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Where To Buy Oral Vitamin K For Newborns

However, the question comes up, are there any other regimens that are helpful? What about weekly or daily administration of oral vitamin K? There is one really interesting study that compares the weekly and daily regimen. Based on that study, the most promising oral regimen seems to be giving a weekly dose of oral vitamin K for the first six months of life.

where to buy oral vitamin k for newborns

The good thing about giving vitamin K by mouth weekly instead of just three times during infancy is that the weekly dose seems to protect these babies with undiagnosed gallbladder disease. This regimen used to be used in Denmark. What they did is that all babies got two milligrams of oral vitamin K after birth and then one milligram orally weekly as long as the babies were getting at least half of their feedings through breast milk.

What they did in Denmark is they tracked all of the babies that had gallbladder problems during that time. During this about six-year period, there were 23 babies that had that rare gallbladder problem. Out of those 23 babies, only one of them had a case of vitamin K deficiency bleeding, but it was not in the brain. None of these babies had bleeding in the brain, which showed that the oral weekly dose did protect these babies with the gallbladder problems.

An oral dose of vitamin K is not recommended. Oral vitamin K is not consistently absorbed through the stomach and intestines, and it does not provide adequate amounts for the breastfed infant. Infants who receive the intramuscular shot of vitamin K do not require further supplementation.

Of respondents, 77 (74%) knew that oral vitamin K is not as effective as IM vitamin K at preventing late-onset VKDB. Most respondents (87%) did not know that oral vitamin K has been shown to normalize biochemical indices of coagulation. Of respondents, 60% either did not know or did not believe that oral vitamin K decreases the risk of early-onset VKDB.

We also asked about practices regarding circumcision. Of respondents, 25 (23%) performed circumcisions as part of their clinical responsibilities. These included 9 family medicine practitioners (36%), 8 general pediatricians (32%), 5 pediatric hospitalists (20%), and 3 neonatologists (12%). Among the physicians who performed circumcisions, 1 (4%) reported ever having performed a circumcision on an infant who had only received oral and no IM vitamin K, but 7 (28%) reported that they would do so. Furthermore, 4 (16%) reported that they would perform a circumcision on an infant who had received neither oral nor IM vitamin K. These respondents were all family medicine practitioners at 2 different centers.

Within the medical community, there have been concerns that in offering oral vitamin K as an alternative, clinicians may become complicit in VKDB.21 Some clinicians argue that despite counseling families that oral vitamin K is not equivalent to the IM formulation; many parents may still opt for oral vitamin K when they may have been otherwise swayed to use IM if the oral option was not available. In addition, providing the option of oral vitamin K may create a conundrum should the community become aware of a precedent among certain clinicians. Parents might specifically seek out these clinicians to request oral vitamin K.

The absence of an FDA-approved oral liquid formulation means that only the 5 mg tablet or parenteral formulation is available for prescription. Using the tablet entails cutting and crushing to achieve the typical 2 or 4 mg dose, whereas the parenteral formulation requires additional logistic hurdles once the newborn patient is discharged from the hospital. Because oral liquid formulations are not FDA approved, actual concentrations of vitamin K in over-the-counter formulations may be variable with unclear efficacy or safety.14,21

The AAP continues to recommend IM vitamin K as the sole mode of prophylaxis against VKDB but does not present a firm statement on oral vitamin K prophylaxis.23 Our study shows that not only are perceived rates of IM vitamin K refusal by parents of newborns rising among clinicians, but oral vitamin K is being prescribed with the belief that it is better than nothing. Given these changing times, the AAP should update their policy statement from 2003 to include guidance on oral vitamin K prophylaxis, education for clinicians and families, and a unified approach in discussions on vitamin K prophylaxis.

Our study has several limitations. Only tertiary academic medical centers were included. Although the clinicians who we surveyed worked in different practice settings, all were affiliated with an academic center and cared for newborns born in a medical institution. This may have skewed our findings and made them less applicable to a larger population because higher rates of vitamin K refusal have been associated with deliveries at birth centers and home births.24 Furthermore, because the 3 institutions were chosen as a convenience sample by using a nonprobability sampling method, selection bias may have played a role. Another limitation is that midwives were excluded. Midwife-assisted deliveries are also associated with higher rates of parental vitamin K refusal.24 Our small sample size and limited scope in survey sites may have captured different opinions and practices than had we expanded our survey population and practice locations.24

bBetween 2005 and 2011, one early and four late cases of HDN were reported out of 458,184 breastfed newborns. Vitamin K prophylaxis was rejected from the parents in four cases, and the fifth newborn only received the first dose of vitamin K prophylaxis. The incidence of HDN shown is for infants who completed the three doses of oral vitamin K prophylaxis [16]

Some parents may ask for oral vitamin K instead of the shot. But babies can't absorb the oral form very well, so it doesn't work well to prevent VKDB. A vitamin K shot is the safest and best option for all newborns.

Newborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk. Systematic review of evidence to date suggests that a single intramuscular (IM) injection of vitamin K at birth effectively prevents VKDB. Current scientific data suggest that single or repeated doses of oral (PO) vitamin K are less effective than IM vitamin K in preventing VKDB. The Canadian Paediatric Society and the College of Family Physicians of Canada recommend routine IM administration of a single dose of vitamin K at 0.5 mg to 1.0 mg to all newborns. Administering PO vitamin K (2.0 mg at birth, repeated at 2 to 4 and 6 to 8 weeks of age), should be confined to newborns whose parents decline IM vitamin K. Health care providers should clarify with parents that newborns are at increased risk of VKDB if such a regimen is chosen. Current evidence is insufficient to recommend routine intravenous vitamin K administration to preterm infants undergoing intensive care.

Hemorrhagic disease of the newborn (HDNB) was first identified over a century ago [1], and presents as unexpected bleeding, often with gastrointestinal hemorrhage, ecchymosis and, in many cases, intracranial hemorrhage. In newborns, HDNB is typically caused by vitamin K deficiency due to insufficient prenatal storage of vitamin K, combined with insufficient vitamin K in breast milk. Three types of vitamin K deficiency bleeding (VKDB) have been classified: early onset (occurring in the first 24 hours post-birth), classic (occurring at days 2 to 7) and late onset (at 2 to 12 weeks and up to 6 months of age). Early VKDB is commonly associated with maternal medications that inhibit vitamin K activity, such as antiepileptics. Classic VKDB is associated with low intake of vitamin K, and late VKDB with chronic malabsorption and low vitamin K intake [2].

Since 1961, the American Academy of Pediatrics (AAP) has recommended that a single 0.5 mg to 1.0 mg dose of vitamin K be administered intramuscularly (IM) to all newborns shortly after birth to prevent VKDB [3]. The Canadian Paediatric Society (CPS) has recommended similar prophylactic treatment since 1988, but also proposed that 2.0 mg dose of oral (PO) vitamin K administered within 6 hours of birth, then repeated at 2 to 4 weeks and 6 to 8 weeks of age, was an acceptable alternative [4][5].

The AAP continues to advocate for sole use of IM vitamin K for all newborns. Their recommendation is based on a review of surveillance systems in four countries (Australia, Germany, the Netherlands, and Switzerland), which suggested that administering vitamin K PO was less effective than by the IM route and may be associated with higher incidence of failure [6]. Further, a 1993 review from the AAP vitamin K Ad Hoc Task Force effectively dispelled concerns that IM administration of vitamin K was associated with childhood cancers such as leukemia [7].

One recent practice review has confirmed that routine administration of IM vitamin K at birth effectively prevents VKDB [8]. However, while clinical decisions should always be based on the best evidence available, potential for harm to the infant must also be considered. Although no significant complications following 420,000 vitamin K injections in newborns have been reported [9], the psychological effects of procedural pain on infants (and parents) are unknown. Pain experienced during the neonatal period may have long-term effects [10][11]. The benefits of routine vitamin K administration have been demonstrated historically, but the most effective mode of delivery is yet to be fully determined [12]. By supporting the PO route for administering vitamin K and a formulation designed for parenteral use, the CPS recommendations of 1988 aimed to secure all the apparent benefits of vitamin K for newborns without incurring unnecessary pain [4][13]. Today, clinicians are more aware than ever of potential deleterious effects from early pain exposure and the need for strategies that minimize procedural pain in the neonate [14].

Classic VKDB rarely occurs in newborns who have received parenteral vitamin K at birth [12]. Two clinical trials conducted in the 1960s [8][16] compared various doses of IM vitamin K with no prophylaxis on classic VKDB rates. Their results demonstrated clearly that vitamin K prophylaxis effectively reduces VKDB of any severity in the first week of life [17][18]. 041b061a72


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