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Plasma concentrations after oral or intramuscular vitamin K1 in neonates
Insights
Giving vitamin K1 orally at birth to healthy newborns effectively raises plasma vitamin K1 levels, offering protection against early hemorrhagic disease. Oral administration at birth is supported for well, mature infants.
Area of Science:
- Pediatrics
- Biochemistry
- Pharmacology
Background:
- Hemorrhagic disease of the newborn (HDN) is a serious condition.
- Vitamin K1 is crucial for blood clotting.
- Optimal administration route and timing for vitamin K1 prophylaxis in infants require clarification.
Purpose of the Study:
- To compare plasma vitamin K1 concentrations after oral versus intramuscular administration.
- To evaluate the impact of timing (at birth vs. with first feed) on oral vitamin K1 absorption.
- To assess the adequacy of oral vitamin K1 at birth for preventing early HDN.
Main Methods:
- 107 healthy, breastfed infants received 1 mg vitamin K1.
- Administration routes: oral at birth, intramuscular at birth, or oral with the first feed.
- Plasma vitamin K1 levels were measured via venous blood samples within 24 hours.
Main Results:
- Oral vitamin K1 at birth showed peak plasma concentrations at 4 hours (median 73 ng/ml).
- Intramuscular injection resulted in significantly higher peak concentrations (median 1781 ng/ml at 12 hours).
- 24-hour plasma concentrations after oral administration were substantially higher than previously estimated adult and newborn values.
Conclusions:
- Oral vitamin K1 at birth is effective in raising plasma vitamin K1 levels in healthy, mature infants.
- This route and timing support protection against early-onset hemorrhagic disease of the newborn.
- Further research is needed to determine optimal dosing for sustained protection.
Abstract:
One hundred and seven healthy, breast fed infants received 1 mg vitamin K1 either at birth (orally or intramuscularly) or with the first feed (orally). Venous blood samples collected in the next 24 hours were assayed for plasma vitamin K1. In babies given the vitamin orally at birth, the peak median concentration (73 ng/ml) occurred at four hours. By 24 hours median plasma concentrations had fallen to 23 ng/ml and 35 ng/ml in the groups fed vitamin K1 at birth or with the first feed, respectively; this difference was not, however, significant. Plasma concentrations after intramuscular injection exceeded those in the oral groups at all comparable times, with a peak median concentration of 1781 ng/ml at 12 hours falling to 444 ng/ml at 24 hours. Since median plasma vitamin K1 concentrations 24 hours after oral administration were some 100 times and 1000 times greater than previously estimated adult and newborn values respectively, this study supports giving vitamin K1 orally at birth to well, mature babies to protect against early haemorrhagic disease of the newborn. Further studies are needed to determine the optimum dose for protection over subsequent weeks.