Vitamin K Administration to Babies - Essay Example

The Role of Vitamin K in the control of hemorrhage in babies' risk to VKDB Introduction: There are several elements that will be discussed here with regard to specific standards of practice and this would deal with the Vitamin K administration to babies. Here I would critically analyse the research, clinical guidelines and policy bases of vitamin K administration and use the extent and thoroughness of evidence to evaluate the truth or veracity of the arguments. The relevance of this learning and research to the future midwifery practice could be reflected on and I will discuss several issues related to standards of practice in control of hemorrhage and the use of vitamin K specifically in newborns. I would use clinical evidence as well as theory and research studies with review of literature and background to support the discussion. Vitamin K and Blood clotting Vitamin K (Phylloquinone) is known as the clotting vitamin as blood would not clot without it. Bruising and excess bleeding would be common symptoms of Vitamin K deficiency as blood clotting would take longer time than usual with deficiency in the vitamin (Bay et al, 2006; DoH, 1998). Specific recommendations of doses of vitamin K may vary according to age, gender and even conditions of health. This essay is however specifically on the application of vitamin K to babies orally or through intravenous means to prevent VKDB in newborns. Vitamin K deficiency causes a bleeding condition which is known as the hemorrhagic disease of the newborn or HDN and this can occur anytime between the first months of being born (Puckett and Offringa, 2007). Puckett and Offringa (2007) divided hemorrhagic disease of the newborn into three categories of early, classic and late HDN with early HDN occurring within 24 hours, classic HDN occurring between 1 to 7 days and late HDN occurring between 2 to 12 weeks with intracranial, cutaneous or gastrointestinal bleeding. Bleeding in the newborn can be through gums, nose or gastrointestinal tract especially in babies who had complicated delivery including breech delivery and the risks increase when mothers take certain drugs such as anticonvulsants to treat epileptic conditions during pregnancy. However hemorrhagic bleeding could be prevented by providing vitamin K to babies after birth and babies could also be given vitamin K supplements with parental consent (NICE guidelines, 2006). In certain formula milk available for toddlers in the market, vitamin K has been added because of its attributes of clotting the blood as breast milk is without sufficient vitamin K. Vitamin K is also administered orally or through intravenous means to prevent occurrence of VKDB in newborns (DoH/RCM, 1999). The main focus of this discussion brings out the scientific basis of the application of Vitamin K to newborn babies to prevent the occurrence of VKDB. Usually Vitamin K is given in oral or intravenous form and this study shows the evidence base of such practice. Considering a background of VKDB or Vitamin K, vitamin K was initially administered selectively to prevent hemorrhagic disease in newborn babies who required medical support at birth (Von Kries, 1998). However it has been recommended that all newborn babies should be given vitamin K prophylactically to protect babies from the rare but serious condition of Vitamin K Deficiency Bleeding (VKDB). VKDB or Vitamin K deficiency bleeding is however a rare condition and found in 1 in 10000 babies and among the affected babies, at least half will die or may have significant brain damage because there may be internal hemorrhage in the brain. Breastfeeding can develop vitamin K deficiency as vitamin K is not found in required amounts in breast milk so requisite food supplements and extra amounts of vitamin K will have to be provided to the baby after birth (DoH- RCM, 1999, NHS, 2007). Vitamin K is given only to high risk babies and among 800000 births, the deficiency and the bleeding occur in about 80 and among these 4 to 6 may even die due to bleeding into the brain and 20 remain brain damaged because of the bleeding but may not die. According to the NICE guidelines (2006), 'Vitamin K should be offered for all infants and administered with a single dose of 1 mg IM. If parents decline IM Vitamin K for their baby, oral Vitamin K should be offered as second line'. These babies who are identified as having high risks of bleeding due to pregnancy conditions or liver disease or even complicated birth should be given vitamin K after birth although in most cases vitamin K deficiency occurs without much prior warning and the risk factors are not properly identified (Mager et al, 2006). The babies who are at risk of bleeding problem should be given extra amounts of vitamin K as food supplements. If pregnant mothers were on anticonvulsant drugs for epilepsy or babies who have been premature or had complicated or breech delivery or even developed a form of liver disease are more vulnerable to internal or external bleeding (Stable and Rankin, 2005). According to the Department of Health (1999), the following principles are laid out for vitamin K administration and deficiency 1. Vitamin K prophylaxis is effective in preventing VKDB. 2. All newborn babies should receive an appropriate vitamin K regimen, to be agreed with the parents' informed consent. 3. There are two ways of vitamin K administration. Vitamin K can be given either by intramuscular injection or by using an oral preparation (from the RCM paper by DoH, 1999) In a paper by Danielsson et al (2004) it is argued that in many developing countries vitamin K prophylaxis is not administered routinely during birth as there may be cost issues as cost effectiveness of vitamin K administration is not known. Intracranial hemorrhage is however quite common with vitamin K deficiency and in this study by Danielsson et al, cases of intracranial hemorrhage have been studied in infants aged below 13 weeks and evidence of vitamin K deficiency was identified. The incidence of intracranial hemorrhage cases caused by vitamin K deficiencies has also been studied and the results showed that late onset vitamin K deficiency bleeding in infants who did not receive prophylaxis was quite high and mortality was at 9% of the total cases of the deficiency although Vitamin K administered prior to birth does not necessarily prevent hemorrhages (Crowther and Henderson, 2007). 42% of the infants who showed the condition developed neurological or brain abnormalities and there has been a reduction in incidence of vitamin K deficiency following the introduction of vitamin K prophylaxis in hospitals. Vitamin K deficiency bleeding has been considered as a public health problem and especially for children. Vitamin K prophylaxis could help reduce infant mortality and morbidity (NICE, 2006). Puckett and Offringa (2007) have suggested that a single dose (1.0 mg) of intramuscular vitamin K after birth would be effective in the prevention of classic HDN. Both oral and intramuscular/intravenous (1.0 mg) vitamin K prophylaxis helps in improving biochemical indices of blood coagulation status within 1-7 days. 1. Department of Health guidelines have recommended that all newborn babies should receive an appropriate vitamin K regimen to prevent VKDB (DoH-RCM, 1999). Midwives have also been asked to familiarize themselves with vitamin K prophylaxis 2. The safety and efficacy of vitamin K prophylaxis, or on the desirability of routine administration needs more research according to the Department of Health to avert fears of childhood leukemia. 3. According to the Department of Health, every healthcare trust should have a clear protocol concerning the administration of vitamin K (DoH/RCM 1999). 4. The parents decide whether their child should receive vitamin K at birth and also the method, whether intravenous manner or orally although parents may not be aware of the risks and benefits of such Vitamin K use. 5. Unlicensed products for use of vitamin K administration should not be used. 6. The Department of Health also mentions that the argument that breastfed babies are at higher risk of vitamin K deficiency should not in any way undermine the promotion of breastfeeding as the best start in life. 7. Midwives should remain alert to episodes of minor bleeding and to prolonged jaundice in infants which may be symptoms of Vitamin K deficiency. Sutor (2003) has pointed out that neonatal bleeding may not be primarily due to Vitamin K deficiency and there may be other reasons. Sutor shows that VKDB is a form of bleeding caused by reduced activity of VK dependent coagulation factors and increased activity of VK independent coagulation factors. In a bleeding infant, the prothrombin percentage, fibrinogen levels and platelet counts would be diagnostic tools and indicators of VKDB. The upper age limit of VKDB manifestation is at 6 months and the cause of the manifestation of vitamin K deficiency and consequent bleeding is not completely known. The poor intake and consumption of Vitamin K would be one of the factors in VKDB and the classic form of VKDB could be prevented by a single oral dose of VK after birth although according to Sutor (2003), intramuscular application of Vitamin K would be most effective but may have disadvantages. Vitamin K prophylaxis as is more common now is also effective in preventing VKDB and a single oral prophylaxis would be followed by repeated oral administration. Three oral doses of VK would protect many babies (Sutor, 2003). Vitamin K administration and prophylaxis prevents intracranial hemorrhages and the onset of bleeding and continuous oral administration would be more effective than a single oral dose of Vitamin K. According to Sutor, 'The risks of VKDB are minimized if prophylaxis recommendations are followed and if warning signs are recognized and promptly acted upon' (Sutor, 2003, 375) Conclusion The efficacy of vitamin K administration has been questioned due to possible links with cancer although the problems of intravenous administration do not apply to oral prophylaxis although the oral means may be less reliable. However it is important that despite lack of vitamin K in breast milk, breast feeding should be promoted and vitamin K supplements should be given (DoH/RCM 1999). According to Sutor's study and several other related studies, the intracranial VKDB in children could be reduced if the significance and warning signs such as icterus, failure to thrive, feeding problems, minor, bleeding, diseases with cholestasis are considered. Based on the evidence and research studies considered here, it can be said that although the intravenous application of VK is considered more effective, it may have side effects so the oral dose is popular. However the oral dose or even the intravenous dose of VK prophylaxis will have to be evaluated further to understand the implications in preventing VKDB. Bibliography Bay A, Oner AF, Celebi V, Uner A. (2006) Evaluation of vitamin K deficiency in children with acute and intractable diarrhea. Adv Ther. May-Jun;23(3):469-74. Crowther CA, Henderson-Smart DJ, from the Cochrane Reviews, (2007)Vitamin K prior to preterm birth for preventing neonatal periventricular haemorrhage http://www.cochrane.org/reviews/en/ab000229.html Danielsson N, D P Hoa, N V Thang, T Vos and P M Loughnan (2004) Intracranial haemorrhage due to late onset vitamin K deficiency bleeding in Hanoi province, Vietnam Archives of Disease in Childhood Fetal and Neonatal Edition;89:F546-F550 Department of Health. (1998) Vitamin K for Babies. PLO/CNO/998/4. DoH: London Department of Health and Social Services, Northern Ireland. (1998) Vitamin K for Newborn Babies. HSS (MD) 12/98. DHSS: Belfast Department of Health. (1999) Vitamin K RCM Paper. DoH: London Fear NT, Roman E, Ansell P, Simpson J, Day N, Eden OB; (2003) United Kingdom Childhood Cancer Study. Vitamin K and childhood cancer: a report from the United Kingdom Childhood Cancer Study. Br J Cancer. Oct 6;89(7):1228-31. 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