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Vitamin K prior to preterm birth for preventing neonatal periventricular haemorrhage
C A Crowther1, D J Henderson-Smart
1Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, South Australia, AUSTRALIA, SA 5006. caroline.crowther@adelaide.edu.au
Insights
Antenatal vitamin K for women at risk of preterm birth did not significantly prevent periventricular haemorrhage in infants. Further research is needed to confirm any potential benefits for neonatal neurological injury.
Area of Science:
- Neonatal care
- Obstetrics
- Neurology
Background:
- Preterm infants face risks of periventricular haemorrhage (PVH), a potential indicator of brain damage and neurodevelopmental issues like cerebral palsy.
- Vitamin K supplementation is explored for its potential to enhance coagulation in preterm neonates.
Purpose of the Study:
- To evaluate the efficacy of antenatal vitamin K in preventing periventricular haemorrhage (PVH) and associated infant neurological injury in cases of imminent very preterm birth.
Main Methods:
- A systematic review of randomized or quasi-randomized trials was conducted, searching major databases up to September 2000.
- Included trials involved vitamin K administration (parenteral or oral) to women at risk of preterm birth.
- Primary outcomes focused on neonatal mortality, PVH (ultrasound), and long-term neurodevelopment; secondary outcomes included other neonatal morbidities and maternal side effects.
Main Results:
- Five trials involving over 420 women were analyzed, with variable quality noted.
- Antenatal vitamin K showed a non-significant trend towards reducing all grades of PVH and severe PVH.
- Excluding lower-quality trials eliminated this trend, and neurodevelopmental data was limited and inconsistent.
Conclusions:
- Current evidence does not demonstrate a significant preventive effect of antenatal vitamin K on periventricular haemorrhages in preterm infants.
- The administration of vitamin K to women prior to very preterm birth requires further investigation to establish its role in neonatal neurological protection.
Background:
Preterm infants are at risk of periventricular haemorrhage. This can be a sign of brain damage that might lead to neurodevelopmental abnormalities, including cerebral palsy. It has been suggested that vitamin K might improve coagulation in preterm infants.
Objectives:
The objective of this review was to assess the effects of vitamin K administered to women at risk of imminent very preterm birth to prevent periventricular haemorrhage and associated neurological injury in the infant.
Search Strategy:
We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to September 2000.
Selection Criteria:
Randomised or quasi-randomised trials of vitamin K administered parenterally or orally to women at risk of imminent preterm birth. The primary outcomes were neonatal mortality, neonatal neurological morbidity, as measured by the presence of periventricular haemorrhage (PVH) on ultrasound during the first week of life, and long term neurodevelopment. Secondary outcomes included other neonatal morbidity and any maternal side effects.
Data Collection And Analysis:
Eligibility, trial quality assessment and data extraction were done independently by two reviewers.
Main Results:
Five trials were included, involving more than 420 women. The trials were of variable quality. Antenatal vitamin K was associated with a non-significant trend to a reduction in all grades of periventricular haemorrhage (relative risk (RR) 0.82, 95% confidence interval (CI) 0.67-1.00) and in severe PVH (grades 3 and 4) (RR 0.75, 95% CI 0.45-1.25) for babies receiving prenatal vitamin K compared with control babies. This trend disappeared when poorer quality trials were excluded. Information on neurodevelopment was only given for a small sample of children in one trial with discrepancy in results given in the two reports.
Reviewer'S Conclusions:
Vitamin K administered to women prior to very preterm birth has not been shown to significantly prevent periventricular haemorrhages in preterm infants.