Vitamin K And The Newborn

Vitamin K and the Newborn 1. NO VITAMIN K——— if the baby is NOT in a high risk group the chances of baby suffering a significant haemorrhage is 1:10 000. Of these children 1:4 to 1:8 will suffer brain damage and 1:10 will die. 2.ORAL VITAMIN K——–if the baby receives one dose the risk of the baby suffering a haemorrhage is 1:20 000. If the baby receives a full course the chance of significant haemorrhage is unknown although some cases have been reported. 3. INJECTION OF VITAMIN K——-the baby is protected against the disease unless there is a problem with the liver.

CHOICES

VITAMIN K Informed decision making The facts about vitamin k and blood clotting: Vitamin K is a fat soluble vitamin that we obtain from our diet and from the bacteria in the gut, we make it. Vitamin K is necessary for the blood to clot normally Newborn babies have prolonged clotting times this is because the blood needs to flow through the network of small vessels in the placenta without clotting. The blood clotting timesafter the birth until around day five and then gradually return to normal by the seventh day Vitamin K is given to protect babies against haemorrhagic disease of the newborn Mature breastmilk contains little vitamin K, whereas colostrums is rich in it. Baby formula milks all have vitamin K added to them

VITAMIN K AND THE NEWBORN Haemorrhagic disease of the newborn Excessive bleeding is more likely to occur early in the first week of life, however dangerous haemorrhage may occur late at any time until the child is fully weaned. Some babies are clearly at higher risk than others but half of the cases occur without any risk factors having been identified. Risk factors: 1. 1. 1. 1. 1.

Babies born before 36wks If a baby has an infection If baby is born small and under weight If the baby needs help to establish breathing at birth If the baby has bruises

1. 1. 1. 1. 1. 1. 1.

If the baby is being circumcised Unwell babies Babies who are unable to feed or are not absorbing their feeds Caesarean section or forceps or ventouse Breech births Mum is epileptic or has TB Mums who are drug users or mal nourished 1. Mum or baby have liver disease Facts 1. The disease can present either early or late 1. In the first week the baby may ooze from the cord stump, have stomach bleeding which is often not severe or more rarely bleeding into the brain 1. The early disease is more common 1-2% of babies who have NOT had the vitamin K. 1. Late onset of the disease is more severe. The babies have a large sudden bleed often into the brain. It occurs in exclusively breastfeeding babies or bottle feeding babies that are not absorbing their feeds properly. In most cases the mother or baby are usually discovered to have a liver disease. It is rare and occurs 5-10 babies out of every 100,000 babies. 1. The treatment is vitamin K by injection and a transfusion of fresh frozen plasma which is a blood product.

Considerations 1. A study published in 1992 suggested that the vitamin K injection was associated with an increased risk of childhood cancer. Oral vitamin K was used in many centres as a result. 1. Further studies published in 1993 and 1996 were unable to find the same association. It was therefore felt that the original claim was unsubstantiated. The use of vitamin K injection as routine started to become widespread again. 1. Out of four studies published in 1998, only one found no link between the injection of vitamin K and cancer, the remaining 3 were unable to exclude a possible increased risk of contracting leukaemia in 1 to 6 year olds. The recommendations by the authors of these studies is that `whilst a small risk cannot be excluded, it seems prudent to recommend a policy of giving injections of vitamin K only to those babies at particularly high risk and orally to others.` 1. Although there is a product licensed for use orally, it is not widely used it is very expensive and the dose is very high. 1. It is usual to give the preparation for injection orally, and in repeated doses, there are any number of protocols for giving it, each hospital deciding what they think is best. Often babies are not actually given all the doses that are prescribed. There is some evidence that supplementation of oral vitamin k should continue until the baby is weaned. 1. Vitamin k given by injection involves giving one dose. The baby receives the injection, usually into the leg muscle soon after birth at the same time as the baby being weighed and generally checked over. Ensuring the baby receives the maximum amount of colostrums may be protective against the early disease. Page Title Page Title

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