van Hasselt Peter M, de Koning Tom J, Kvist Nina, de Vries Elsemieke, Lundin Christina Rydahl, Berger Ruud, Kimpen Jan L L, Houwen Roderick H J, Jorgensen Marianne Horby, Verkade Henkjan J
Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584EA, Utrecht, The Netherlands.
Pediatrics. 2008 Apr;121(4):e857-63. doi: 10.1542/peds.2007-1788.
Newborns routinely receive vitamin K to prevent vitamin K deficiency bleeding. The efficacy of oral vitamin K administration may be compromised in infants with unrecognized cholestasis. We aimed to compare the risk of vitamin K deficiency bleeding under different prophylactic regimens in infants with biliary atresia.
From Dutch and Danish national biliary atresia registries, we retrieved infants who were either breastfed and received 1 mg of oral vitamin K at birth followed by 25 microg of daily oral vitamin K prophylaxis (Netherlands, 1991-2003), 2 mg of oral vitamin K at birth followed by 1 mg of weekly oral prophylaxis (Denmark, 1994 to May 2000), or 2 mg of intramuscular prophylaxis at birth (Denmark, June 2000-2005) or were fed by formula. We determined the absolute and relative risk of severe vitamin K deficiency and vitamin K deficiency bleeding on diagnosis in breastfed infants on each prophylactic regimen and in formula-fed infants.
Vitamin K deficiency bleeding was noted in 25 of 30 of breastfed infants on 25 microg of daily oral prophylaxis, in 1 of 13 on 1 mg of weekly oral prophylaxis, in 1 of 10 receiving 2 mg of intramuscular prophylaxis at birth, and in 1 of 98 formula-fed infants (P < .001). The relative risk of a bleeding in breastfed compared with formula-fed infants was 77.5 for 25 microg of daily oral prophylaxis, 7.2 for 1 mg of weekly oral prophylaxis, and 9.3 for 2 mg of intramuscular prophylaxis at birth.
A daily dose of 25 microg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia. One milligram of weekly oral prophylaxis offers significantly higher protection to these infants and is of similar efficacy as 2 mg of intramuscular prophylaxis at birth. Our data underline the fact that event analysis in specific populations at risk can help to evaluate and improve nationwide prophylactic regimens.
新生儿常规接受维生素K以预防维生素K缺乏性出血。口服维生素K的疗效在未被识别的胆汁淤积婴儿中可能会受到影响。我们旨在比较不同预防方案下胆道闭锁婴儿维生素K缺乏性出血的风险。
从荷兰和丹麦的国家胆道闭锁登记处，我们检索了以下婴儿：母乳喂养且出生时接受1毫克口服维生素K，随后每日口服25微克维生素K进行预防（荷兰，1991 - 2003年）；出生时接受2毫克口服维生素K，随后每周口服1毫克进行预防（丹麦，1994年至2000年5月）；或出生时接受2毫克肌肉注射预防（丹麦，2000年6月 - 2005年），或者是配方奶喂养的婴儿。我们确定了每种预防方案下母乳喂养婴儿以及配方奶喂养婴儿在诊断时严重维生素K缺乏和维生素K缺乏性出血的绝对风险和相对风险。
在每日口服25微克预防方案下的30名母乳喂养婴儿中，有25名出现维生素K缺乏性出血；在每周口服1毫克预防方案下的13名婴儿中，有1名出现；在出生时接受2毫克肌肉注射预防的10名婴儿中，有1名出现；在98名配方奶喂养婴儿中，有1名出现（P < 0.001）。母乳喂养婴儿与配方奶喂养婴儿相比，每日口服25微克预防方案下出血的相对风险为77.5，每周口服1毫克预防方案下为7.2，出生时接受2毫克肌肉注射预防方案下为9.3。
每日25微克的维生素K剂量未能预防因胆道闭锁导致未被识别的胆汁淤积的表面健康婴儿出现出血情况。每周口服1毫克预防方案为这些婴儿提供了显著更高的保护，并且与出生时2毫克肌肉注射预防方案的疗效相似。我们的数据强调了在特定风险人群中进行事件分析有助于评估和改进全国性预防方案这一事实。
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