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Vitamin K Deficiency Bleeding VKDB

07/03/07. Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh). . 3 months old childFever 2 days, extreme irritability 1 day, bulging AFCT head doneProlonged PT and PTTKCorrected after Vit K and Plasma. 07/03/07. Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh).

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Vitamin K Deficiency Bleeding VKDB

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    1. Vitamin K Deficiency Bleeding (VKDB) Dr Rajesh Kumar MD (PGI), DM (Neonatology) PGI, Chandigarh, India Rani Children Hospital, Ranchi

    2. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) 3 months old child Fever 2 days, extreme irritability 1 day, bulging AF CT head done Prolonged PT and PTTK Corrected after Vit K and Plasma

    3. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    4. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    5. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    6. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    7. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Early HDN 40 wks, term baby born NVD, had h/o seizure on phenobarbitone Baby had cephalhematoma, was hypotonic, Vit K was given USG head showed ICH Lab report :PT, PTTK increased

    8. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    9. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    10. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    11. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vitamin K Deficiency Incomplete carboxylation of coagulation proteins that do not form appropriate complexes with Ca&phospholip

    12. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Conditions associated with Vit K Bleeding Hemorrhagic deficiency of newborn & infants(VKDB) Chronic diarrhoeas & malabsorption Liver disorders-hepatitis Warfarin and other drugs Prolonged antibiotics

    13. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) History Haemorrhagic disease of newborn: Townsend 1894 Dam et al 1952: Parenteral vit K prevents Hgic disaese in newborn (n= 33,000) VKDB: Committee of the International Society on Thrombosis and Hemostasis in 1999 Method of prophylaxis: ?

    14. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Case selection criteria Age 2 days to 12 months Prolonged PT(>1.5 times) & PTTK Which normalised within 24 hrs of Vit K Absence of liver disease and/or septicemia

    15. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Age distribution in VKDB 0-1 days…………………..nil 1-6 days…………………..12.5% 7-30 days…………………27.5% 1-3 mths…………………..32.5% 3-6 mths…………………..07.5% 6-9 mths…………………..10% 9-12 mths…………………7.5% >12 mths………………….2.5%

    16. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    17. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Late VKDB Incidence: 4.4 –7.2 per lac With IM prophylaxis: 1.4 – 6.4 per lac

    18. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Why is newborn Vit K deficient? Maternal:cord blood ratio—30:1 Hepatic content in neonate-25% of adult Human milk content(2-15ug/l)-25% cowmilk Colostrum rich in Vit K not given Sterile gut Plasma half-life-72 hrs

    19. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Limited placental transfer of Vit K; 30-60 % of adult value at birth Breast fed will have adult value by 6 weeks Formula fed has much higher value; 10 fold Lipid soluble Phytonadion (1 mg) injection at birth: Vit K level at 6 wks 1.5 times higher than breast fed babies

    20. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Pregnant mothers Tablets of vit k 20mg/day in the last month of pregnancy--- Improve blood levels of newborn Improve Vit K content of breast milk Esp. in mothers taking medications Must be given routinely

    21. What are the Forms of Vitamin K?

    22. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Refers to a group of 2-methyl-1,4-naphthoquinone derivatives which can fulfill an essential co-factor function in humans in the biosynthesis of a number of calcium-binding proteins, some of which are essential for haemostasis. In nature, vitamin K occurs as phylloquinone in plants menaquinones produced by bacteria.

    23. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vitamin K1 Phylloquinone: found in dairy products, green vegetables, and vegetable oils, is an aqueous, colloidal solution of vitamin K1. Phytomenadione Phytonadione Phytylmenadione 3-Phytylmenadione Phytylmenaquinone

    24. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vitamine K2 Menaquinone, which is synthesized by gut flora. Menatetrenone MK4 Vitamin K2(20) Vitamin MK4

    25. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vitamine K 3 Menadione: It is a synthetic, water soluble form that is no longer used medically because of its ability to produce hemolytic anemia. Menadione Menadione sodium bisulfite Menadiol Menadiol sodium phosphate Menadiol sodium phosphate hexahydrate

    26. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vitamine K 4 Acetomenaphthone

    27. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Kaplin: Acetomenaphthone K-NAT: Vitamin K3, IM / IV (slow IV), Concerns about hemolytic anemia Kenadion: Vitamin K1, IM / IV (slow IV)

    28. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vit K by IV route

    29. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Dose of Vit K1

    30. Treatment of VKDB?

    31. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vit K should be administered subcutaneously or intravenously but not intramuscularly to avoid hematoma formation at the site of injection Plasma should be administered to infants with serious bleeding manifestations.

    32. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vit K prophylaxis

    33. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    34. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vit K prophylaxis

    35. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vit K prophylaxis I.M. Vit K at birth Oral mixed miclellar Vit K (Konakion): 2 mg at birth, 7 days, 30 days ( many failures) Weekly oral Vit K (2 mg) for 3 months Oral 2 mg at birth, 25 mcg daily from 7 days to 3 months

    36. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh)

    37. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Vitamin K1 should be given to all newborns as a single, intramuscular dose of 0.5 to 1 mg. Additional research should be conducted on the efficacy, safety, and bioavailability of oral formulations and optimal dosing regimens of vitamin K to prevent late VKDB. Health care professionals should promote awareness among families of the risks of late VKDB associated with inadequate vitamin K prophylaxis from current oral dosage regimens, particularly for newborns who are breastfed exclusively.

    38. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Oral Vit K1 Efficacy in oral administration is uncertain Oral administration contraindicated in Premature, sick neonate, on antibiotic Cholestasis, diarrhea

    39. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) For 5 kg baby with cholestasis Drops ABDEC: 1 ml TDS Drops EVION: 1 -2 ml TDS Vit K: Kenadion 10: ½ ampoule EOD Inj Kenadion 1 once weekly Syp CALCIMAX: 5 ml TDS (Vit D 1800 IU) ? CALCIROL Sachet:

    40. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) 3 ml ABDEC Vit A: 15000 IU Vit D: 1200 IU 3 ml VISYNERAL Z Vit A: 3000 IU Vit D: 1200 IU

    41. 07/03/07 Dr Rajesh Kumar, MD (PGI, Chandigarh), DM (Neonatology, PGI, Chandigarh) Evion drops: upto 10 ml per day UDCA (150 mg): 1 tab per day Syp Phenobarb: 6 ml per day Vit D: 5000- 8000 IU per day Vit A: 10,000 – 15000 per day

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