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Erythromycin and Vitamin K Prophylaxis in the Newborn

Erythromycin and Vitamin K Prophylaxis in the Newborn. Lynette Barnhart, RNC, SNNP Magidah Kobty, RNC, SNNP University of Texas Medical Branch at Galveston School of Nursing Neonatal AHA GNRS 5303. Objectives. Explain the origin of Erythromycin and Vitamin K

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Erythromycin and Vitamin K Prophylaxis in the Newborn

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  1. Erythromycin and Vitamin K Prophylaxis in the Newborn Lynette Barnhart, RNC, SNNP Magidah Kobty, RNC, SNNP University of Texas Medical Branch at Galveston School of Nursing Neonatal AHA GNRS 5303

  2. Objectives Explain the origin of Erythromycin and Vitamin K Review Texas requirements for administration Briefly review erythromycin usage Briefly review vitamin K usage Review evidence based practice Discuss long term outcomes and management of positive findings

  3. Origin • Erythromycin • 1881 Carl Crede • Prophylaxis of ophthalmianeonatorum(ON) • Gonococcal or Chlamydial infection treatment (Rai, et al, 2012) (CDC, 2010) • Vitamin K (Phytonadione) • 1894 Townsend • 1943 Dam and Doisy • Prophylaxis of Vitamin K Deficiency Bleeding (VKDB) (“Hemorrhagic disease, 2012”).

  4. Mandatory Erythromycin prophylaxis (Texas Administrative Code, 2013) • Texas Health and Safety Code 81.091 • Physician, nurse, or midwife • Administer within 2 hours after birth • Failure to treat • Class B misdemeanor • Free of charge • If family is unable to pay for prophylaxis • Parental refusal • May result in a CPS referral

  5. Erythromycin usage in patient care • Erythromycin Ophthalmic Ointment USP, 0.5% • Topical administration to eyes bilaterally at birth • Premature Infants • Eyes fused • Mechanism of action (“Truven Health”, 2013).

  6. Adverse Effects of Erythromycin • May cause irritation and blurred vision • Allergic reaction • Rash, swelling, breathing difficulties (“Truven Health”, 2013).

  7. Vitamin K prophylaxis • Currently not mandated in TX • Recommended by AAP • Administration at delivery • Now rare condition in the United States (“Hemorrhagic disease”, 2013)

  8. Vitamin K • Fat soluble vitamin • Essential for function of blood coagulation • At birth • Reduced vitamin K stores • Minimal placental transfer • After birth • Vitamin K is limited in breast milk (Van Winckel et al, 2008)

  9. VKDB • Three classifications • Early onset • Within 24 hours • Maternal drugs that inhibit vitamin K • Classic onset • 24 hours-7 days • Delayed/insufficient feedings • Late onset • 2-12 weeks • Exclusive breastfeeding • Malabsorptionsyndroms • Cholestasis (Lippi & Fanchini, 2011)

  10. Vitamin K Dosage • Term infants • 0.5mg-1mg IM at birth • Preterm infants (<32 weeks) • >1000gms • 0.5mg IM at birth • <1000gms • 0.3mg/kg IM at birth (“Truven Health”, 2013).

  11. Adverse effects of Vitamin K administration • Injection site irritation • Black box warning • Shock • Cardiac arrest • Respiratory arrest (“Truven Health”, 2013).

  12. Evidence Based Practice • Erythromycin • Meta analysis • Reduction of chlamydial and gonorrheal ON (Darling, 2010) • Vitamin K • Randomized trials • Single dose reduces a life threatening bleeding occurrence in newborns (Puckett & Offringa, 2009)

  13. Long Term Outcome • Erythromycin • With treatment ON cases are very rare • Resistance to N. gonorrhea (CDC, 2010) • Vitamin K • With prophylaxis fatal condition is now rare (“Hemorrhagic disease”, 2013)

  14. References Center for Disease Control and Prevention (2010). Retrieved on October 10, 2014 from http://www.cdc.gov/std/treatment/2010/gonococcal-infections.htm Darling, Elizabeth (2010). A Meta-analysis of the Efficacy of Ocular Prophylactic Agents used for the Prevention of Gonococcal and Chlamydial OphthalmiaNeonatorum. Journal of Midwifery & Women’s Health, 55(4), 319-327. Dekker, Rebecca (2012). Is Erythromycin Eye Ointment Always Necessary for Newborns? Retrieved October 9, 2013 from http://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/ Hemorrhagic disease of the newborn (2012) Retrieved October 13, 2013, from http://emedicine.medscape.com/article/974489-overview Hemorrhagic disease of the newborn (2013) Retrieved October 6, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/007320.htm Lippi, G., and Franchini, M. (2011). Vitamin K in neonates: facts and myths Blood Transfusion 9(1) 4-9. doi: 10.2450/2010.0034-10

  15. References • Puckett, R. M., & Offringa, M. (2009, Jan 21, 2009). Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. The Cochrane Library. http://dx.doi.org/10.1002/14651858.CD002776 • Rai, M.K., Deshmukh, S.D., Ingle, A.P., & Gade, A.K. (2012) Silver nanoparticles: the powerful nanoweapon against multidrug-resistant bacteria. Journal of Applied Microbiology, 112(5), 841-852. Doi:10.1111/j.1365-2672.2012.05253.x • Texas Administrative Code. (2013) Retrieved on October 3, 2013 from http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=136 • Truven Health Analytics Inc (2013). Micromedex Neofax. (Version1.12.0b1425) (Mobile application software). Retrieved from http.//itunes.apple.com. • Van Winckel, M., De Bruyne, R., Van Develde, S., and Van Biervliet, S. (2008). Vitamin K, and update for the Pediatrician. European Journal of Pediatrics. 168(2). P 127-134.

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