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2006. Available from: https://www. nice.org.uk/guidance/cg37/evidence/cg37-postnatal-care-full-guideline3. Cited 1 May 2015
- McMillan D, Fetus and Newborn Committee. Routine administration of vitamin k to newborns position statement. A joint position statement with the College of Family Physicians of Canada [Internet]. Ottawa: Canadian Paediatric Society;2014.
- Newborn guideline 13. Newborn nursing care pathway [Internet]. Perinatal Services BC: Vancouver;2013.
- Women's health program and child Health program: practice guidelines. (Vitamin Kfor prevention of vitamin K deficiency bleeding (VKDB) in newborns Internet. Winnpeg: Winnipeg Regional Health Authority; 2014. Available from: http://www.wrha.mb.ca/extranet/eipt/files/EIPT-026-001.pdf.
- Golding J, Greenwood R, Birmingham K, Mott M. Childhood cancer, intramuscular vitamin K, and pethidine given during labour. BMJ. 1992; 305(6849):341-6.
- Ross JA, Davies SM. Vitamin K prophylaxis and childhood cancer. Med Pediatr Oncol. 2000;34(6):434-7.
- Mihatsch WA1Braegger CBronsky JCampoy CDomellof MFewtrell MMis NFHojsak IHulst JIndrio FLapillonne AMlgaard CEmbleton Nvan Goudoever J ESPGHAN Committee on Nutrition. Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2016;63(1):123-9.
- Ipema HJ. Use of oral vitamin K for prevention of vitamin K deficiency bleeding in neonates when injectable vitamin K is not available. Ann Pharmacother. 2012;46:879-83.
- Hansen KN, Minousis M, Ebbesen F. Weekly oral vitamin K prophylaxis in Denmark. Acta Paediatr. 2003;92(7):802-5.
- IJland MM, Pereira RR, Cornelissen EAM. Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005: evaluation of the current guideline. Euro J Pediatr. 2008;167:165-9.
- Witt M, Kvist N, Horby Jorgensen M, Hulscher JBF, Verkade HJ, also, on behalf of the Netherlands Study group of Biliary Atresia Registry (NeSBAR). Prophylactic dosing of vitamin Kto prevent bleeding. Pediatrics. 2016; 137(5):e20154222.
- Solves P, Altes A, Ginovart G, Demestre J, Fontcuberta J. Late hemorrhagic disease of the newborn as a cause of intracerebral bleeding. Ann Hematol. 1997;75:65-6. Q Springer-Verlag 1997
- Latini G, Quartulli L, De Mitri B, Del Vecchio A, Vecchio C. Intracranial hemorrhage associated with vitamin K deficiency in breastfed infant after intramuscolare vitamin K prophylaxis at birth. Follow up at 18 months. Acta Paediatr. 2000;89:878-86.
- Ciantelli M, Bartalena L, Bernardini M, Biver P, Chesi F, Boldrini A, Sigali E. Late vitamin K deficiency bleeding after intramuscular prophylaxis at birth: a case report. J Perinatol. 2009;29:168-9.
- Italian Society of Neonatology. Profilassi con la vitamina K nell'emorragia da deficit di vitamina K. Consensus Conference, Siena 2 aprile 2004. 2004.
- Neonatal Vitamin K Administration for the Prevention of Hemorrhagic Disease: A Review of the Clinical Effectiveness, Comparative Effectiveness, and Guidelines. Canadian agency for drug and technologies in health. 2015.
- Malguzzi S, Col M, Ghitti C, Clavenna A. Prevenzione dell'emorragia tardiva del neonato con vitamina K. Quaderni acp. 2005;12:26-8.