Effect of oral vitamin K prophylaxis on prothrombine time and activated partial thromboplastin time: a randomized controlled comparison with an intramuscular vitamin K in infants
Keywords:
oral vitamin K, prophylaxis, PT, APTT
Abstract
Background Low plasma concentration of vitamin K in thenewborn accounts for serious bleeding in the neonatal period and
early infancy. The aim of prophylactic vitamin K is to prevent
bleeding. Oral prophylaxis is preferable to intramuscular (IM)
administration because oral administration is less expensive and
less traumatic.
Objective To compare oral vs. intramuscular vitamin K on
prothrombine time (PT) and activated partial thromboplastin time
(APTT) during the first 60 days of life.
Methods We randomized newborn infants to either receive oral
vitamin K 2 mg at birth and repeated at 7 and 30 days of life or
the 1 mg intramuscular vitamin K. PT and APTT were monitored
at 0, 15, and 45 days of age. Independent t-test, repeated
measurement, and regression analysis were used for statistical
analyses and comparison of the results.
Results Fifty infants were assigned into the oral group and 50 to
the IM group. All participants completed 60 days of study. Both
PT and APTT decreased after administration of oral or IM vitamin
K, and the values did not differ significantly at any time point
and through the period of investigation. Using regression analysis
it was shown that only vitamin K administration was correlated
with PT and APTT with P value were 0.044 and 0.036,
respectively. During 60 days of study, there was no hemorrhagic
diathesis in both groups.
Conclusions Through the first 60 days of life, 3 doses of oral
vitamin K maintain hemostasis by decreasing PT and APTT in
infants at values equal to those achieved by the intramuscular
preparation. Diathesis hemorrhagic event did not occur in both
groups.
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vitamin K for the prevention of late vitamin K deficiency
bleeding. Arch Dis Child Fetal Neonatal Ed 2003; 88:F109-12.
Vitamin K deficiency bleeding (VKDB) in infancy. Thromb
Haemost 1999;81:456-61.
2. Puckett RM, Offringa M. Prophylactic vitamin K for vitamin
K deficiency bleeding in neonates (Cochrane Review) Issue
1 2003. Cited 2003 June 1. Oxford: Update Software.
Available from: URL: http://www.update-software.com
3. Isarangkura P, Chuansumrit A. Vitamin K deficiency in
infants. Presented at Education Program IX th Congress
International Society of Haematology, Bangkok, Thailand;
October 24-28, 1999.
4. American Academy of Pediatrics. Vitamin K Ad Hoc Task
Force. Controversies concerning vitamin K and the newborn.
Pediatrics 1993;91:1001-3.
5. Golding J, Greenwood R, Birmingham K. Childhood cancer,
intramuscular vitamin K, and pethidine given during labour.
BMJ 1992;305:541-6.
6. Chalmers EA. Neonatal coagulation problems. Arch Dis
Child Fetal Neonatal Ed 2004;89:475-8.
7. Hey E. Vitamin K-what, why, and when. Arch Dis Child
Fetal Neonatal Ed 2003;88:F80-3.
8. Klebanoff MA, Read JS, Mills JL. The risk of childhood
cancer after neonatal exposure to vitamin K. N Engl J Med
1993;329:905-8.
9. Passmore SJ, Draper G, Brownbill P. Case-control studies of
relation between childhood cancer and neonatal vitamin K
administration. BMJ 1998;316:178-84.
10. Moeslichan S. Proposal pemberian profilaksis vitamin K 1
sebagai salah satu upaya menurunkan angka kematian bayi.
Jakarta, 2001.
11. Greer FR, Marshall SP, Severson RR. A new mixed micellar
preparation for oral vitamin K prophylaxis: randomized
controlled comparison with an intramuscular formulation
in breastfed infants. Arch Dis Child 1998;79:300-5.
12. Andrew M. Developmental hemostasis : relevance to newborns
and infants. In: Nathan DG, Orkin SH, editors. Nathan and
Oski’s Hematology of infancy and childhood. 5 th ed.
Philadelphia: WB Saunders Company; 1998. p. 136-42.
13. Widdershoven, Kollee L, van Munster P. Biochemical vitamin
K deficiency in early infancy: diagnostic limitation of
conventional coagulation tests. Helv Pediatr Acta 1986; 41:195-
201.
14. van Cott EM, Laposata M. Coagulation. In: Jacobs DS, editor.
The laboratory test handbook. 5 th ed. Cleveland: Lexi-Comp;
2001. p. 327-58.
15. Loughnan PM, McDougall PN. Does intramuscular vitamin
K 1 act as an unintended depot preparation? J Pediatr Child
Health 1996;32:251-4.
16. Clark FI, James EJ. Twenty seven years experience with oral
vitamin K1 therapy in neonats. J Pediatr 1995;127:301-4.
17. Wariyar U, Hilton S, Pagan J. Six years experience of
prophylactic oral vitamin K. Arch Dis Child Fetal Neonatal
Ed 2000;82:64-8.
18. Motohara K, Masuda I, Endo F. Vitamin K deficiency in
infancy. In: Simopoulus AP, editor. Selected vitamins, minerals,
and functional consequences of maternal malnutrition. World
Rev Nutr Diet. Basel: Karger, 1991; p. 85-108.
19. Greer FR. Do breastfed-infants need supplemental vitamins?
Pediatric Clinic of North America 2001;48:115-8.
20. Greer FR, Marshall SP, Foley AL. Improving the vitamin K
status of breastfeeding infants with maternal vitamin K
supplements. Pediatrics 1997;99:88-92.
21. Von Kries R. Oral versus intramuscular phytomenadione:
safety and efficacy compared. Drug Safety 1999;21:1-6.
22. Taylor P. Fat soluble vitamin. In: Gilman AG, Rall TW, editor.
The pharmacological basis of therapeutics, vol 2. International
ed. Singapore: McGraw-Hill Book Co; 1992. p. 1563-7.
23. Pereira SP, Shearer MJ, Williams R. Intestinal absorption of
mixed micellar phylloquinone is unreliable in infants with
conjugated hyperbilirubinemia: implications for oral
prophylaxis of vitamin K deficiency bleeding. Arch Dis Child
Fetal Neonatal Ed 2003;88:F113-8.
24. von Kries R, Hachmeister A, Gobel U. Oral mixed micellar
vitamin K for the prevention of late vitamin K deficiency
bleeding. Arch Dis Child Fetal Neonatal Ed 2003; 88:F109-12.
Published
2007-07-01
How to Cite
1.
Limantara V, S. S, Mudita I, Retayasa W, Kardana M. Effect of oral vitamin K prophylaxis on prothrombine time and activated partial thromboplastin time: a randomized controlled comparison with an intramuscular vitamin K in infants. PI [Internet]. 1Jul.2007 [cited 25Apr.2024];47(3):109-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/355
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Received 2016-08-25
Accepted 2016-08-25
Published 2007-07-01
Accepted 2016-08-25
Published 2007-07-01
