[Fwd: Vitamin K Waiver]

[Guest guest]

Untitled

Vitamin K Informed Consent and Waiver

Vitamin K injections are routinely given to newborns when they are born

in the hospital, to prevent vitamin K deficiency bleeding (VKDB). VKDB

presents in three different ways:

• Early VKDB, occurring on the first day of life, is rare and confined

to infants born to mothers who have received medications that interfere

with vitamin K metabolism. These include the anticonvulsants phenytoin,

barbiturates or carbamazepam, the antitubercular drugs rifampicin or

isoniazid and the vitamin K antagonists warfarin and phenprocoumarin.

The reported incidence in infants of mothers who have received such

medications without vitamin K supplementation is between 6 and 12 per

cent

Classical VKDB occurs from one to seven days after birth and is more

common in infants who are unwell at birth or who have delayed onset of

feeding. Bleeding is usually from the umbilicus, gastrointestinal

tract, skin punctures, surgical sites and uncommonly in the brain.

Severe intracranial hemorrhage may occur suddenly and result in death

or severe CNS dysfunction. The incidence reported in the literature is

variable, with rates of 0.25 to 1.5 per cent in early reports of both

sick and well infants to 0 to 0.44 per cent in recent reviews

predominantly of well infants. There is considerable uncertainty about

the true rates of classical VKDB since full diagnostic criteria

outlined above were seldom met.

• Late VKDB occurs from eight days to six months after birth, with most

presenting at one to three months. It is almost completely confined to

fully breast-fed infants. Several recent reports emphasize a late form

of hemorrhagic disease occurring at 4-6 weeks of age, often manifest as

intracranial bleeding, and occurring exclusively in breast-fed infants

who did not receive vitamin K as newborns or have fat malabsorption.

Other sites of bleeding include skin, gastrointestinal tract, umbilicus

or surgical sites. About 30 per cent have minor bruising or other signs

of coagulopathy (warning bleeds), preceding the serious hemorrhage.

Infants at risk may have signs of predisposing cholestatic liver

disease such as prolonged jaundice, pale stools, and

hepatosplenomegaly. The rate of VKDB in infants who did not receive

vitamin K at birth has been reported as between five and 20 per 100,000

births. The mortality is about 30 per cent (Loughnan and McDougall

1993).

Not all parents are comfortable with having their newborns

injected with vitamin K. This document tells you the reasons vitamin K

is routinely given to all newborns born in hospital. The disorders

above are almost completely preventable if the vitamin K injection is

given at birth.

Your midwife can provide a form of oral vitamin K. K-Quinone-is an oil

soluble source of vitamin K-1 (phytonadione), the non-toxic natural

form of vitamin K present in plants. K-Quinoe is extracted from

alfalfa, nettles and green tea. Each drop provides 2 mg of vitamin K-1

activity. This particular product has not been studied by the medical

community and may provide some degree of protection against VKDB,

although it will probably not be effective against vitamin K deficiency

caused by a babys inability to metabolize fats. The vitamin K is given

at birth, at one to two weeks of age, and at six weeks of age.

The mother can purchase this vitamin K when she orders her birth kit

and take it herself if she wants to increase vitamin K levels in her

breastmilk. Mothers given oral supplements of 0.5 - 3.omg vitamin K per

day produce substantially increased breast milk vitamin K levels.

If you do not want your baby to receive vitamin K please sign and date

below. If you want your baby to receive injectable vitamin K you must

arrange with a doctor to have the vitamin K injection present at the

birth, or to have your baby seen by the doctor in the babys first week

of life, and given the injection at the physicians office.

If you want to use oral vitamin K, please tell your midwife.

- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - - - - - - -

I/we refuse to give vitamin K to our new baby. I/we have read the

preceding information and understand this could result in serious

injury or even death.

_________________________________________ _________________

Parents signatures

Date

I/we agree to have the vitamin K injection and will arrange for a

doctor to do this.

_________________________________________ _________________

Parents signatures

Date

I/We have decided to use oral vitamin K for our baby. We agree to be

sure that all three doses are administered at the appropriate intervals

of birth, one to two weeks, and at six weeks.

_________________________________________ _________________

Parents signatures

Date

--

Untitled

Internal Virus Database is out-of-date.

Checked by AVG.

Version: 7.5.524 / Virus Database: 270.5.0/1557 - Release Date: 7/17/2008 5:36

AM