Guest guest Posted June 22, 2007 Report Share Posted June 22, 2007 Would it have been a common practice to inject Vitamin K in the year 1977? My sons jaundice was high enough at midnight of day 4 that they transfered him to a childrens hospital, did a blood exchange and put him under the lights. > > All this is material out of my childbirth class handout on pediatric > options. Sorry it is so long, but Ii wanted to give you all of it. Most of > the sources are cited. Some of this material is from the fensende midwifery > list. - Kathy > -------------------- > > Vitamin K to Newborns > Breastmilk is low in vitamin K, but this is not a deficiency, nor is it a > hazard for the newborn. We were taught that the gut utilizes bacteria in > the synthesis of vitamin K. Because formula is extremely processed and > sterilized, etc. in its manufacture, it takes the formula-fed infant longer > to build up enough of these friendly bacteria than it does in the breastfed > infant. The substance lactoferrin in breastmilk helps the " digestive system > [to be] colonized with non-pathogenic bacteria " which are necessary for the > infant to synthesize her own vitamin K. My source for this is the " Resource > Notebook for the Breastfeeding Educator Program " , 1995 edition, by Debbie > Bocar, RN, BSN, BSS, MEd, MSN, IBCLC (and probably Doctor of Education by > now; she was working on it last year at the time of the course). She gives > her source as 1994. > ---- > >From UNDERSTANDING DIAGNOSTIC TESTS DURING THE CHILDBEARING YEAR, 5th Ed. > pages 648, 649: " Other studies have shown that cord blood lacks detectable > vitamin K (Shearer, 1982). In addition, breast-milk from the unsupplemented > mother contains a small amount. Administration of 1 mg. IV vitamin K to > laboring women produces very low plasma cord blood levels. Is nature > insulating the newborn from hight levels of Vitamin K for reasons yet to be > discovered? Just because we haven't figured out why does not make this a > pahtological event. (Emphasis from the poster) We must always beware of > science's attempts to improve upon nature. Remember, that's how they sold > us on bottlefeeding and hospital birth in the first place! > Science has yet to answer why the newborn does not have adult levels of > clotting factors, why s/he receives low levels of maternal vitamin K both > before and after birth, and why the normal newborn may produce a clotting > inhibitor. (Some symptomatic babies, no doubt, suffer from high levels of > the heparin-like inhibitor. Unfortunately, no differential diagnosis is > done to determine if a baby is having clotting difficulties since all > babies are treated prophylactically.) What does vitamin K do to the vast > majority of newborns who do not have a hemorrhagic problem? The fact that > too much vitamin K may cause hemolysis evokes questions regarding vitamin > K's stress on the liver, and whether the production of certain clotting > factors are low at birth to facilitate the immature liver's metabolism of > bilirubin. (Perhaps vitamin K overrides the heparin-like inhibitor commonly > present, promoting what amounts to abnormal clotting for a newborn?) " > ---- > Could it be because the liver of a newborn is not yet ready to handle the > increased production of prothrombin? I definitely see an increase in > jaundice in the babies we give vit k. > ---- > Vit K - Newborns > First, I am opposed to most intervention that is done in hospitals when a > baby is born. My pen pal's cousin is a nurse in Ireland who has done > studies on vitamin K. My pen pal sent me an article her cousin wrote that > appeared in the July19/volume 9/number 43/1995 issue of NURSING STANDARD > magazine. The title is " K is for Knowledge: Alarmist literature prompts > Jane to demand that pregnant women be told the full facts about > vitamin K " . Also, my pen pal sent me an article from the British Medical > Journal volume 305 August 8, 1992 and BMJ volume 310 March 11, 1995 which > are studies that connect vitamin K to childhood cancers such as leukemia. I > also have an article from Pediatrics in Review volume 7 number 4 Oct 4 1985 > that is in favor of vitamin K. > The allopathic authorities say that vitamin K prevents hemorrhagic disease > of newborns. Personally, I don't believe this is a great risk.Has anyone > ever heard of any newborn that has died of hemorrhagic disease? Was it an > epidemic at one time? I know that Jewish people wait 7 or 8 days to > circumcize their sons because there is a chance of hemorrhaging before that > time (at least I think this is the reason). Maybe because of all the > circumcisions that are done, the doctors push the vitamin K. > Another bit of info about vitamin K: too much of it can cause jaundice. > Also, the shot and the drops are available in England and parts of the U.S. > However, in the southern U.S. only the injection is available, or so they > will tell you. When we refused the shot, first they went haywaire and then > they miraculously came up with some drops the pharmacist cooked up. Then > our baby was stricken with jaundice. The pediatrician on call scared us > into thinking our baby was at risk because her body temp. was low. However, > the nurse (who hadn't communicated with the ped) came in and said it was > normal for some babies to have a lower body temp and it was no big deal. > However, by that time we had been scared into agreeing to the drops. I'd > like to hear from other parents who have had a similar experience. - > Jillani > _____________________ > > Why is Vit K given? > > In the 1986 NAPSAC Summit video Doris Haire gives an excellent explanation > of how and why obstetric anesthesia/analgesia causes newborn hemorrhagic > conditions. Knowing the historical and current heavy uses of narcotics and > forceful delivery techniques (mighty vac, forceps, head pulling etc.) it is > my belief that the routine administration of Vitamin K has evolved out of > the need to protect newborns from iatrogenic conditions rather than > inherent problems of gently born babies. In this sense it is a simple, > effective and needed technology, however its risks (jaundice and some types > of childhood leukemia--injectable) may not be worthwhile when babies have > been born without trauma or drug exposure. > _________________________ > > Here's the scoop I was taught on Vit. K in nursing school, and verified in > many nutritional texts: > Vit K. is manufactured by BACTERIA in the LARGE INTESTINE and absorbed by > the body. NO KNOWN ORAL FORM EXISTS that has been shown to be effective > for adults. (Although they are constantly researching to try and make > one.) It is in LOTS of foods, it just doesn't get absorbed from the foods. > The vitamin gets destroyed in the acidic environment of the stomach. > Since newborns are sterile in every sense, it takes several months before > their intestines have enough live bacteria to manufacture this vitamin. > Breast fed babies actually have an advantage because momma's breast isn't > sterile, so they can begin to get their bacteria from there. > Vitamin K is a very extremely necessary part of blood clotting cycles. If > my child was going to have a circumcision, any type of forced extraction at > birth, vacuum, forceps, whatever, etc. than I would seriously consider this > SHOT. The oral forms make parents happier, but are generally less > effective. They are somewhat effective if given very early after birth, > because the baby's intestinal system is more " open " to absorbing things > during this time--also the reason antibodies from colostrum are less > beneficial and less absorbed after the first 48 hours. > To understand the necessity of these bacteria to vitamin K and blood > clotting, I had a patient who died from massive internal hemorrhage after > being on antibiotics for serious staph infection for 6 weeks. The staph > was still there, but all his " good " bacteria was dead and no longer > producing vitamin K, so he bled to death. > Don't waste money on any vitamin K pills or supplements, or believe anyone > who tells you their vitamin K can be absorbed. It is a lie. The pill > would have to travel through the highly acidic stomach and highly alkaline > small intestine without being altered, and then suddenly dissolve and be > absorbed in the nearly neutral large intestine. > Seuferer seuferer@... fax: (515) 827-5945 > ________________________ > > http://www.nando.net/newsroom/ntn/health/011598/health1_11686_noframe s.html > Vitamin injection suspected in raised cancer risk > Copyright © 1998 Nando.net Copyright © 1998 Reuters > LONDON (January 15, 1998 8:13 p.m. EST http://www.nando.net) - A vitamin > injection given to new-born babies in many Western countries may be > increasing their risk of developing childhood leukemia, British doctors > said Friday. Infants in Britain, the United States and most European > countries are given vitamin K shortly after birth to prevent a deficiency > of the vitamin, a rare condition that can cause hemorrhaging, brain damage > and death. But conflicting results of four new studies probing the link > between the vitamin and childhood cancers have cast doubt on its safety. > " We think there may be a risk. Intramuscular vitamin K looks like it may be > dangerous, " Gerald Draper, the director of the Childhood Cancer Research > Group, told Reuters. > Two studies published in the British Medical Journal found no evidence of a > link. The results of a third were inconclusive but a fourth said the > vitamin injection could be associated with an acute form of leukemia. " We > all thought there really wasn't a risk but we can't be absolutely certain. > We can't exclude it on the basis of the data. The papers give very > disparate results but they don't absolutely exclude it, " Draper added. > Research carried out by Dr. Louise , of the Sir Spence > Institute of Child Health in Newcastle upon Tyne, produced the most > startling results. She and her colleagues studied 685 children in northern > England who developed cancer before their 15th birthday and a control group > of 3,442 healthy children. They found no link with vitamin K and all > childhood cancers but they uncovered a raised risk for acute lymphoblastic > leukemia, the most common childhood cancer. " It is not possible, on the > basis of currently published evidence, to refute the suggestion that > neonatal intramuscular vitamin K administration increases the risk of early > childhood leukemia, " she said. > Professor Golding, of the University of Bristol in southwest England, > first raised the alarm about the possible dangers of vitamin K in a 1992 > study, but most subsequent research failed to support her evidence. Some > doctors now suspect that if there is a link between the injection and > leukemia it could be due to the high levels of the vitamin inserted into > the blood. Others think it may be caused by another constituent in the > injection, rather than the vitamin K itself. " Vitamin K injection was a > relatively easy way of preventing a deficiency without any side effects. > Now people are worried that there may be a cost attached in terms of > cancer, " said Draper. > Although there is no conclusive evidence, recent studies have raised enough > doubt for doctors to recommend oral supplements of vitamin K except in the > most serious cases of a deficiency. " Regular low dose oral > supple-mentation can be effective, making it unnecessary to give a form of > treatment over which doubt still lingers, " said . > Acute lymphoblastic leukemia, characterized by an increased number of white > corpuscles in the blood, accounts for about 85 percent of childhood > leukemia. There is no cure but medical advances have pushed survival rates > as high as 60 percent and remission rates have reached up to 90 percent. > By PATRICIA REANEY, Reuters > __________________ > > Treatise on Vitamin K > > While looking up my reference on " late-onset hemorrhagic disease " I came > across several items of interest in this discussion. I hope I don't make > anyone angry by posting this, but I am not satisfied with the > non-conclusions we've not come to in this discussion. While reading the > following from my textbooks, I had these questions: > 1. Re: the breast-fed infants with hemorrhagic disease: how soon and how > often are they breast-fed? How much colostrum do they receive? Are they > allowed to stay at the breast or is feeding time limited (how much hindmilk > do they receive)? What sort of birth trauma is present in these infants? > 2. Why not only inject those infants who are at risk or who have > symptoms? Bleeding ceases in 2-4 hours, if one is watching the infant > closely, is this sufficient? > 3. What about giving mothers supplementary vitamin K or having them eat a > diet high in vitamin K? Before birth? After birth? > 4. If what we need is friendly bacteria in the intestinal tract, what > about acidophilus? Would it be possible to give the newborn acidophilus? Or > would giving it to the mother be helpful at all (I wouldn't think so...)? > 5. If HDN is " completely prevented " by vitamin K injection, why do these > nursing texts give instructions (one even in the " Drug Guide " box) for > observation for symptoms? These texts assume that all infants are going to > receive vitamin K, yet they instruct watching for symptoms. > 6. The second text, in chapter 32, says that vitamin K " may be obtained > from food " but is usually synthesized in the gut. So why wouldn't giving > mom plenty of vitamin K-rich foods work? > > First of all, let me quote from NURSING CARE OF INFANTS AND CHILDREN, 4th > ed, Whaley & Wong (1991), p 372: > " Hemorrhagic disease of the newborn is a bleeding disorder that may appear > within 1 to 5 days of life as a result of a deficiency of vitamin K. > Newborn vitamin K stores are virtually absent, and there is a moderate > deficiency of prothrombin activity, which decreases until approximately 72 > hours after birth when it begins to increase. Consequently, vitamin > K-dependent coagulation factors (II, VII, IX, X) are significantly reduced. > In addition, the newborn's sterile intestinal tract is unable to synthesize > the vitamin until feedings have begun. Breast-fed infants are particularly > at risk because human milk is a poor source of vitamin K. Hemorrhagic > manifestations rarely occur in infants fed fortified cow's milk formula > from the first day of life because this formula is an adequate source of > the vitamin. > " Signs and symptoms of hemorrhagic disease typically appear 24 to 72 hours > after birth and can include oozing from the umbilicus or circumcision site, > bloody or black stools, hematuria, ecchymoses on skin and scalp, epistaxis, > or bleeding from punctures. Diagnoses can be confirmed in the presence of > prolonged prothrombin time (PT) and partial thromboplastin time (PTT) > accompanies by normal platelet count and fibrinogen levels. > " A late form (late-onset hemorrhagic disease) appears at about 4 to 7 weeks > of age. This late-onset disease occurs in totally or predominantly > breast-fed infants. It appears to be related to a factor in breast milk > that inhibits vitamin K synthesis by the infant's bacterial flora. > Manifestations of late-onset disease are evidence of intracranial > hemorrhage, deep ecchymoses, bleeding from the gastrointestinal tract, > and/or bleeding from mucous membranes, skin punctures, or surgical > incisions. > > THERAPEUTIC MANAGEMENT > " The goal of management is prevention of hemorrhagic disease of the newborn > with prophylactic administration of vitamin K. In the United States, > intramuscular administration of vitamin K (Aquamephyton, Mephyton) in a > dose of 0.5 to 1 mg once during the first 24 hours of life is a standard > practice. The use of prophylactic vitamin K is not routinely practiced in > all countries. > " In newborns with the disease, treatment is the same as the preventive > measures, except that the vitamin may be given intravenously to prevent a > hematoma at an intramuscular site. Bleeding usually ceases within 2 to 4 > hours of vitamin K administration. > " Some have reported success with daily oral administration of vitamin K to > the infants (McNinch and others, 1985; Olson, 1987) or to the mothers > during the last month of pregnancy (O'Connor and Addiego, 1986). To prevent > late-onset disease it is recommended that mothers of breast- feeding infants > receive oral vitamin K supplementation (von Kries and others, 1987). None > of these is standard practice. > " Breast-feeding mothers are encouraged to increase their intake of foods > containing vitamin K, primarily vegetables. The best sources are green > vegetables, especially broccoli. " > > Also from MATERNAL NEWBORN NURSING: A FAMILY-CENTERED APPROACH, 4th ed, > OLDS, LONDON & LADEWIG (1992), p 889-890: > " A prophylactic injection of vitamin K is given to prevent hemorrhage, > which can occur due to low prothrombin levels in the first few days of life > (see the accompanying Drug Guide -- Vitamin K-1 phytonadione). The > potential for hemorrhage is considered to result from the absence of gut > bacterial flora, which influences the production of vitamin K in the > newborn (see Chapter 32 for further discussion). Controversy exists over > whether the administration of vitamin K may predispose the newborn to > significant hyperbilirubinemia. Cunningham et al. 1989 indicate there is no > evidence to support this concern as long as a standard dose of 1 mg is > given. Some people have questioned the need to give vitamin K to newborns > who have had a nontraumatic birth. > " A study by Von Kries (1988) looked at replacing parenteral vitamin K with > oral vitamin K to avoid injecting the infant. The study demonstrated a > considerably higher level of vitamin K present after intramuscular > administration than after oral administration. Thus, parenteral vitamin K > prophylaxis is a safer means of providing infants with high vitamin K load. > " The vitamin K injection is given intramuscularly in the middle one-third > of the vagus lateralis muscle located in the lateral aspect of the thigh > (Figure 29-4). An alternate site is the rectus femoris muscle in the > anterior aspect of the thigh. However, this site is near the sciatic nerve > and femoral artery and should be used with caution. > > " DRUG GUIDE -- VITAMIN K-1 PHYTONADIONE (AQUAMEPHYTON) > " OVERVIEW OF NEONATAL ACTION " Phytonadione is used in prophylaxis and > treatment of hemorrhagic disease of the newborn. It promotes liver > formation of the clotting factors II, VII, IX, and X. At birth the neonate > does not have the bacteria in the colon that is necessary for synthesizing > fat-soluble vitamin K-1, therefore the newborn may have decreased levels of > prothrombin during the first 5-8 days of life reflected by a prolongation > of prothrombin time. > > ROUTE, DOSAGE, FREQUENCY > " Intramuscular injection is given in the vastus lateralis thigh muscle. A > one-time only prophylactic dose of 0.5-1.0 mg is given in the birthing area > or upon admission to the newborn nursery. If the mother received > anticoagulants during pregnancy, an additional dose may be ordered by the > physician and is given at 6-8 hours post first injection. > > NEONATAL SIDE EFFECTS > " Pain and edema may occur at injection site. Possible allergic reactions > such as rash and urticaria. > > NURSING CONSIDERATIONS > " Observe for bleeding (usually occurs on second or third day). Bleeding may > be seen as generalized ecchymoses or bleeding from umbilical cord, > circumcision site, nose, or gastrointestinal tract. Results of serial PT > and PTT should be assessed. > " Observe for jaundice and kernicterus especially in pre-term infants. > " Observe for signs of local inflammation. > " Protect drug from light. " > from Chapter 32 (p 1054): " Several transient coagulation-mechanism > deficiencies normally occur in the first several days of a newborn's life. > Foremost among these is a slight decrease in the level of prothrombin, > resulting in a prolonged clotting time during the initial week of life. > Vitamin K is required for the liver to form prothrombin (factor II) and > proconvertin (factor VII) for blood coagulation. Vitamin K, a fat- soluble > vitamin, may be obtained from food, but it is usually synthesized by > bacteria in the colon, and consequently a dietary source is unnecessary. > However, intestinal flora are practically nonexistent in newborns, so they > are unable to synthesize vitamin K. > " Bleeding due to vitamin K deficiency generally occurs on the second or > third day of life, but it may occur earlier in babies of mothers treated > with phenytoin sodium (Dilantin) or phenobarbital. These drugs impair > vitamin K activity, and bleeding may be seen at birth. Coumarin compounds > are vitamin K antagonists that can cross the placenta. Thus the baby > exposed to maternal coumarin can also manifest bleeding in the first 24 > hours of life. Bleeding may also occur in babies receiving parenteral > nutrition without adequate vitamin K additives (1mg/week). Bleeding from > the nose, umbilical cord, circumcision site, gastrointestinal tract, and > scalp, as well as generalized ecchymoses may be seen. Internal hemorrhage > may occur. > " This disorder can be completely prevented by the prophylactic use of an > injection of vitamin K. A dose of 1 mg of AquaMEPHYTON is given as part of > newborn care immediately following birth, and consequently the disease is > rarely seen today. Larger doses are contraindicated because they may result > in the development of hyperbilirubinemia. " > _______________________ > > Treatise 2 on Vitamin K > > Hemorrhagic Disease of the Newborn (HDNB) can occur anytime in the 1st few > months of life. Early HDNB occurs in the 1st 24 hrs, Classical HDNB is at 1 > to 7 days (most often at 2 to 5 days) and Late HDNB is usually between 2 & > 8 wks, but can occur anytime in the 1st year. When the clotting factors get > too low the baby can develop spontaneous bleeding- anything from bruising > and umbilical bleeding, to intrathoracic, intra-abdominal, or intracranial > hemorrhage. > Newborns have only 20-50% of the coagulation activity of adults, including > the vit. k dependent clotting factors (prothrombin, proconvertin, & > others). Levels in premature babies are even lower. Vitamin K prevents HDNB > by increasing the activity of these K-dependent clotting factors. Incidence > of HDNB is 1:1200 if no vit k is given and 1:20,000 if k is given to high > risk babies only. > Risk factors include: Maternal: exposure to anticonvulsants, barbiturates, > aspirin, or antibiotics. Newborn: prematurity, low birth weight, difficult > births (forceps, shoulder dystocia, excessive molding, breech, > cephalhematoma), malabsorption conditions (e.g. bowel obstruction, cystic > fibrosis), exposure to any of the drugs listed under maternal risks > (including breastfeeding exposure), and, ironically enough, exclusive > breastfeeding. Breastmilk has about 2-15 mg/liter of vit. k, formula has > about 50 mg/liter. One study said that out of 198 cases of HDNB, 186 were > breastfed and only 3 were exclusively bottle fed. > Initial symptoms can include: vomiting, lethargy, pallor, loss of appetite, > fever, convulsions, unconsciousness, dyspnea, nodular purpura (widespread > deep ecchymosis), bleeding from circumcision or injection sites, or other > hemorrhage. Intracranial hemorrhage is seen in 50-80% of affected babies > and causes death or severe handicap in 50-70% of those babies. > Vitamin K is fat soluble. It comes from plants & vegetable oils (Type K-1) > and is also synthesized by bacteria in the gut (type K-2), but K-2 is not a > major source in the 1st 4-6 months of life. Food sources of K are leafy > greens (spinach, kale, turnip, etc.), cabbage, cauliflower, peas, kelp, > alfalfa, nettles, green tea, chlorophyll, dairy products, egg yolks, > safflower & other polyunsaturated oils, and fish liver oils. Vit. K is > destroyed by freezing & radiation. > Placental transport of vit. k is documented, but babies levels will be much > lower than moms. Cord blood has levels at 1/10th to 1/2 of maternal level. > There was, however, a significant decrease in intracranial hemorrhage in > preemies when their moms got IM vit. k 4-5 hrs before delivery. > Studies vary as to the effectiveness of oral vitamin k. Late HDNB seems to > still be a problem when K is given orally, so repeated doses are usually > recommended, though advice about when to give them & how much to give > varies. We don't seem to have oral K available in the US, but the > injectable form may be given orally (Double the dose- draw up 2 ampules, > remove the needle, and squirt into baby's mouth) The stuff tastes terrible, > and in my own personal experience babies react worse to the oral dose then > the injection, so I usually give it IM. I use a 27g needle and give it > while the baby is nursing. Most of them don't even cry. > If a mom doesn't want to give the baby vit. k, I recommend that she take > Vit. k during her pregnancy and the first few months of breastfeeding. It's > available in pill form at health food stores. It may not be as effective, > but it seems like an acceptable alternative for low risk babies. I've heard > of shepherds purse tincture being given instead of K, but I don't know much > about it. > ________________________ > > Vitamin K Treatise 3 > > Vitamin K prophylaxis is primarily used to prevent late hemorrhagic disease > of the newborn (LHDN). Late onset LHDN is a syndrome of severe bleeding in > infants, between one and six months of age, commonly causing Intracranial > Hemorrhage with a 50% mortality rate. The incidence is 1:1200 in the UK. It > can be of idiopathic or secondary origin This occurs between 2 weeks and 6 > months of age. It is due to impaired absorption of vitamin K in the > newborn's gut. This can be due to immature liver function, biliary atresia > or alpha antitripsin abnormalities. Often the infant has mild hepatitis > with no outward symptoms and recovers spontaneously. Recent research points > to temporary inability of the liver to produce the bile salts necessary to > absorb the fat soluble vitamin K. The early and classic versions of this > are far less common with the reduction in traumatic deliveries and with > proper care of women on anticonvulsant and anticoagulant RX. In Holland, > where LHDN is almost non-existent, the midwives provide 1 mg vit K po at > birth then the mothers give the baby 25 ug weekly po until 6 months. They > have a special oral vitamin K preparation. > > I have experience of two cases of LHDN in Ontario in the last few years > Case 1: LHDN, Intracranial Haemorrhage, Winter 1992 Baby boy K, born at > home, spontaneous labour and birth at term. No molding or caput noted. > APGAR scores 9 at 1 and 5 minutes. Parents declined vitamin K prophylaxis. > Exclusively breastfed, thrived. At the age of 5 weeks the mother > accidentally cut the infant's finger when clipping his nails. She paged the > midwife to notify her that it took a long time to stop bleeding. The > following day she paged her midwife and stated that the baby was pale, had > a high pitched cry, wasn't feeding and was limp and floppy . The midwife > advised the mother to take the baby to the hospital. On admission he had > prolonged clotting times which normalised after parenteral vitamin K > administration. He remained in the hospital for several weeks. He has > residual motor and cognitive brain damage, the extent of which will not be > known until he is older. > Case 2: Late HDN? warning bleed, Spring 1994 Baby girl S. was born at home > in June, 1994 at 41 weeks gestation following an uncomplicated pregnancy > and labour. Her APGAR scores were 9 at one minute and 10 at 5 minutes, > birthweight 7 lb.. Molding 2+ of parietal and frontal bones was noted on > the newborn examination. At approximately one hour following the birth 0.5 > mg of vitamin K was given orally. She received a further 0.5 mg of vitamin > K orally on day 10. She was exclusively breastfed. On day 12 her mother > reported blood and mucous in her stool. The midwife assessed Baby S at home > and reported as follows: Nursing vigorously Q 1-3 hours, alert, Resp. 41, > apical rate 136, temp 36.1C, skin-clear, dry and pink, eyes-clear, cord > stump healed, urine ++, stools-yellow curds with about 1 tsp. of mucousy > red blood, weight 7 lb 6 oz. In view of the increased risk of further > bleeding and after discussion with the parents, regarding the risks of Late > Haemorrhagic Disease of the Newborn (LHDN) vitamin K 1.0 mg was given > intramuscularly. Consultation with a neonatologist resulted in no further > treatment or investigations. Baby S has thrived since then. > > Risks of Oral Vitamin K Prophylaxis > Research has demonstrated that the use of a single, oral dose of vitamin K > is not protective for the more severe mortality and morbidity of LHDN. > (Greer et al., 1988; Greer et al., 1995; McNinch and Tripp, 1991; Motohara > et al, 1987; Shinzawa et al., 1989; Von Kries et al., 1987a) In a recent > two year prospective study of 27 infants who were diagnosed with VKDB, six > had been given oral vitamin K. (McNinch & Tripp, 1991) Multiple oral dose > routines have problems with format of the preparation and compliance with > the routine. > In a United Kingdom National cohort study of all children born during one > week in 1970, vitamin K administration at birth was found to have a > significant association with childhood cancer. (Golding et al., 1990) > Golding et al. published a further case control study in 1992, which > demonstrated parenteral vitamin K administration and smoking as > independently significant factors in the subsequent development of > childhood cancer. > In examining this study I found a number of factors which may have > confounded the results or limit it's generalisability. Primarily, the > numbers of children studied was small, only 33 children with cancer were > used, this reduced the power of the study. Records of vitamin K > administration, both dosage and route were of poor quality and a large > number of assumptions were used to assign treatment to index cases and > controls. Intravenous (IV) and intramuscular (IM) administration of vitamin > K were combined. Significant differences in vitamin K levels in neonates > following IV and IM vitamin K have been demonstrated in a study by Loughnan > and McDougall (1995). Controls were matched to cases by age, parity and > social class. A more rigorous matching to include maternal smoking, type of > delivery and other potential confounding factors would have improved the > strength of the study. > Three other studies have been completed in the USA, Denmark and Sweden. The > American trial was a prospective case control study, while both the Danish > and Swedish were retrospective case control studies. While each of these > studies found the same difficulty with quality of record keeping re vitamin > K administration, the degree of missing information was smaller. The Danish > and Swedish studies relied on retrospective data and compared groups from > different time periods. Environmental and social differences over periods > of 30 years may not have been fully excluded from the results as > confounding factors. None of these studies has found any causal link with > childhood cancer and IM vitamin K administration.(Klebanoff, et al., 1993; > Ekelund et al., 1993; Olson et al., 1995) > ---- > Haemostasis 1990;20(1):8-14 - Medline > > Vitamin K1 levels and coagulation factors in healthy term newborns till 4 > weeks after birth. > Pietersma-de Bruyn AL, van Haard PM, Beunis MH, Hamulyak K, Kuijpers JC > Department of Gynecology and Obstetrics, Reinier de Graaf Gasthuis, The > Netherlands. > > Vitamin K1 serum levels were assessed by means of an off-line > multidimensional liquid chromatography in 18 mothers, shortly after > delivery, and in their healthy term infants. Umbilical cord and venous > blood samples were assayed up to 4 weeks of life. Concurrently, levels of > coagulation factors II and X, antithrombin III and platelets were > established. Although the detection limit of the assay was as low as 22 > pg/ml, vitamin K1 concentration appeared to be still beyond that level in > cord blood or in newborn serum within 30 min after birth, whereas > vitamin-K-dependent coagulation factors are already at a level of 40%, > without evidence for the presence of descarboxy prothrombin, in any of the > investigated neonates. After 3 days, breast-fed neonates had lower vitamin > K1 levels than formula-fed infants (0.76 and 1.44 ng/ml, respectively). The > levels of the vitamin-K-dependent coagulation factors II and X, however, > were comparable, regardless of the kind of feeding. After 28 days, > breast-fed neonates had even lower vitamin K1 levels (0.49 ng/ml, while the > formula-fed infants showed higher vitamin K1 levels (4.45 ng/ml). But even > then, the levels of vitamin-K-dependent coagulation factors II and X were > comparable, regardless of the kind of feeding. From this we conclude that > the serum levels of vitamin K1 in formula-fed neonates exceed those of > breast-fed infants from the moment of feeding (24 h and later) without a > concomitant rise in vitamin-K-dependent coagulation factors. A relationship > between vitamin K1 levels and vitamin-K-dependent coagulation factors could > not be established in healthy term breast-fed or formula-fed infants. > PMID: 2323682, UI: 90215547 > _______________________ > > Br J Obstet Gynaecol 1996 Nov;103(11):1078-1084 MedLine > > Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial > haemorrhage in Shizuoka prefecture. > Nishiguchi T, Saga K, Sumimoto K, Okada K, Terao T > Department of Obstetrics and Gynecology, Hamamatsu University School of > Medicine, Shizuoka, Japan. > > OBJECTIVE: To compare three methods of vitamin K prophylaxis for neonatal > vitamin K deficient intracranial haemorrhage. > DESIGN: We designed three strategies for vitamin K prophylaxis: 1. > therapeutic administration of vitamin K in a mass screening system using > the hepaplastin test; 2. routine oral administration of vitamin K to > newborn infants; and 3. administration of vitamin K to lactating mothers > during the late neonatal period in addition to the routine method. We > evaluated the efficacy of these methods by determining hepaplastin test > values at the first month of age. > POPULATION: 66,076 full term healthy newborn infants without any > complications. > RESULTS: Of 55,513 infants in the mass screening system, 3068 infants > received vitamin K therapeutically. At the first month of age, in the group > where vitamin K was administered therapeutically, 56 infants (1.83%) > exhibited low hepaplastin test values (< 40%) despite vitamin K > administration. But extremely low values (< 20%), indicating a very high > risk of neonatal intracranial haemorrhage, were observed in 34 (0.06%) of > 52,445 infants who did not receive vitamin K. In the routine administration > system, oral administration of vitamin K twice within the first week of > life showed a lower incidence (0.19%) of low level cases than a single > administration (1.56%). An additional administration of vitamin K to > lactating mothers throughout the late neonatal period showed an effective > result. > PMID: 8916992, UI: 97074565 > ___________________ > Kathy > > > Rev. Kathy Rateliff; Doula, childbirth & cord blood educator > Administrator, T2 Shepherd Ministries - Titus 2:1-8 > http://www.geocities.com/Heartland/Ranch/4172 > <mailto:Rateliff@...> > > > > > -------------------------------------------------------- > Sheri Nakken, R.N., MA, Hahnemannian Homeopath > Vaccination Information & Choice Network, Nevada City CA & Wales UK > $$ Donations to help in the work - accepted by Paypal account > earthmysteriestours@... voicemail US 530-740-0561 > (go to http://www.paypal.com) or by mail > Vaccines - http://www.nccn.net/~wwithin/vaccine.htm > Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm > Reality of the Diseases & Treatment - > http://www.nccn.net/~wwithin/vaccineclass.htm > Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2007 Report Share Posted June 22, 2007 Yes, certainly Sheri >Would it have been a common practice to inject Vitamin K in the year=20 >1977? My sons jaundice was high enough at midnight of day 4 that=20 >they transfered him to a childrens hospital, did a blood exchange=20 >and put him under the lights.=20 > >>> -------------------------------------------------------- Sheri Nakken, R.N., MA, Hahnemannian Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK $$ Donations to help in the work - accepted by Paypal account earthmysteriestours@... voicemail US 530-740-0561 (go to http://www.paypal.com) or by mail Vaccines - http://www.nccn.net/~wwithin/vaccine.htm Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm Reality of the Diseases & Treatment - http://www.nccn.net/~wwithin/vaccineclass.htm Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2007 Report Share Posted June 23, 2007 yes definitely Sheri At 12:12 PM 6/22/2007 -0000, you wrote: >Would it have been a common practice to inject Vitamin K in the year=20 >1977? My sons jaundice was high enough at midnight of day 4 that=20 >they transfered him to a childrens hospital, did a blood exchange=20 >and put him under the lights.=20 -------------------------------------------------------- Sheri Nakken, R.N., MA, Hahnemannian Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK $$ Donations to help in the work - accepted by Paypal account earthmysteriestours@... voicemail US 530-740-0561 (go to http://www.paypal.com) or by mail Vaccines - http://www.nccn.net/~wwithin/vaccine.htm Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm Reality of the Diseases & Treatment - http://www.nccn.net/~wwithin/vaccineclass.htm Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2010 Report Share Posted January 13, 2010 All this is material out of my childbirth class handout on pediatric options. Sorry it is so long, but Ii wanted to give you all of it. Most of the sources are cited. Some of this material is from the fensende midwifery list. - Kathy -------------------- Vitamin K to Newborns Breastmilk is low in vitamin K, but this is not a deficiency, nor is it a hazard for the newborn. We were taught that the gut utilizes bacteria in the synthesis of vitamin K. Because formula is extremely processed and sterilized, etc. in its manufacture, it takes the formula-fed infant longer to build up enough of these friendly bacteria than it does in the breastfed infant. The substance lactoferrin in breastmilk helps the " digestive system [to be] colonized with non-pathogenic bacteria " which are necessary for the infant to synthesize her own vitamin K. My source for this is the " Resource Notebook for the Breastfeeding Educator Program " , 1995 edition, by Debbie Bocar, RN, BSN, BSS, MEd, MSN, IBCLC (and probably Doctor of Education by now; she was working on it last year at the time of the course). She gives her source as 1994. ---- >From UNDERSTANDING DIAGNOSTIC TESTS DURING THE CHILDBEARING YEAR, 5th Ed. pages 648, 649: " Other studies have shown that cord blood lacks detectable vitamin K (Shearer, 1982). In addition, breast-milk from the unsupplemented mother contains a small amount. Administration of 1 mg. IV vitamin K to laboring women produces very low plasma cord blood levels. Is nature insulating the newborn from hight levels of Vitamin K for reasons yet to be discovered? Just because we haven't figured out why does not make this a pahtological event. (Emphasis from the poster) We must always beware of science's attempts to improve upon nature. Remember, that's how they sold us on bottlefeeding and hospital birth in the first place! Science has yet to answer why the newborn does not have adult levels of clotting factors, why s/he receives low levels of maternal vitamin K both before and after birth, and why the normal newborn may produce a clotting inhibitor. (Some symptomatic babies, no doubt, suffer from high levels of the heparin-like inhibitor. Unfortunately, no differential diagnosis is done to determine if a baby is having clotting difficulties since all babies are treated prophylactically.) What does vitamin K do to the vast majority of newborns who do not have a hemorrhagic problem? The fact that too much vitamin K may cause hemolysis evokes questions regarding vitamin K's stress on the liver, and whether the production of certain clotting factors are low at birth to facilitate the immature liver's metabolism of bilirubin. (Perhaps vitamin K overrides the heparin-like inhibitor commonly present, promoting what amounts to abnormal clotting for a newborn?) " ---- Could it be because the liver of a newborn is not yet ready to handle the increased production of prothrombin? I definitely see an increase in jaundice in the babies we give vit k. ---- Vit K - Newborns First, I am opposed to most intervention that is done in hospitals when a baby is born. My pen pal's cousin is a nurse in Ireland who has done studies on vitamin K. My pen pal sent me an article her cousin wrote that appeared in the July19/volume 9/number 43/1995 issue of NURSING STANDARD magazine. The title is " K is for Knowledge: Alarmist literature prompts Jane to demand that pregnant women be told the full facts about vitamin K " . Also, my pen pal sent me an article from the British Medical Journal volume 305 August 8, 1992 and BMJ volume 310 March 11, 1995 which are studies that connect vitamin K to childhood cancers such as leukemia. I also have an article from Pediatrics in Review volume 7 number 4 Oct 4 1985 that is in favor of vitamin K. The allopathic authorities say that vitamin K prevents hemorrhagic disease of newborns. Personally, I don't believe this is a great risk.Has anyone ever heard of any newborn that has died of hemorrhagic disease? Was it an epidemic at one time? I know that Jewish people wait 7 or 8 days to circumcize their sons because there is a chance of hemorrhaging before that time (at least I think this is the reason). Maybe because of all the circumcisions that are done, the doctors push the vitamin K. Another bit of info about vitamin K: too much of it can cause jaundice. Also, the shot and the drops are available in England and parts of the U.S. However, in the southern U.S. only the injection is available, or so they will tell you. When we refused the shot, first they went haywaire and then they miraculously came up with some drops the pharmacist cooked up. Then our baby was stricken with jaundice. The pediatrician on call scared us into thinking our baby was at risk because her body temp. was low. However, the nurse (who hadn't communicated with the ped) came in and said it was normal for some babies to have a lower body temp and it was no big deal. However, by that time we had been scared into agreeing to the drops. I'd like to hear from other parents who have had a similar experience. - Jillani _____________________ Why is Vit K given? In the 1986 NAPSAC Summit video Doris Haire gives an excellent explanation of how and why obstetric anesthesia/analgesia causes newborn hemorrhagic conditions. Knowing the historical and current heavy uses of narcotics and forceful delivery techniques (mighty vac, forceps, head pulling etc.) it is my belief that the routine administration of Vitamin K has evolved out of the need to protect newborns from iatrogenic conditions rather than inherent problems of gently born babies. In this sense it is a simple, effective and needed technology, however its risks (jaundice and some types of childhood leukemia--injectable) may not be worthwhile when babies have been born without trauma or drug exposure. _________________________ Here's the scoop I was taught on Vit. K in nursing school, and verified in many nutritional texts: Vit K. is manufactured by BACTERIA in the LARGE INTESTINE and absorbed by the body. NO KNOWN ORAL FORM EXISTS that has been shown to be effective for adults. (Although they are constantly researching to try and make one.) It is in LOTS of foods, it just doesn't get absorbed from the foods. The vitamin gets destroyed in the acidic environment of the stomach. Since newborns are sterile in every sense, it takes several months before their intestines have enough live bacteria to manufacture this vitamin. Breast fed babies actually have an advantage because momma's breast isn't sterile, so they can begin to get their bacteria from there. Vitamin K is a very extremely necessary part of blood clotting cycles. If my child was going to have a circumcision, any type of forced extraction at birth, vacuum, forceps, whatever, etc. than I would seriously consider this SHOT. The oral forms make parents happier, but are generally less effective. They are somewhat effective if given very early after birth, because the baby's intestinal system is more " open " to absorbing things during this time--also the reason antibodies from colostrum are less beneficial and less absorbed after the first 48 hours. To understand the necessity of these bacteria to vitamin K and blood clotting, I had a patient who died from massive internal hemorrhage after being on antibiotics for serious staph infection for 6 weeks. The staph was still there, but all his " good " bacteria was dead and no longer producing vitamin K, so he bled to death. Don't waste money on any vitamin K pills or supplements, or believe anyone who tells you their vitamin K can be absorbed. It is a lie. The pill would have to travel through the highly acidic stomach and highly alkaline small intestine without being altered, and then suddenly dissolve and be absorbed in the nearly neutral large intestine. Seuferer seuferer@... fax: (515) 827-5945 ________________________ http://www.nando.net/newsroom/ntn/health/011598/health1_11686_noframes.html Vitamin injection suspected in raised cancer risk Copyright © 1998 Nando.net Copyright © 1998 Reuters LONDON (January 15, 1998 8:13 p.m. EST http://www.nando.net) - A vitamin injection given to new-born babies in many Western countries may be increasing their risk of developing childhood leukemia, British doctors said Friday. Infants in Britain, the United States and most European countries are given vitamin K shortly after birth to prevent a deficiency of the vitamin, a rare condition that can cause hemorrhaging, brain damage and death. But conflicting results of four new studies probing the link between the vitamin and childhood cancers have cast doubt on its safety. " We think there may be a risk. Intramuscular vitamin K looks like it may be dangerous, " Gerald Draper, the director of the Childhood Cancer Research Group, told Reuters. Two studies published in the British Medical Journal found no evidence of a link. The results of a third were inconclusive but a fourth said the vitamin injection could be associated with an acute form of leukemia. " We all thought there really wasn't a risk but we can't be absolutely certain. We can't exclude it on the basis of the data. The papers give very disparate results but they don't absolutely exclude it, " Draper added. Research carried out by Dr. Louise , of the Sir Spence Institute of Child Health in Newcastle upon Tyne, produced the most startling results. She and her colleagues studied 685 children in northern England who developed cancer before their 15th birthday and a control group of 3,442 healthy children. They found no link with vitamin K and all childhood cancers but they uncovered a raised risk for acute lymphoblastic leukemia, the most common childhood cancer. " It is not possible, on the basis of currently published evidence, to refute the suggestion that neonatal intramuscular vitamin K administration increases the risk of early childhood leukemia, " she said. Professor Golding, of the University of Bristol in southwest England, first raised the alarm about the possible dangers of vitamin K in a 1992 study, but most subsequent research failed to support her evidence. Some doctors now suspect that if there is a link between the injection and leukemia it could be due to the high levels of the vitamin inserted into the blood. Others think it may be caused by another constituent in the injection, rather than the vitamin K itself. " Vitamin K injection was a relatively easy way of preventing a deficiency without any side effects. Now people are worried that there may be a cost attached in terms of cancer, " said Draper. Although there is no conclusive evidence, recent studies have raised enough doubt for doctors to recommend oral supplements of vitamin K except in the most serious cases of a deficiency. " Regular low dose oral supple-mentation can be effective, making it unnecessary to give a form of treatment over which doubt still lingers, " said . Acute lymphoblastic leukemia, characterized by an increased number of white corpuscles in the blood, accounts for about 85 percent of childhood leukemia. There is no cure but medical advances have pushed survival rates as high as 60 percent and remission rates have reached up to 90 percent. By PATRICIA REANEY, Reuters __________________ Treatise on Vitamin K While looking up my reference on " late-onset hemorrhagic disease " I came across several items of interest in this discussion. I hope I don't make anyone angry by posting this, but I am not satisfied with the non-conclusions we've not come to in this discussion. While reading the following from my textbooks, I had these questions: 1. Re: the breast-fed infants with hemorrhagic disease: how soon and how often are they breast-fed? How much colostrum do they receive? Are they allowed to stay at the breast or is feeding time limited (how much hindmilk do they receive)? What sort of birth trauma is present in these infants? 2. Why not only inject those infants who are at risk or who have symptoms? Bleeding ceases in 2-4 hours, if one is watching the infant closely, is this sufficient? 3. What about giving mothers supplementary vitamin K or having them eat a diet high in vitamin K? Before birth? After birth? 4. If what we need is friendly bacteria in the intestinal tract, what about acidophilus? Would it be possible to give the newborn acidophilus? Or would giving it to the mother be helpful at all (I wouldn't think so...)? 5. If HDN is " completely prevented " by vitamin K injection, why do these nursing texts give instructions (one even in the " Drug Guide " box) for observation for symptoms? These texts assume that all infants are going to receive vitamin K, yet they instruct watching for symptoms. 6. The second text, in chapter 32, says that vitamin K " may be obtained from food " but is usually synthesized in the gut. So why wouldn't giving mom plenty of vitamin K-rich foods work? First of all, let me quote from NURSING CARE OF INFANTS AND CHILDREN, 4th ed, Whaley & Wong (1991), p 372: " Hemorrhagic disease of the newborn is a bleeding disorder that may appear within 1 to 5 days of life as a result of a deficiency of vitamin K. Newborn vitamin K stores are virtually absent, and there is a moderate deficiency of prothrombin activity, which decreases until approximately 72 hours after birth when it begins to increase. Consequently, vitamin K-dependent coagulation factors (II, VII, IX, X) are significantly reduced. In addition, the newborn's sterile intestinal tract is unable to synthesize the vitamin until feedings have begun. Breast-fed infants are particularly at risk because human milk is a poor source of vitamin K. Hemorrhagic manifestations rarely occur in infants fed fortified cow's milk formula from the first day of life because this formula is an adequate source of the vitamin. " Signs and symptoms of hemorrhagic disease typically appear 24 to 72 hours after birth and can include oozing from the umbilicus or circumcision site, bloody or black stools, hematuria, ecchymoses on skin and scalp, epistaxis, or bleeding from punctures. Diagnoses can be confirmed in the presence of prolonged prothrombin time (PT) and partial thromboplastin time (PTT) accompanies by normal platelet count and fibrinogen levels. " A late form (late-onset hemorrhagic disease) appears at about 4 to 7 weeks of age. This late-onset disease occurs in totally or predominantly breast-fed infants. It appears to be related to a factor in breast milk that inhibits vitamin K synthesis by the infant's bacterial flora. Manifestations of late-onset disease are evidence of intracranial hemorrhage, deep ecchymoses, bleeding from the gastrointestinal tract, and/or bleeding from mucous membranes, skin punctures, or surgical incisions. THERAPEUTIC MANAGEMENT " The goal of management is prevention of hemorrhagic disease of the newborn with prophylactic administration of vitamin K. In the United States, intramuscular administration of vitamin K (Aquamephyton, Mephyton) in a dose of 0.5 to 1 mg once during the first 24 hours of life is a standard practice. The use of prophylactic vitamin K is not routinely practiced in all countries. " In newborns with the disease, treatment is the same as the preventive measures, except that the vitamin may be given intravenously to prevent a hematoma at an intramuscular site. Bleeding usually ceases within 2 to 4 hours of vitamin K administration. " Some have reported success with daily oral administration of vitamin K to the infants (McNinch and others, 1985; Olson, 1987) or to the mothers during the last month of pregnancy (O'Connor and Addiego, 1986). To prevent late-onset disease it is recommended that mothers of breast-feeding infants receive oral vitamin K supplementation (von Kries and others, 1987). None of these is standard practice. " Breast-feeding mothers are encouraged to increase their intake of foods containing vitamin K, primarily vegetables. The best sources are green vegetables, especially broccoli. " Also from MATERNAL NEWBORN NURSING: A FAMILY-CENTERED APPROACH, 4th ed, OLDS, LONDON & LADEWIG (1992), p 889-890: " A prophylactic injection of vitamin K is given to prevent hemorrhage, which can occur due to low prothrombin levels in the first few days of life (see the accompanying Drug Guide -- Vitamin K-1 phytonadione). The potential for hemorrhage is considered to result from the absence of gut bacterial flora, which influences the production of vitamin K in the newborn (see Chapter 32 for further discussion). Controversy exists over whether the administration of vitamin K may predispose the newborn to significant hyperbilirubinemia. Cunningham et al. 1989 indicate there is no evidence to support this concern as long as a standard dose of 1 mg is given. Some people have questioned the need to give vitamin K to newborns who have had a nontraumatic birth. " A study by Von Kries (1988) looked at replacing parenteral vitamin K with oral vitamin K to avoid injecting the infant. The study demonstrated a considerably higher level of vitamin K present after intramuscular administration than after oral administration. Thus, parenteral vitamin K prophylaxis is a safer means of providing infants with high vitamin K load. " The vitamin K injection is given intramuscularly in the middle one-third of the vagus lateralis muscle located in the lateral aspect of the thigh (Figure 29-4). An alternate site is the rectus femoris muscle in the anterior aspect of the thigh. However, this site is near the sciatic nerve and femoral artery and should be used with caution. " DRUG GUIDE -- VITAMIN K-1 PHYTONADIONE (AQUAMEPHYTON) " OVERVIEW OF NEONATAL ACTION " Phytonadione is used in prophylaxis and treatment of hemorrhagic disease of the newborn. It promotes liver formation of the clotting factors II, VII, IX, and X. At birth the neonate does not have the bacteria in the colon that is necessary for synthesizing fat-soluble vitamin K-1, therefore the newborn may have decreased levels of prothrombin during the first 5-8 days of life reflected by a prolongation of prothrombin time. ROUTE, DOSAGE, FREQUENCY " Intramuscular injection is given in the vastus lateralis thigh muscle. A one-time only prophylactic dose of 0.5-1.0 mg is given in the birthing area or upon admission to the newborn nursery. If the mother received anticoagulants during pregnancy, an additional dose may be ordered by the physician and is given at 6-8 hours post first injection. NEONATAL SIDE EFFECTS " Pain and edema may occur at injection site. Possible allergic reactions such as rash and urticaria. NURSING CONSIDERATIONS " Observe for bleeding (usually occurs on second or third day). Bleeding may be seen as generalized ecchymoses or bleeding from umbilical cord, circumcision site, nose, or gastrointestinal tract. Results of serial PT and PTT should be assessed. " Observe for jaundice and kernicterus especially in pre-term infants. " Observe for signs of local inflammation. " Protect drug from light. " from Chapter 32 (p 1054): " Several transient coagulation-mechanism deficiencies normally occur in the first several days of a newborn's life. Foremost among these is a slight decrease in the level of prothrombin, resulting in a prolonged clotting time during the initial week of life. Vitamin K is required for the liver to form prothrombin (factor II) and proconvertin (factor VII) for blood coagulation. Vitamin K, a fat-soluble vitamin, may be obtained from food, but it is usually synthesized by bacteria in the colon, and consequently a dietary source is unnecessary. However, intestinal flora are practically nonexistent in newborns, so they are unable to synthesize vitamin K. " Bleeding due to vitamin K deficiency generally occurs on the second or third day of life, but it may occur earlier in babies of mothers treated with phenytoin sodium (Dilantin) or phenobarbital. These drugs impair vitamin K activity, and bleeding may be seen at birth. Coumarin compounds are vitamin K antagonists that can cross the placenta. Thus the baby exposed to maternal coumarin can also manifest bleeding in the first 24 hours of life. Bleeding may also occur in babies receiving parenteral nutrition without adequate vitamin K additives (1mg/week). Bleeding from the nose, umbilical cord, circumcision site, gastrointestinal tract, and scalp, as well as generalized ecchymoses may be seen. Internal hemorrhage may occur. " This disorder can be completely prevented by the prophylactic use of an injection of vitamin K. A dose of 1 mg of AquaMEPHYTON is given as part of newborn care immediately following birth, and consequently the disease is rarely seen today. Larger doses are contraindicated because they may result in the development of hyperbilirubinemia. " _______________________ Treatise 2 on Vitamin K Hemorrhagic Disease of the Newborn (HDNB) can occur anytime in the 1st few months of life. Early HDNB occurs in the 1st 24 hrs, Classical HDNB is at 1 to 7 days (most often at 2 to 5 days) and Late HDNB is usually between 2 & 8 wks, but can occur anytime in the 1st year. When the clotting factors get too low the baby can develop spontaneous bleeding- anything from bruising and umbilical bleeding, to intrathoracic, intra-abdominal, or intracranial hemorrhage. Newborns have only 20-50% of the coagulation activity of adults, including the vit. k dependent clotting factors (prothrombin, proconvertin, & others). Levels in premature babies are even lower. Vitamin K prevents HDNB by increasing the activity of these K-dependent clotting factors. Incidence of HDNB is 1:1200 if no vit k is given and 1:20,000 if k is given to high risk babies only. Risk factors include: Maternal: exposure to anticonvulsants, barbiturates, aspirin, or antibiotics. Newborn: prematurity, low birth weight, difficult births (forceps, shoulder dystocia, excessive molding, breech, cephalhematoma), malabsorption conditions (e.g. bowel obstruction, cystic fibrosis), exposure to any of the drugs listed under maternal risks (including breastfeeding exposure), and, ironically enough, exclusive breastfeeding. Breastmilk has about 2-15 mg/liter of vit. k, formula has about 50 mg/liter. One study said that out of 198 cases of HDNB, 186 were breastfed and only 3 were exclusively bottle fed. Initial symptoms can include: vomiting, lethargy, pallor, loss of appetite, fever, convulsions, unconsciousness, dyspnea, nodular purpura (widespread deep ecchymosis), bleeding from circumcision or injection sites, or other hemorrhage. Intracranial hemorrhage is seen in 50-80% of affected babies and causes death or severe handicap in 50-70% of those babies. Vitamin K is fat soluble. It comes from plants & vegetable oils (Type K-1) and is also synthesized by bacteria in the gut (type K-2), but K-2 is not a major source in the 1st 4-6 months of life. Food sources of K are leafy greens (spinach, kale, turnip, etc.), cabbage, cauliflower, peas, kelp, alfalfa, nettles, green tea, chlorophyll, dairy products, egg yolks, safflower & other polyunsaturated oils, and fish liver oils. Vit. K is destroyed by freezing & radiation. Placental transport of vit. k is documented, but babies levels will be much lower than moms. Cord blood has levels at 1/10th to 1/2 of maternal level. There was, however, a significant decrease in intracranial hemorrhage in preemies when their moms got IM vit. k 4-5 hrs before delivery. Studies vary as to the effectiveness of oral vitamin k. Late HDNB seems to still be a problem when K is given orally, so repeated doses are usually recommended, though advice about when to give them & how much to give varies. We don't seem to have oral K available in the US, but the injectable form may be given orally (Double the dose- draw up 2 ampules, remove the needle, and squirt into baby's mouth) The stuff tastes terrible, and in my own personal experience babies react worse to the oral dose then the injection, so I usually give it IM. I use a 27g needle and give it while the baby is nursing. Most of them don't even cry. If a mom doesn't want to give the baby vit. k, I recommend that she take Vit. k during her pregnancy and the first few months of breastfeeding. It's available in pill form at health food stores. It may not be as effective, but it seems like an acceptable alternative for low risk babies. I've heard of shepherds purse tincture being given instead of K, but I don't know much about it. ________________________ Vitamin K Treatise 3 Vitamin K prophylaxis is primarily used to prevent late hemorrhagic disease of the newborn (LHDN). Late onset LHDN is a syndrome of severe bleeding in infants, between one and six months of age, commonly causing Intracranial Hemorrhage with a 50% mortality rate. The incidence is 1:1200 in the UK. It can be of idiopathic or secondary origin This occurs between 2 weeks and 6 months of age. It is due to impaired absorption of vitamin K in the newborn's gut. This can be due to immature liver function, biliary atresia or alpha antitripsin abnormalities. Often the infant has mild hepatitis with no outward symptoms and recovers spontaneously. Recent research points to temporary inability of the liver to produce the bile salts necessary to absorb the fat soluble vitamin K. The early and classic versions of this are far less common with the reduction in traumatic deliveries and with proper care of women on anticonvulsant and anticoagulant RX. In Holland, where LHDN is almost non-existent, the midwives provide 1 mg vit K po at birth then the mothers give the baby 25 ug weekly po until 6 months. They have a special oral vitamin K preparation. I have experience of two cases of LHDN in Ontario in the last few years Case 1: LHDN, Intracranial Haemorrhage, Winter 1992 Baby boy K, born at home, spontaneous labour and birth at term. No molding or caput noted. APGAR scores 9 at 1 and 5 minutes. Parents declined vitamin K prophylaxis. Exclusively breastfed, thrived. At the age of 5 weeks the mother accidentally cut the infant's finger when clipping his nails. She paged the midwife to notify her that it took a long time to stop bleeding. The following day she paged her midwife and stated that the baby was pale, had a high pitched cry, wasn't feeding and was limp and floppy . The midwife advised the mother to take the baby to the hospital. On admission he had prolonged clotting times which normalised after parenteral vitamin K administration. He remained in the hospital for several weeks. He has residual motor and cognitive brain damage, the extent of which will not be known until he is older. Case 2: Late HDN? warning bleed, Spring 1994 Baby girl S. was born at home in June, 1994 at 41 weeks gestation following an uncomplicated pregnancy and labour. Her APGAR scores were 9 at one minute and 10 at 5 minutes, birthweight 7 lb.. Molding 2+ of parietal and frontal bones was noted on the newborn examination. At approximately one hour following the birth 0.5 mg of vitamin K was given orally. She received a further 0.5 mg of vitamin K orally on day 10. She was exclusively breastfed. On day 12 her mother reported blood and mucous in her stool. The midwife assessed Baby S at home and reported as follows: Nursing vigorously Q 1-3 hours, alert, Resp. 41, apical rate 136, temp 36.1C, skin-clear, dry and pink, eyes-clear, cord stump healed, urine ++, stools-yellow curds with about 1 tsp. of mucousy red blood, weight 7 lb 6 oz. In view of the increased risk of further bleeding and after discussion with the parents, regarding the risks of Late Haemorrhagic Disease of the Newborn (LHDN) vitamin K 1.0 mg was given intramuscularly. Consultation with a neonatologist resulted in no further treatment or investigations. Baby S has thrived since then. Risks of Oral Vitamin K Prophylaxis Research has demonstrated that the use of a single, oral dose of vitamin K is not protective for the more severe mortality and morbidity of LHDN. (Greer et al., 1988; Greer et al., 1995; McNinch and Tripp, 1991; Motohara et al, 1987; Shinzawa et al., 1989; Von Kries et al., 1987a) In a recent two year prospective study of 27 infants who were diagnosed with VKDB, six had been given oral vitamin K. (McNinch & Tripp, 1991) Multiple oral dose routines have problems with format of the preparation and compliance with the routine. In a United Kingdom National cohort study of all children born during one week in 1970, vitamin K administration at birth was found to have a significant association with childhood cancer. (Golding et al., 1990) Golding et al. published a further case control study in 1992, which demonstrated parenteral vitamin K administration and smoking as independently significant factors in the subsequent development of childhood cancer. In examining this study I found a number of factors which may have confounded the results or limit it's generalisability. Primarily, the numbers of children studied was small, only 33 children with cancer were used, this reduced the power of the study. Records of vitamin K administration, both dosage and route were of poor quality and a large number of assumptions were used to assign treatment to index cases and controls. Intravenous (IV) and intramuscular (IM) administration of vitamin K were combined. Significant differences in vitamin K levels in neonates following IV and IM vitamin K have been demonstrated in a study by Loughnan and McDougall (1995). Controls were matched to cases by age, parity and social class. A more rigorous matching to include maternal smoking, type of delivery and other potential confounding factors would have improved the strength of the study. Three other studies have been completed in the USA, Denmark and Sweden. The American trial was a prospective case control study, while both the Danish and Swedish were retrospective case control studies. While each of these studies found the same difficulty with quality of record keeping re vitamin K administration, the degree of missing information was smaller. The Danish and Swedish studies relied on retrospective data and compared groups from different time periods. Environmental and social differences over periods of 30 years may not have been fully excluded from the results as confounding factors. None of these studies has found any causal link with childhood cancer and IM vitamin K administration.(Klebanoff, et al., 1993; Ekelund et al., 1993; Olson et al., 1995) ---- Haemostasis 1990;20(1):8-14 - Medline Vitamin K1 levels and coagulation factors in healthy term newborns till 4 weeks after birth. Pietersma-de Bruyn AL, van Haard PM, Beunis MH, Hamulyak K, Kuijpers JC Department of Gynecology and Obstetrics, Reinier de Graaf Gasthuis, The Netherlands. Vitamin K1 serum levels were assessed by means of an off-line multidimensional liquid chromatography in 18 mothers, shortly after delivery, and in their healthy term infants. Umbilical cord and venous blood samples were assayed up to 4 weeks of life. Concurrently, levels of coagulation factors II and X, antithrombin III and platelets were established. Although the detection limit of the assay was as low as 22 pg/ml, vitamin K1 concentration appeared to be still beyond that level in cord blood or in newborn serum within 30 min after birth, whereas vitamin-K-dependent coagulation factors are already at a level of 40%, without evidence for the presence of descarboxy prothrombin, in any of the investigated neonates. After 3 days, breast-fed neonates had lower vitamin K1 levels than formula-fed infants (0.76 and 1.44 ng/ml, respectively). The levels of the vitamin-K-dependent coagulation factors II and X, however, were comparable, regardless of the kind of feeding. After 28 days, breast-fed neonates had even lower vitamin K1 levels (0.49 ng/ml, while the formula-fed infants showed higher vitamin K1 levels (4.45 ng/ml). But even then, the levels of vitamin-K-dependent coagulation factors II and X were comparable, regardless of the kind of feeding. From this we conclude that the serum levels of vitamin K1 in formula-fed neonates exceed those of breast-fed infants from the moment of feeding (24 h and later) without a concomitant rise in vitamin-K-dependent coagulation factors. A relationship between vitamin K1 levels and vitamin-K-dependent coagulation factors could not be established in healthy term breast-fed or formula-fed infants. PMID: 2323682, UI: 90215547 _______________________ Br J Obstet Gynaecol 1996 Nov;103(11):1078-1084 MedLine Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial haemorrhage in Shizuoka prefecture. Nishiguchi T, Saga K, Sumimoto K, Okada K, Terao T Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan. OBJECTIVE: To compare three methods of vitamin K prophylaxis for neonatal vitamin K deficient intracranial haemorrhage. DESIGN: We designed three strategies for vitamin K prophylaxis: 1. therapeutic administration of vitamin K in a mass screening system using the hepaplastin test; 2. routine oral administration of vitamin K to newborn infants; and 3. administration of vitamin K to lactating mothers during the late neonatal period in addition to the routine method. We evaluated the efficacy of these methods by determining hepaplastin test values at the first month of age. POPULATION: 66,076 full term healthy newborn infants without any complications. RESULTS: Of 55,513 infants in the mass screening system, 3068 infants received vitamin K therapeutically. At the first month of age, in the group where vitamin K was administered therapeutically, 56 infants (1.83%) exhibited low hepaplastin test values (< 40%) despite vitamin K administration. But extremely low values (< 20%), indicating a very high risk of neonatal intracranial haemorrhage, were observed in 34 (0.06%) of 52,445 infants who did not receive vitamin K. In the routine administration system, oral administration of vitamin K twice within the first week of life showed a lower incidence (0.19%) of low level cases than a single administration (1.56%). An additional administration of vitamin K to lactating mothers throughout the late neonatal period showed an effective result. PMID: 8916992, UI: 97074565 ___________________ Kathy Rev. Kathy Rateliff; Doula, childbirth & cord blood educator Administrator, T2 Shepherd Ministries - Titus 2:1-8 http://www.geocities.com/Heartland/Ranch/4172 < mailto:Rateliff@...> Quote Link to comment Share on other sites More sharing options...
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