Twenty-seven years of experience with oral vitamin K1 therapy in neonates,☆☆,

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Abstract

Healthy term infants born at the University of Missouri have received vitamin K prophylaxis as a single oral dose since 1967. A retrospective study was undertaken to determine whether either hemorrhagic disease of the newborn or any unexplained intracranial hemorrhage occurred in an infant who received orally administered vitamin K, but none could be found in three separate databases. We conclude that we have met our duty of providing appropriate care. (J PEDIATR 1995;127:301-4)

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METHODS

In our hospital vitamin K is given by nasogastric tube because the individual who initiated the oral vitamin K policy also established an assessment for anomalies12 that includes brief placement of a nasogastric tube. Before 1 hour of age, the nurse inserts the tube, checks placement, aspirates and measures the stomach contents, places the 0.2 ml of vitamin K1 in the tube, and flushes the preparation into the stomach with a small amount of air.

Obstetric delivery logs and nursery admission

RESULTS

A total of 30,870 deliveries occurred at the University of Missouri from 1972 through 1993. In this same period, 7642 inborn infants were admitted to the NICU. Accordingly, at least 23,228 well babies received a single oral dose of vitamin K1.

The medical records database search for HDN identified one patient as such in 1982 and another in 1990; the records were retrieved for review. Both were inborn term babies with no evidence of HDN. The billing database search for HDN identified two patient

DISCUSSION

We do not endorse this means of testing a hypothesis. Nonetheless, the information obtained is clinically useful. Administration of the vitamin K by nasogastric tube eliminates any uncertainty as to whether the dose actually reaches the stomach. Infants who are breast fed before admission to the nursery have any colostrum present removed before the vitamin K dose is administered. All infants are then fed within 1 to 3 hours after birth. There is no policy of giving a second dose if the infant

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From the Department of Pediatrics, Children's Hospital, University of Missouri, Columbia

☆☆

Reprint requests: Frank I. Clark, MD, JD, Associate Professor, Clinical Child Health, Children's Hospital, One Hospital Dr., Columbia, MO 65212.

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