Symptoms of vitamin K (VK) deficiency include: melena (black tarry stools sometimes difficult to differentiate from meconium, but can be tested by placing the stool in water to see if the water turns pink. Meconium will not cause the water to turn pink.), cephalohematoma, vomiting of blood, prolonged jaundice, failure to thrive and warning bleeds such as bleeding from the umbilical site, nasal and oral bleeding, and prolonged bleeding at puncture sites.
Diagnosis of VK deficiency is made by drawing a Prothrombin time (PT), fibrinogen, and platelet count. A prolonged PT together with normal fibrinogen and platelet levels is indicative of VK deficiency. Laboratory values of plasma or urinary VK levels can be drawn in addition to PT and fibrinogen studies. Administration of 1.0 mg of VK should produce a correction of the prolonged PT, and bleeding. VK is rapidly absorbed and begins to work within 30 minutes of administration. VK can be given any time after birth, especially if prolonged or abnormal bleeding is noted in the newborn. In addition, the newborn may appear quite healthy for several days or weeks, and the only sign will be what the practitioner may consider prolonged or inconsequential bleeding around the umbilical stump. Note: Newborns do not bleed easily!
Clients must understand why vitamin K is suggested, and that one injection is not necessarily adequate to prevent a later onset of this disorder in exclusively breastfed infants. They must be told signs and symptoms of VK deficiency bleeding (VKDB) that they might notice during the course of normal caretaking. VKDB can be fatal, or produce developmental and cognitive delays in the infant. Its rarity may not allow the practitioner ample experience to recognize it. In addition, a good teaching tool would include potential concerns for infants receiving VK injections. Davis's Drug Guide for Nurses states the general side effects of phytonadione ( vitamin K1) one milligram include jaundice, hemolytic anemia, flushing, rash urticaria, or a mild local reaction at the injection site. In addition any foreign entity given by injection can cause an anaphylactic reaction. While this is extremely rare, if that were to happen in the home, it would be a devastating event. One half to one milligram of vitamin K1 is the standard intramuscular dosage for a newborn, whereas 2 mg is the standard oral dosage. Phytonadione is not absorbed from the gastro-intestinal tract unless there are some bile salts present.
In addition to a clear, informative written teaching tool, have parents sign a statement saying they want VK to be administered or that they decline VK regardless how the medication is provided (by you or by the parent). If a parent is not truly informed, or their practitioner refuses on the grounds that they are "aiding and abetting homebirth," that may place the midwife in legal limbo for not providing a standard routine medication, not to mention the heartache of having a baby die or become developmentally disabled over a disease that can be prevented nutritionally.
-Sandra Stine, brief excerpt from an article published in Issue 53 of Midwifery Today, March 2000.
Reprinted from Midwifery Today E-News (Vol 1 Issue 41, Oct 8, 1999)
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