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[Prothrombin and acarboxyprothrombin activity in neonates after oral and intramuscular administration of vitamin K]
B Goldschmidt1, M Verbényi, I Kovács
1Pest Megyei Semmelweis Kórház Csecsemö és Gyermekosztály, Budapest.
Insights
Oral vitamin K1 at birth is ineffective for preventing vitamin K deficiency in newborns. However, administering vitamin K1 orally with the first milk feed protects against early hemorrhagic disease in healthy, full-term infants.
Area of Science:
- Biochemistry
- Neonatal Medicine
- Pediatric Hematology
Context:
- Vitamin K deficiency bleeding (VKDB) is a serious condition in newborns.
- Prophylaxis with vitamin K1 is standard practice, but optimal administration route and timing are debated.
- Hypoprothrombinemia and elevated acarboxyprothrombin indicate vitamin K deficiency.
Purpose:
- To investigate the efficacy of oral versus intramuscular vitamin K1 prophylaxis.
- To compare the effects of vitamin K1 administration at birth versus with the first feed.
- To assess impact on Factor II clotting activity and acarboxyprothrombin levels in term newborns.
Summary:
- Oral vitamin K1 at birth and untreated infants showed decreased Factor II clotting activity and increased acarboxyprothrombin.
- Intramuscular vitamin K1 (1 mg) and oral vitamin K1 (2-3 mg) with the first feed increased Factor II clotting activity.
- These effective prophylaxis groups significantly reduced acarboxyprothrombin levels, with none detected by 5-7 days.
Impact:
- Oral vitamin K1 at birth is insufficient for preventing vitamin K deficiency.
- Oral vitamin K1 administration with the first milk feed is effective in protecting newborns from early hemorrhagic disease.
- This finding supports optimizing vitamin K1 prophylaxis for neonatal health.
Abstract:
The effect of prophylaxis with oral or intramuscular vitamin K1 (Konakion) on the hypoprothrombinaemia and on the rate of detectable acarboxyprothrombin of full-term newborns was investigated. Factor II clotting activity, factor II activity by Echis carinatus venom, factor II protein concentration and acarboxyprothrombin were determined in four groups of breast-fed infants. In the untreated group and in the group where the babies received vitamin K1 orally at birth the factor, II clotting activity was decreased and the rate of acarboxyprothrombin positive cases was increased significantly (from 30% and 28% to 55% and 52% respectively) at the 3d and 5-7th days of age. By the other two groups where 1 mg vitamin K1 was given intramusculary or 2-3 mg vitamin K1 was given orally with the first milk-feed, the factor II clotting activity increased at 3d and 5-7th days of life. In these groups the rate of acarboxyprothrombin positive babies was reduced at 3d day of life from 36% and 35% (cord blood values) to 16% and 13% respectively, and there was found acarboxyprothrombin in none of the babies at 5-7th days of life. These findings support that vitamin K1 given orally at birth is ineffective to prevent vitamin K deficiency, but when it was given with the first feed orally to well, mature babies it seems to be enable to protect the early haemorrhagic disease of the newborns.