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30 Cards in this Set
- Front
- Back
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Name the 3 separate forms of vitamin K deficiency bleeding in newborns and the ages they appear. |
1. Early: the first 24 hours of life 2. Classic: first week of life 3. Late: one month or older |
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What is the drug name of vitamin K? |
phytonadione |
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How do the babies with vitamin K deficiency tend to bleed? -- 7 presentations |
1. SEVERE bruising or cephalohemata at the places that usually bruise upon delivery (e.g., scalp and face)
2. Unexpected bleeding after circumcision
3. Bleeding at umbilical area.
4. Epistaxis
5. Excessive bleeding at injection or venipuncture sites
6. GI bleeding or melena (best noticed once the meconium has passed)
7. Intracranial bleeding (least common but most feared) |
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List 5 possible concerns of new parents who decline the dose of IM phytonadione offered in the nursery. |
1. The pain the shot causes 2. Preservative exposure 3. The perceived high dose 4. Excessive technology 5. (Unsubstantiated) association with childhood cancer |
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What is the dosage of vitamin K recommended by the AAP to prevent early, classic, and late vitamin D deficiency bleeding? |
0.5 to 1.0 mg IM as a single dose |
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What is the incidence of each of the 3 forms of vitamin D deficiency related bleeding? |
1. Early: 1 in 300 2. Classic: 1 in 300 3. Late: 4-10 in 100,000 |
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What are the steps in managing parents who refuse vitamin K for their newborn? |
The handling is similar for those who refuse immunizations:
1. Respectfully find out what the parents' concerns about vitamin K exactly are. 2. Attempt to correct misinformation 3. Recommend intramuscular vitamin K while giving the reasons for it. 4. Provide written materials when available 5. Parents should sign document indicating that they received information, had questions answered, and understood risks of declining. |
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As an alternative to IM vitamin K dosing, oral preparations are available in Europe, either single or multiple-dose. How effective are they? |
Effectiveness is indeed present, but not to the extent of the IM shot. In addition, trials involving randomization have not been done. |
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What is by-far-and-away the most common cause of early onset vitamin K deficiency bleeding in newborns? |
The mother's use of vitamin-K antagonistic drugs during the pregnancy. |
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What are the three major sets of drugs taken by pregnant women that mess with vitamin K? |
1. Anticonvulsants 2. Anti-TB drugs 3. Vitamin K-antagonist anticoagulants |
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Name 3 anti-convulsant drugs notorious for their bad effect on vitamin K. |
1. Phenytoin (Dilantin) 2. Barbiturates 3. Carbamazepine |
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Name 2 anti-TB drugs that also mess with vitamin K |
1. Rifampin 2. Isoniazid |
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Name 2 anticoagulant drugs that antagonize vitamin K. |
1. Warfarin 2. Phenprocoumon |
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How can early-onset vitamin K deficiency bleeding be ameliorated? |
By the administration of vitamin K to the mother in the last 2-4 weeks of the pregnancy. |
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Though neonatal vitamin K deficiency typically appears during days 2 to 7 of life, how late can it appear? |
It can appear up to the end of the first month. |
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What is the most common cause of "classic" vitamin K deficiency bleeding? |
The parents' declining the vitamin K injection in the nursery. |
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Name 2 non-specific presentations of "classic" neonatal vitamin-D deficiency bleeding. |
1. Looking "ill" 2. Poor, delayed feeding |
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What is the age range for the presentation of late onset vitamin K deficiency neonatal bleeding. |
From 2 weeks to as late as 6 mos. of age |
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Name the most common presentation of late onset vitamin K deficiency bleeding in infants. |
More than half present with acute intracranial hemorrhage |
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At birth, how much vitamin K has the infant received from the mother, and how did it get there? |
None! Vitamin K does not cross the placenta! (Trick question. So sue.) |
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How much vitamin K reaches the infant from breast milk? |
Not much: 1-4 mcg/L |
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Where do infants get their vitamin K? |
It is produced by intestinal flora once their guts have been colonized. |
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What species of bacteria is particularly associated with the synthesis of vitamin K in the gut? |
Bacteroides |
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Name 2 items that recur during history-taking of an infant with late-onset vitamin K deficiency bleeding. |
1. Refusal of the vitamin K shot in the nursery 2. An infant that has been exclusively breast fed for the first 6 mos. of life |
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What oral preparations (approved by the FDA) are available in the USA? |
One and only one: phytonadione 5mg tablets |
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What oral preparations (approved by the FDA) are available in the USA? |
One and only one: phytonadione 5mg tablets (Though compounding pharmacies may prepare a 1 mg/mL suspension that is stable only a few days with refrigeration.) |
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What vitamin K preparation is commonly given to babies whose parents demand that the vitamin be given orally?
Is there a concern about so using this preparation? |
The injectable version (Hospira 0.5 gm/0.5 mL)--even no data on the oral bioavailability of this preparation yet exists (as of 5/26/2016). |
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According to the Canadian Paedriatric Society, how should ORAL vitamin K be administered? |
2 mg at birth, a second dose at one week of age, and a third at 6 weeks |
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True or false: IM phytonadione has been proven effective in the prevention of every form of vitamin-K deficiency related bleeding. |
False. A single dose of IM vitamin K is indeed effective in preventing the "classic" form, but it has not been tested in randomized trials for effect on the "late" form. |
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How do the vitamin K levels in very young newborns compare with those of older kids? |
They are very low. Therefore, checking a vitamin K level won't clinch a diagnosis of vitamin-K deficiency related bleeding. |
