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PubMed2006

Intracranial hemorrhage in a term newborn with severe von Willebrand disease type 3 associated with sinus venous thrombosis.

Intracranial hemorrhage of term neonates with severe von Willebrand disease type 3 and near normal delivery have not been published to date. We report on a term newborn with severe type 3 VWD who suffered a large intracranial bleeding presumably subsequent to sinus venous thrombosis. This case is remarkable in two aspects: i) with respect to the low risk of perinatal intracranial hemorrhage even in neonates with VWD type 3 and ii) since VWD type 3 with factor VIII:C levels < 5 IU/dl does not seem to protect from thromboembolism. Guidelines for the management of hemophilia advise atraumatic delivery of neonates with known or suspected bleeding disorders, however primary caesarean section in the absence of complications is not obligatory. To answer the question whether the presented case could have an impact on the recommended management we carried out a worldwide survey including 24 participating specialized centers. Except a single case from Sweden of a female neonate with VWD type 3 who also had an inhibitor against VWF no further cases were reported to us. We conclude that CNS bleeding in term neonates with severe VWD type 3 is a rare event that requires additional risk factors for manifestation. Therefore, the amendment of current guidelines does not seem to be mandatory.

Adult↗
PubMed1996

Controversies surrounding the administration of vitamin K to newborns: a review.

OBJECTIVE: To determine (1) the most effective method of administering vitamin K to infants to prevent hemorrhagic disease of the newborn (HDNB) and (2) the safest method, in light of preliminary evidence suggesting that intramuscular administration of vitamin K is associated with childhood cancer. DATA SOURCES: A MEDLINE search of articles published between Jan. 1, 1991, and Apr. 30, 1994, with the use of MeSH terms "hemorrhagic disease of the newborn", articles were limited to those involving human subjects, from birth to adolescence, and to articles from journals indexed through Index Medicus and written in English. References of all articles found through the initial search, the earliest of which was published in 1967, were also reviewed. STUDY SELECTION: Six controlled trials met the selection criteria: a minimum 4-week follow-up period, a minimum of 60 subjects and a comparison of oral and intramuscular administration or of regimens of single and multiple doses taken orally. All retrospective case reviews were evaluated. Because of its thoroughness, the authors selected a meta-analysis of almost all cases involving patients more than 7 days old published from 1967 to 1992. Only five studies that concerned safety were found, and all of these were reviewed. DATA EXTRACTION: In controlled trials, the risk of HDNB caused by vitamin K deficiency among infants receiving different regimens of vitamin K; in case studies, method of vitamin K administration and incidence of hemorrhagic disease; and in studies concerning safety, odds ratios and relative risks of childhood cancer following intramuscular administration of vitamin K. DATA SYNTHESIS: Vitamin K (1 mg, administered intramuscularly) is currently the most effective method of preventing HDNB. The previously reported relation between intramuscular administration of vitamin K and childhood cancer has not been substantiated. An oral regimen (three doses of 1 to 2 mg, the first given at the first feeding, the second at 2 to 4 weeks and the third at 8 weeks) may be an acceptable alternative but needs further testing in large clinical trials. CONCLUSION: There is no compelling evidence to alter the current practice of administering vitamin K intramuscularly to newborns.

Administration, Oral↗
PubMed2000

[The anthropometric indices, morbidity and mortality of newborn infants with diabetic fetopathy].

UNLABELLED: A study was carried out to examine the anthropometric characteristics, neonatal morbidity and mortality in newborn infants with diabetic fetopathy. MATERIAL AND METHODS: Infant anthropometric measurements were obtained, neonatal morbidity and early neonatal mortality were determined in 15 neonates with diabetic fetopathy over 6 years. RESULTS: Among the study population, 33.3% of children had macrosomia. The incidence of aspiration syndrome and meconium aspiration syndrome was 40%, transient tachypnea was 33% and the observed incidence of hyaline membrane disease was 26%. The cardiologic pathology was result of patent ductus arteriosus, myocardial hypertrophy and persistent pulmonary hypertension. The most frequent biochemical changes were transient neonatal hypoglycemia and hyperbilirubinemia. The perinatal mortality rate was 26.7%, with cases of hemorrhagic disease of newborn and the incidence of neonatal thromboembolism. CONCLUSION: Despite the current improvements of diabetes care in pregnancy, newborn infants with diabetic fetopathy have a high level of morbidity and early neonatal mortality.

Anthropometry↗
PubMed2005

Pattern of admissions to neonatal unit.

OBJECTIVE: To document the number, disease pattern and outcome of patients admitted to neonatal unit. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was conducted in the Neonatal Unit of National Institute of Child Health, Karachi, Pakistan from 1st January 2001 to 31st December 2001. PATIENTS AND METHODS: The data of all the admitted neonates was analyzed for age and weight at the time of admission, sex, duration of stay, cause of admission and outcome. RESULTS: A total of 1984 neonates were admitted during study period. Among them 62.1% were males, 17.54% were admitted within 6 hours of their life, and 51.36% within 72 hours of birth. The low birth weight accounted for 55.4% admissions. Neonatal infection was the major cause of admission (45.21%) comprising 30.64% cases of septicemia, 9.82% of pneumonia and 4.73% of meningitis. Other causes of admission were birth asphyxia (18.85%), neonatal jaundice (13.15%), pre-term (6.87%), meconium aspiration syndrome (3.67%), hemorrhagic disease of newborn (2.21%), diarrhea (2.11%) and hyaline membrane disease (1.05%). 48.53% were discharged with satisfactory condition, 25.5% died and 25.85% left against medical advice (LAMA) and or discharged on request (DoR). CONCLUSION: Low birth weight (LBW), infections and birth asphyxia were the major causes of neonatal admission.

Female↗
PubMedDate not supplied

Enterovirus uveitis.

Enterovirus uveitis (EU) is a new infant eye disease that was first observed in 1980. Three distinct subtypes of human echoviruses, EV19/K, EV11/A and EV11/B, caused five hospital outbreaks of EU in different Siberian cities in 1980-1989, affecting approximately 750 children, predominantly below 1 year of age. Sporadic EU cases were also retrospectively diagnosed in other regions of Russia and in different countries of the Former Soviet Union. The illness was characterised by rapid iris destruction and severe complications, including cataract and glaucoma. The disease has been a subject of intensive studies and was reproduced in lower primates after intraocular inoculation of isolated enterovirus strains. Importantly, prototype EV11 and EV19 strains did not induce notable disease in experimental monkeys. Some of the EU-causing strains were shown to be similar phylogenetically and in their pathogenetic properties to the enterovirus strains associated with multisystem hemorrhagic disease of newborns. In this review we present a summary of the vast epidemiological, virological, clinical and experimental data on this new form of ophthalmic infection.

Adult↗
PubMed1992

Comparative study of oral versus injectable vitamin K in neonates.

One hundred term exclusively breast fed babies weighing more than 2.5 kg were evaluated to determine the efficacy of various modes and doses of Vitamin K to prevent hemorrhagic disease of newborn (HDN). The babies were grouped into four categories of 25 each: Group A--1 mg Vitamin K intramuscular (Menadione sodium disulphite) at birth; Group B--0.5 mg Vitamin K intramuscular; Group C--1 mg Vitamin K orally, and group D--no Vitamin K. The prothrombin index was estimated in all babies between 36-72 hours of age. The results revealed a prothrombin index in Groups A, B, C and D as 94.98 +/- 7.64%, 95.08 +/- 9.91%, 92.51 +/- 10.10% and 80.39 +/- 15.90%, respectively. The differences between Groups A, B and C were insignificant. However, Group D, prothrombin index was significantly reduced as compared with the other three groups. It is, therefore, concluded that oral Vitamin K is as effective as injectable Vitamin K and its usage is recommended in our country to reduce complications and costs of parenteral therapy.

Administration, Oral↗
PubMed1992

Enzymatic sample hydrolysis and HPLC in a study of phylloquinone concentration in human milk.

Phylloquinone (vitamin K) is essential to prevent hemorrhagic diseases in newborns. We were interested in determining the concentration of phylloquinone in human milk and in elucidating the factors that influence that concentration. Human milk contains lipid constituents encapsulated with phylloquinone in the fat globules. To eliminate the lipids, we combined sonication and an enzymatic treatment with lipase to prevent degradation by drastic hydrolysis. Despite the low phylloquinone concentrations and the procedure's complexity (lipase treatment, two HPLC steps, and an on-line thermoinduced postcolumn reduction followed by fluorescence detection), within-day and day-to-day CVs of 5.2% and 5.8% were obtained (n = 8, mean = 1.86 micrograms/L, and n = 7, mean = 1.74 micrograms/L, respectively). The mean concentration of phylloquinone in 126 samples was 1.15 +/- 0.82 micrograms/L (mean +/- SD); no correlation was observed between the vitamin concentration and the postpartum date of collection. There was a positive correlation between phylloquinone concentration and phospholipid and cholesterol content (r = 0.5578 and 0.6020, respectively).

Animals↗
PubMed1996

Fat-soluble vitamins in cord blood and colostrum in the south of China.

Certain diseases have been associated with micronutrient deficiencies in China, and nutritional assessments have become important means of preventing such diseases. In the present study, fat-soluble vitamins including vitamins A, D, E, K, and beta-carotene in the cord blood and colostrum of Chinese subjects in Guilin, China, were assayed and compared with those of Japanese subjects in Osaka, Japan. These vitamins were analyzed by high-performance liquid chromatography. Vitamin A and E levels in the cord blood and colostrum of the Chinese group showed almost the same values as those of the Japanese group. There was also no significant difference in vitamin D level in cord blood between the two groups, while significantly lower levels of beta-carotene and cryptoxanthin, and a higher level of PIVKA-II (protein induced in vitamin K absence) in cord blood were observed in the Chinese group. These findings pointed to a restricted intake of green-yellow vegetables in the Chinese group and an increased risk of hemorrhagic disease in newborn of that group is suggested.

China↗
PubMed1996

Massive thymic hemorrhage in a neonate: an entity revisited.

The authors describe a case of early neonatal death of a full-term infant who had respiratory distress and anemia after fetal distress during labor. Postmortem examination disclosed mediastinal compression by a large fresh hemorrhage into the left lobe of the thymus. Massive thymic hemorrhage is an extremely rare but sometimes lethal occurrence; it may represent a manifestation of early-onset hemorrhagic disease of the newborn.

Anemia, Neonatal↗
PubMedDate not supplied

[General vitamin K prevention in newborn infants].

Vitamin K is required for the synthesis of active forms of some coagulation factors. Bleeding due to low levels of the vitamin K dependent coagulation factors (classic hemorrhagic disease of the newborn) is most frequently seen in newborns with a low intake of breast milk, who are not fed supplemental formula, since transplacental transfer of vitamin K seems to be small and breast milk is relatively deficient in vitamin K. Severe bleeding due to vitamin K deficiency is also observed in 4-12 weeks old infants. The reason for the deficiency in otherwise healthy infants of this age is unclear. Classic hemorrhagic disease of the newborn is not existent in infants given vitamin K intramuscularly at birth. Also, the late manifestation of vitamin K deficiency has been observed virtually exclusively in infants, who had not been given vitamin K parenterally at birth. Since most newborns will be breast fed and supplemental formula feeding will not be required in most healthy full term newborns, all newborns should be given a dose of vitamin K intramuscularly immediately after birth. Whether it is safe to administer vitamin K to the mother or orally to the child requires further investigation.

Breast Feeding↗
PubMed1995

Twenty-seven years of experience with oral vitamin K1 therapy in neonates.

Healthy term infants born at the University of Missouri have received vitamin K prophylaxis as a single oral dose since 1967. A retrospective study was undertaken to determine whether either hemorrhagic disease of the newborn or any unexplained intracranial hemorrhage occurred in an infant who received orally administered vitamin K, but none could be found in three separate databases. We conclude that we have met our duty of providing appropriate care.

Administration, Oral↗
PubMed2001

[Effect of oral and intramuscular vitamin K on the factors II, VII, IX, X, and PIVKA II in the infant newborn under 60 days of age].

BACKGROUND: Neonates on exclusive breast feeding that do not receive vitamin K at birth are at higher risk hemorrhagic disease of the newborn. AIM: To compare the effect of oral or intramuscular administration of vitamin K1 (VK1), on clotting factors II, VII, IX, X and PIVKA II, in children until the 60 days of age with exclusive breast feeding or mixed feeding. PATIENTS AND METHODS: Forty healthy full term infants, distributed in two groups, A: 20 with mixed feeding (formula-feeding and breast-feeding) and B: 20 with exclusive breast feeding, were studied. Nine infants of each group received 1 mg of VK1 intramuscularly and eleven 2 mg VK orally 5 ml of cord blood was collected initially from each infant. Venous blood samples were taken on 15, 30 and 60 days of age. RESULTS: All factors increased in a progressive form reaching levels over 50% at 60 days of age, in both groups. PIVKA II decreased significantly during the study period (p < 0.01). Factor II increased more in children with mixed feeding that received intramuscular vitamin K, than in the rest of study groups. No other differences between groups were observed. No infant had an abnormal bleeding during the study period. CONCLUSIONS: Oral administration of vitamin K is as effective as the intramuscular route in the prevention of the hemorrhagic disease of the newborn.

Administration, Oral↗
PubMed1995

Effect of oral water soluble vitamin K on PIVKA-II levels in newborns.

Intramuscular administration of vitamin K for prophylaxis against hemorrhagic disease of the newborn has the disadvantage of increased cost, pain, anxiety to parents and risk of transmission of infection. Oral route is a better alternative. Oral absorption of vitamin K has been shown to be equally good using special oral preparations. However, this preparation is not available in India. A prospective study was carried out on 51 full term, healthy breastfed newborns to evaluate if the injectable water soluble preparation of vitamin K (menadione sodium bisulphite) could be as effective. Fourteen babies received 1 mg vitamin K intramuscularly, 24 received 2 mg vitamin K orally while 13 controls did not receive vitamin K at birth. PIVKA-II levels were measured in cord blood and at 72-78 hours of age in all babies as a marker of vitamin K deficiency. The overall PIVKA-II prevalence in cord blood was 64.7%. At 72-78 hours, PIVKA-II was present in 50% of babies in IM group, 58.3% of babies in oral group and in 76.9% of babies in 'no vitamin K' group (p > 0.05). The PIVKA-II levels decreased or did not change at 72-78 hours in 91.6% of babies in oral group versus 92.8% of babies in IM group (p > 0.05). On the other hand, PIVKA-II levels increased in 30.7% of babies who did not receive vitamin K as against in 7.8% of babies receiving vitamin K in either form (p < 0.05). Hence, vitamin K prophylaxis is required for all newborns at birth and injectable vitamin K (menadione sodium bisulphite) given orally to term healthy babies is effective in preventing vitamin K deficiency state.

Administration, Oral↗
PubMedDate not supplied

[Sonographic detection of an intragastric blood clot in neonatal hemorrhage disease].

Caused by a hemorrhagic disease of a newborn without laboratory findings of coagulopathy, a dramatic blood loss due to gastrointestinal bleeding was observed in a high risk female newborn of 37. weeks of gestational age. By ultrasound the globular 3 centimeter diameter tumor in the stomach was defined as a blood clot. It disappeared in the following days under ultrasound observation.

Female↗
PubMed2006

Prenatal vitamin K1 administration in epileptic women to prevent neonatal hemorrhage: is it effective?

OBJECTIVE: To summarize current knowledge on whether prenatal prophylactic vitamin K1 administration to epileptic women receiving enzyme-inducing antiepileptic drugs (AEDs) to prevent neonatal hemorrhage is effective. STUDY DESIGN: A computerized MEDLINE search was conducted using the terms antiepileptic drug, hemorrhagic disease of the newborn, pregnancy and vitamin K since 1966 to July 2004, limited only to human studies. English-language publications were selected based on their relevance to the clinical effectiveness of administration of oral vitamin K to epileptic women exposed to enzyme-inducing AEDs for prevention of hemorrhagic disease of the newborn (HDN). RESULTS: No randomized, controlled trial testing prenatal vitamin K1 administration for reducing the incidence or severity of neonatal hemorrhage was identified. This review summarizes the data from published observational studies. CONCLUSION: There is inadequate evidence to recommend the routine administration of prenatal vitamin K to epileptic women exposed to enzyme-inducing AED therapy in order to prevent HDN.

Anticonvulsants↗