E-DRUG: Vitamine K1 (phytomenadione) and K3 (menadione) (2)
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[3 responses in one message. BS]
1. There is a very good article
"Vitamin K propohylaxis in less developed countries" Policy Issues and relevance to breastfeeding promotion" Vitora CG et al. Am J Pub Health 1998; 88:203-9.
I think there is the need for both preps. The oral prep is useful for long term treatment of children (eg in liver diseases)
Hope this helps
Kind regards
Ingrid Bucens
Paediatrician
Technical Advisor, Maternal and Neonatal Health Program
Health Alliance International
East Timor
Phone East Timor: +670 725 5038
Phone Australia: +61 438 892702
"ingrid bucens" <ingbucens@hotmail.com>
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2. I agree that both injectable and oral are probably needed. It's a significant issue, but not at the top of the survival list.
Chris Morgan
International Child Health Specialist
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
GPO Box 2284, Melbourne 3001 Australia
cmorgan@burnet.edu.au
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3. Bottom line: Vit K at birth is proven to prevent haemorrhagic disease of newborn.
IM Vit K is better than oral vit K (both in terms of efficacy as programmatically, because if oral Vit K is given, it seems that it is optimal to give more than one dose at birth).
Interestingly, this was a hot topic in Victoria about 10 years ago. Following a paper, I think from UK, that IM Vit K at birth was associated with the later development of ALL (since disproven), there was a policy change in Victoria re Vit K at birth. The policy changed so that instead of single IM dose of Vit K at birth , 3 doses of oral Vit K were given over a number of weeks (I forget the schedule), the first dose of which was at birth.
The local experience showed that there was an unacceptable incidence of neonatal heamorrhagic or delayed heamorrhagic disease with the use of oral vit K. A number of those who bled, had not got three scheduled doses. After, after a period of time (I forget exactly how long, but maybe a year) policy was reversed and reverted back to the single dose IM at birth..
I think, especially in a context where three scheduled contacts with a health worker may not be guaranteed, that a single dose of Vit K is the safer way to go.
In a primary health care setting I see no need to have oral Vit K. Keep things simple and avoid mixed messages about which preparation to use at birth. Use of regular oral Vit K in chronic liver disease is beyond the scope of most primary health care settings, but could
be considered in more regions with more advanced health care systems with supporting programs.
Mick Creati
Paediatrician and International Child Health Specialist
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
GPO Box 2284, Melbourne 3001 Australia
http://www.burnet.internationalhealth.edu.au
creati@burnet.edu.au
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