الفهرس 
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Abstract
Preterm infants receive special attention because they are at great risk of vitamin K deficiency bleeding and they. have many risk factors of bleeding such as their relatively immature .hemostatic and hepatic functions putting them at risk of hypoglycemia, cholestasis,. hyperbilirubenemia, bleeding and impairment of drug. metabolism .Vitamin K deficiency bleeding in preterm newborn babies has not been mentioned in the literature. May be due to that most preterm infants admitted to neonatal care units have received prophylactic vitamin K and also because parentral nutrition is given early in the hospital course providing preterm infants with sufficient amount of vitamin K. Aim of the work : To compare the effect of high versus low prophylactic dose of vitamin K on the incidence of bleeding in preterm infants more than 28 weeks’ and less than 37 weeks’ gestational age as well as on serum level of vitamin k. Materials and Methods: It included 90 healthy preterm infants 28 weeks or more and less than 37 weeks’ gestational age. Their gestational age ranged between 28 and less than 37 weeks and they were similar as regard TPN and enteral feeding. Preterm infants included were randomly assigned to one of two groups, 45 infants in each group. In group 1, infants were given vitamin K 0.2 mg intramuscularly while in group 2, infants were given vitamin K 0.5 mg intramuscularly immediately after infant’s resuscitation and stabilization. We excluded preterm infants with fetal intracranial hemorrhage, maternal antiplatelet antibodies; alloimmune thrombocytopenia, maternal drug intake of known vitamin K antagonists, eg anticonvulsants (carbamazepine and barbiturates), antituberculous (isoniazide and rifapmcin), antibiotics (cephalosporins) and anticoagulants (coumarin and warfarin). We also excluded those with major congenital anomalies, marked bruising at birth, and preterm infants with any bleeding disorders as DIC or thrombocytopenia. Written consents with an explanation regarding the benefits and risks of the study were taken from the parents of all enrolled neonates before their recruitment. All infants included were subjected to complete history taking, clinical examination and investigations including CBC and coagulation profile; prothrombin time (PT), activated partial thromboplastin time (APTT) and INR before vitamin K administration and five days after vitamin K administration. Serum level of vit K on 5th day and 25th day of life, sepsis work up; blood culture and CRP, plain X ray abdomen if necrotizing enterocolitis was suspected and transfontanellar ultrasound to diagnose IVH within the first 3 days of life. We monitored any bleeding tendency including mucocutanous bleeding, gastrointestinal bleeding, intraventricular hemorrhage (grade III or IV), change in serum level of vitamin K throughout the study duration, complications of prematurity in the form of bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis as well as mortality. Results: No significant differences among both studied groups as regards primary outcomes in the form of mucocutaneous, gastrointestinal and intraventricular hemorrhages (grade III or IV). No significant differences among both studied groups as regards secondary outcomes in the form of BPD, ROP, NEC, sepsis and mortality. Prothrombin time and INR were significantly higher among group I compared to group II preterm infants five days after vitamin K administration without increased incidence of bleeding. Conclusion: We can conclude that a lower prophylactic dose of vitamin K (0.2 mg) administrated intramuscularly when compared to a higher dose of 0.5 mg in preterm infants is associated with a significantly lower serum vitamin K level and a significantly longer prothrombin time and increased INR without any increased incidence of mucocutaneous, gastrointestinal or intraventricular hemorrhages (grade III or IV) and without any increased incidence of BPD, NEC, sepsis or mortality. Serum vitamin K level decreased in both groups of lower and higher dose of vitamin K on 25th day compared to 5th day but reached a statistically significant difference only in the higher dose group.