Crowther C A, Henderson-Smart D J
Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, South Australia, AUSTRALIA, SA 5006.
Cochrane Database Syst Rev. 2001(1):CD000229. doi: 10.1002/14651858.CD000229.
Preterm infants are at risk of periventricular haemorrhage. This can be a sign of brain damage that might lead to neurodevelopmental abnormalities, including cerebral palsy. It has been suggested that vitamin K might improve coagulation in preterm infants.
The objective of this review was to assess the effects of vitamin K administered to women at risk of imminent very preterm birth to prevent periventricular haemorrhage and associated neurological injury in the infant.
We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to September 2000.
Randomised or quasi-randomised trials of vitamin K administered parenterally or orally to women at risk of imminent preterm birth. The primary outcomes were neonatal mortality, neonatal neurological morbidity, as measured by the presence of periventricular haemorrhage (PVH) on ultrasound during the first week of life, and long term neurodevelopment. Secondary outcomes included other neonatal morbidity and any maternal side effects.
Eligibility, trial quality assessment and data extraction were done independently by two reviewers.
Five trials were included, involving more than 420 women. The trials were of variable quality. Antenatal vitamin K was associated with a non-significant trend to a reduction in all grades of periventricular haemorrhage (relative risk (RR) 0.82, 95% confidence interval (CI) 0.67-1.00) and in severe PVH (grades 3 and 4) (RR 0.75, 95% CI 0.45-1.25) for babies receiving prenatal vitamin K compared with control babies. This trend disappeared when poorer quality trials were excluded. Information on neurodevelopment was only given for a small sample of children in one trial with discrepancy in results given in the two reports.
REVIEWER'S CONCLUSIONS: Vitamin K administered to women prior to very preterm birth has not been shown to significantly prevent periventricular haemorrhages in preterm infants.
早产儿有发生脑室周围出血的风险。这可能是脑损伤的迹象，可能导致神经发育异常，包括脑瘫。有人提出维生素K可能改善早产儿的凝血功能。
本综述的目的是评估对有极早产风险的妇女给予维生素K，以预防婴儿脑室周围出血及相关神经损伤的效果。
我们检索了Cochrane妊娠与分娩组试验注册库、Cochrane对照试验注册库以及截至2000年9月的参考文献目录。
对有极早产风险的妇女经肠道外或口服给予维生素K的随机或半随机试验。主要结局包括新生儿死亡率、新生儿神经疾病发生率（通过出生第一周超声检查脑室周围出血（PVH）的情况来衡量）以及长期神经发育。次要结局包括其他新生儿疾病发生率和任何母体副作用。
两名评价员独立进行纳入标准、试验质量评估和数据提取。
纳入了5项试验，涉及420多名妇女。试验质量参差不齐。与对照婴儿相比，产前给予维生素K的婴儿在所有等级脑室周围出血（相对危险度（RR）0.82，95%置信区间（CI）0.67 - 1.00）和重度PVH（3级和4级）（RR 0.75，95%CI 0.45 - 1.25）方面有不显著的降低趋势。排除质量较差的试验后，这一趋势消失。仅在一项试验中的一小部分儿童中给出了神经发育信息，两份报告中的结果存在差异。
在极早产之前给予妇女维生素K并未显示能显著预防早产儿脑室周围出血。
