Ijland Marloes M, Pereira Rob Rodrigues, Cornelissen Elisabeth A M
Department of Paediatrics 833, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
Eur J Pediatr. 2008 Feb;167(2):165-9. doi: 10.1007/s00431-007-0443-x. Epub 2007 Mar 1.
Vitamin K prophylaxis is recommended to prevent the hazard of haemorrhage caused by vitamin K deficiency in newborns. The present Dutch guideline recommends 1 mg of vitamin K(1) orally at birth, followed by a daily dose of 25 microg of vitamin K(1) from 1 to 13 weeks of age for breastfed infants. Since the introduction of this prophylaxis, the incidence of vitamin K deficiency bleeding (VKDB) has decreased; however, late VKDB is still reported. From 1 January to 31 December 2005, a nationwide active surveillance was performed by the Netherlands Paediatric Surveillance Unit (NSCK) to study the current incidence and aetiology of late VKDB in infants. Six cases could be validated as late VKDB: all were breastfed, one fatal idiopathic intracranial haemorrhage at the age of 5 weeks and five bleedings secondary to an underlying cholestatic liver disease between the age of 3 and 7 weeks. The total incidence of late VKDB and idiopathic late VKDB was calculated to be 3.2 (95% CI: 1.2-6.9) and 0.5 (95% CI: 0-2.9) per 100,000 live births, respectively. With the current Dutch guideline, idiopathic late VKDB is rare but late VKDB secondary to cholestasis still occurs in breastfed infants. Doubling the daily dose of vitamin K(1) to 50 microg, as is comparable to formula-feeding, may possibly prevent VKDB in this group. Further research, however, is needed to prove this hypothesis.
推荐进行维生素K预防，以防止新生儿因维生素K缺乏而导致出血风险。荷兰现行指南建议在出生时口服1毫克维生素K(1)，对于母乳喂养的婴儿，在1至13周龄期间每日补充25微克维生素K(1)。自从引入这种预防措施以来，维生素K缺乏性出血（VKDB）的发病率有所下降；然而，仍有晚发性VKDB的报告。2005年1月1日至12月31日，荷兰儿科监测单位（NSCK）进行了一项全国性的主动监测，以研究婴儿晚发性VKDB的当前发病率和病因。有6例被确认为晚发性VKDB：均为母乳喂养，1例在5周龄时发生致命性特发性颅内出血，5例在3至7周龄时因潜在的胆汁淤积性肝病继发出血。晚发性VKDB和特发性晚发性VKDB的总发病率分别计算为每10万活产3.2例（95%可信区间：1.2 - 6.9）和0.5例（95%可信区间：0 - 2.9）。按照荷兰现行指南，特发性晚发性VKDB很少见，但母乳喂养婴儿中因胆汁淤积继发的晚发性VKDB仍有发生。将维生素K(1)的每日剂量加倍至50微克，与配方奶喂养相当，可能会预防该组婴儿发生VKDB。然而，需要进一步的研究来证实这一假设。
