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      Uso profiláctico de la vitamina K para prevenir la enfermedad hemorrágica del recién nacido Translated title: Prophylaxis with vitamin K to prevent the haemorrhagic disease of the newborn

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          Abstract

          Resumen El déficit de vitamina K al nacimiento supone un factor de riesgo para desarrollar la enfermedad hemorrágica del recién nacido (EHRN). Este estado pro hemorrágico puede producir sangrados graves principalmente a nivel cutáneo, gastrointestinal y cerebral. Hay buena evidencia de que la administración de vitamina K en el recién nacido (RN) es segura y eficaz, los daños potenciales son leves, por lo que está claro el beneficio neto a favor de la administración. El grupo PrevInfad recomienda administrar a todos los recién nacidos 1 mg de vitamina K de forma profiláctica por vía intramuscular para prevenir la EHRN. En el documento, se hacen consideraciones especiales para prematuros y para niños cuyos padres rechazan la profilaxis intramuscular. Asimismo, se presenta una propuesta operativa e información para padres.

          Translated abstract

          Abstract Vitamin K deficiency at birth is a risk factor for Haemorrhagic disease of the newborn. This bleeding prone situation can produce severe hemorrhages mainly in the skin, gastrointestinal tract and brain. There is strong evidence that the administration of vitamin K to the newborn is safe and effective, potential side effects are mild, so there is a clear benefit of its administration. PrevInfad workgroup recommends the prophylactic administration of 1 mg intramuscular Vitamin K to prevent the Haemorrhagic disease of the newborn. Some special considerations for preterm newborns and for children whose parents reject intramuscular prophylaxis are explained in the document. Moreover, an operative proposal and information for parents are presented.

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          Most cited references47

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          Sucrose for analgesia in newborn infants undergoing painful procedures.

          Administration of oral sucrose with and without non-nutritive sucking is the most frequently studied non-pharmacological intervention for procedural pain relief in neonates.
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            Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review

            We conducted a systematic review to evaluate the burden of late vitamin K deficiency bleeding (VKDB) and the effect of vitamin K prophylaxis on the incidence of VKDB. We searched MEDLINE and other electronic databases, and included all observational studies including population surveys as well as randomized controlled trials (RCT). The median (interquartile range) burden of late VKDB was 35 (10.5 to 80) per 100 000 live births in infants who had not received prophylaxis at birth; the burden was much higher in low- and middle-income countries as compared with high-income countries-80 (72 to 80) vs 8.8 (5.8 to 17.8) per 100 000 live births. Two randomized trials evaluated the effect of intramuscular (IM) prophylaxis on the risk of classical VKDB. Although one trial reported a significant reduction in the incidence of any bleeding (relative risk (RR) 0.73, 95% confidence interval (CI) 0.56 to 0.96) and moderate to severe bleeding (RR 0.19, 0.08 to 0.46; number needed to treat (NNT) 74, 47 to 177), the other trial demonstrated a significant reduction in the risk of secondary bleeding after circumcision in male neonates (RR 0.18, CI 0.08 to 0.42; NNT 9, 6 to 15). No RCTs evaluated the effect of vitamin K prophylaxis on late VKDB. Data from four surveillance studies indicate that the use of IM/subcutaneous vitamin K prophylaxis could significantly reduce the risk of late VKDB when compared with no prophylaxis (pooled RR 0.02; 95% CI 0.00 to 0.10). When compared with IM prophylaxis, a single oral dose of vitamin K increased the risk of VKDB (RR 24.5; 95% CI 7.4 to 81.0) but multiple oral doses did not (RR 3.64; CI 0.82 to 16.3). There is low-quality evidence from observational studies that routine IM administration of 1 mg of vitamin K at birth reduces the incidence of late VKDB during infancy. Given the high risk of mortality and morbidity in infants with late VKDB, it seems appropriate to administer IM vitamin K prophylaxis to all neonates at birth. Future studies should compare the efficacy and safety of multiple oral doses with IM vitamin K and also evaluate the optimal dose of vitamin K in preterm neonates.
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              Vitamin K deficiency bleeding (VKDB) in infancy. ISTH Pediatric/Perinatal Subcommittee. International Society on Thrombosis and Haemostasis.

              Replace the term "Hemorrhagic Disease of the Newborn" (HDN) by "Vitamin K Deficiency Bleeding" (VKDB), as neonatal bleeding is often not due to VK-deficiency and VKDB may occur after the 4-week neonatal period. VKDB is bleeding due to inadequate activity of VK-dependent coagulation factors (II, VII, IX, X), correctable by VK replacement. In a bleeding infant a prolonged PT together with a normal fibrinogen level and platelet count is almost diagnostic of VKDB; rapid correction of the PT and/or cessation of bleeding after VK administration are confirmative. WARNING SIGNS: The incidence of intracranial VKDB can be reduced by early recognition of the signs of predisposing conditions (prolonged jaundice, failure to thrive) and by prompt investigation of "warning bleeds". VKDB can be classified by age of onset into early ( 1 week <6 months), and by etiology into idiopathic and secondary. In secondary VKDB, in addition to breast feeding, other predisposing factors are apparent, such as poor intake or absorption of VK. VK-PROPHYLAXIS: Oral and intramuscular VK (one dose of 1 mg) protect equally well against classical VKDB but intramuscular VK is more effective in preventing late VKDB. The efficacy of oral prophylaxis is increased with a triple rather than single dose and by using doses of 2 mg vitamin K rather than 1 mg. Protection from oral doses repeated daily or weekly may be as high as from i.m. VK. VK-PROPHYLAXIS: VK is involved in carboxylation of both the coagulation proteins and a variety of other proteins. Because of potential risks associated with extremely high levels of VK and the possibility of injection injury, intramuscular VK has been questioned as the routine prophylaxis of choice. Protection against bleeding should be achievable with lower peak VK levels by using repeated (daily or weekly) small oral doses rather than by using one i.m. dose. BREAST FEEDING MOTHERS TAKING COUMARINS: Breast feeding should not be denied. Supervision by pediatrician is prudent. Weekly oral supplement of 1 mg VK to the infant and occasional monitoring of PT are advisable. VKDB as defined is a rare but serious bleeding disorder (high incidence of intracranial bleeding) which can be prevented by either one i.m. or multiple oral VK doses.
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                Author and article information

                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid, Madrid, Spain )
                1139-7632
                June 2021
                : 23
                : 90
                : 195-205
                Affiliations
                [8] Velilla de San Antonio Madrid orgnameCentro de Salud Mejorada del Campo España
                [1] Madrid orgnameHospital Universitario 12 de Octubre orgdiv1Servicio de Neonatología España
                [7] Málaga orgnameCentro de Salud Coín España
                [10] Zaragoza orgnameCentro de Salud Delicias Sur España
                [5] Zaragoza orgnameCentro de Salud Torrero La Paz España
                [4] Madrid orgnamePediatra de Atención Primaria España
                [6] Málaga orgnameCentro de Salud Trinidad España
                [2] Valencia orgnameUniversidad de Valencia orgdiv1Unidad de Pediatría orgdiv2Departamento de Pediatría, Obstetricia y Ginecología España
                [3] Madrid orgnameCentro de Salud Canillejas España
                [9] orgnameGrupo PrevInfad España
                Article
                S1139-76322021000200016 S1139-7632(21)02309000016
                16e8d461-5b01-448f-b3f8-1a896fac49d3

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 47, Pages: 11
                Product

                SciELO Spain

                Categories
                Grupo PrevInfad/PAPPS Infancia y Adolescencia

                Prophylaxis,Vitamin K,Prevention,Haemorrhagic disease of the newborn,Vitamina K,Profilaxis,Prevención,Enfermedad hemorrágica del recién nacido

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