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[Vitamin K for newborn infants: why and how?]
1Kinderklinik der Thüringen-Klinik Georgius Agricola Saalfeld gGmbH.
Insights
Vitamin K deficiency in newborns is confirmed by PIVKA II detection. Oral vitamin K prophylaxis is recommended over intramuscular injections due to potential risks.
Area of Science:
- Biochemistry
- Neonatal Medicine
- Public Health
Context:
- Vitamin K deficiency bleeding (VKDB) remains a concern in newborns.
- Acarboxyprothrombin (PIVKA II) is a reliable biomarker for vitamin K deficiency.
- Epidemiological data highlight the incidence of VKDB.
Purpose:
- To review evidence supporting vitamin K prophylaxis in newborns.
- To compare the safety and efficacy of different vitamin K administration routes.
- To address concerns regarding intramuscular vitamin K injections.
Summary:
- Elevated PIVKA II levels in newborns indicate vitamin K deficiency.
- Both intramuscular and oral vitamin K are effective in preventing hemorrhages.
- Intramuscular injections may be linked to increased cancer risk, warranting caution.
Impact:
- Recommends oral vitamin K administration as the preferred prophylactic method for newborns.
- Suggests limiting intramuscular injections to exceptional cases.
- Emphasizes the importance of continued vitamin K prophylaxis for infant health.
Abstract:
Several publications during the past 10-15 years report on the identification of acarboxyprothrombin (PIVKA II) in a varying proportion of examined newborn and babies (1.9 to 81.5%). These findings prove that the relevant infants were suffering from vitamin K deficiency. Hence, the researchers recommend to continue the prophylactic administration of Vitamin K to newborn. Another argument in favour of vitamin K prophylaxis is supplied by the results of epidemiological studies on the frequency of haemorrhages in newborn and babies caused by vitamin K deficiency. In respect of avoidance of haemorrhages, a single intramuscular injection of vitamin K appears to be the safest mode of application, but repeated peroral administration seems to be practically equally effective. The very frequently performed intramuscular injection of vitamin K is criticised not only because of possible local complications but also because of the greatly enhanced vitamin K concentrations in the blood after the injection. This enhanced concentration is accused of being responsible for the increased risk of malignant tumour growth in those babies who received vitamin K via the i.m. route, compared with the children who had not been given any injection or to whom vitamin K had been administered orally. For this reason vitamin K prophylaxis should be effected in newborn via the oral route (repeated administration), whereas the i.m. route should be an exception. Recommendations to this effect are already on record.