Among the general procedures, care and tests that are performed on the baby as soon as it is born is the prophylactic administration of Vitamin K through a single intramuscular injection.
But, have you ever wondered why this vitamin is so important, and what is the vitamin K deficiency bleeding syndrome that is prevented with the administration of this injection? We explain it in detail in this article.
What is vitamin K deficiency bleeding syndrome?
It is a rare syndrome that occurs in very few cases, but if it occurs it can become very serious or even cause death . Hemorrhagic disease of the newborn (HDN) is a secondary acquired coagulopathy, due to a deficiency in vitamin K-dependent coagulation factors (factors II, VII, IX, and X).
This disease can present itself in three different ways:
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I start early , during the first 24 hours from birth.
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It starts during the first week after birth . It is the most common form of the disease, and the location of the hemorrhage can be gastrointestinal, cutaneous, nasal and secondary to circumcision.
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Late onset , after the second week and during the first three months of life. The most frequent hemorrhages are those of intracranial origin, which are associated with higher mortality and disability. Bleeding of cutaneous and gastrointestinal origin may also occur, associated with liver diseases and intestinal malabsorption.
Incidence of the disease
As we read in the Hospital Pharmacy magazine, Elsevier, the incidence of the disease in Europe when prophylaxis is not administered varies depending on its form. Thus, in the classic form or beginning during the first week of life, the incidence is five to six newborns per 100,000 , while in the late form it can reach seven cases per 100,000 live births.
In developing countries, these values are higher, as hot climates and exclusive maternal nutrition, low in vitamin K, act as risk factors.
How is vitamin K given to the baby?
Although the prophylactic administration of Vitamin K in the newborn is supported by numerous scientific studies, clinical trials and meta-analyzes, the form of administration of the same raises a great debate .
As we can read in the document published by the Ministry of Health on ‘Care after birth’, “the results of different epidemiological studies carried out in different countries with different guidelines for the administration of vitamin K” have determined the most effective for the prevention of HDN :
- 1 mg of vitamin K intramuscularly at birth.
- 2 mg of vitamin K orally at birth, followed in fully or partially breastfed, 1mg orally weekly until the 12th week. In children exclusively fed with formula milk marketed in developed countries, administration is only necessary after birth.
1) Intramuscularly
The American Academy of Pediatrics (AAP) recommends intramuscular administration of a single dose (1 mg) of vitamin K, as this form has been shown to be more protective than when administered orally . The WHO also offers this recommendation, and stresses the importance of the dose being administered respecting at all times skin-to-skin contact between mother and baby.
When administered intramuscularly, it should be done deep into the middle third of the anterolateral aspect of the thigh, with a rapid technique in the introduction of the needle and the inoculation.
Among the disadvantages of administering vitamin K in this way, experts highlight:
- The pain of the injection, something that may be lessened if given while the baby is suckling or is on the mother’s breast
- Very low risk of local neuromuscular damage
Between the years 1990 and 1992, two studies appeared (led by the same researcher) in which it was suggested that vitamin K administered intramuscularly could be associated with an increased risk of developing childhood cancer.
Three subsequent studies carried out by different researchers between 1998 and 2003, on the other hand, concluded that there was no relationship between the administration of the vitamin and the frequency of cancer, therefore, in the absence of more studies that talk about it, there is no relationship direct link between childhood cancer and intramuscular vitamin K.
2) Orally
The main problem with the oral administration of vitamin K is the non-compliance with the doses, since as we have seen, they have to be maintained for a long period of time. Not surprisingly, several countries such as Australia and New Zealand, which had switched to the oral regimen, after confirming an increase in late HDN cases, decided to return to the intramuscular regimen.
Another major disadvantage of oral guidelines is their administration to babies at risk that cannot be identified at birth. In this regard, in the document published by the Ministry of Health we can read:
“The Dutch experience is worth commenting on. With 1 mg orally at birth followed by 25 micrograms of oral vitamin K daily they have seen a very significant increase in the frequency of late HDN in children who were receiving adequate vitamin K prophylaxis.”
“In general, these are cases that we would call secondary, because they are children who debut with massive bleeding around the fifth week of life, but are later confirmed to have some type of liver disease , the most common being bile duct atresia” .
“With the other administration guidelines (intramuscular route), the first symptom is not massive bleeding and there is time to establish adequate treatment with vitamin K when cholestasis is demonstrated”
Can I request that the administration of this vitamin be oral and not intramuscular?
In general, and given the scientific evidence that shows that intramuscular administration protects better against HDN than oral administration, in hospitals in our country Vitamin K is administered in this way.
However, and since it is a painful prick that the baby must receive as soon as it is born, there are parents who consider the possibility of avoiding the injection and administering the vitamin orally. In these cases, the Ministry of Health stresses the importance of strictly complying with the doses taken , and paying special attention when there are risk factors such as prematurity, birth trauma, a mother who has taken antiepileptic drugs, liver disease …
The administration of Vitamin K in premature babies
And finally, it is worth mentioning the guidelines for the administration of Vitamin K in premature infants under 32 weeks or weighing less than 1000 grams. In these cases, it is recommended to act as follows:
“Recently there have been some studies that recommend that in very premature or extremely low weight children the initial dose of vitamin K administered intramuscularly or intravenously be decreased , to avoid accumulations of vitamin K that exceed physiological levels. In premature infants these Lower initial doses (between 0.5 and 0.3mg) seem to protect them from bleeding during the first 25 days of life. Later, if they are breast-fed, they should receive supplements . “
Photos | iStock
Via | Ministry of Health on ‘Care after birth’
More information | Elsevier
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