Vitamin K Deficiency Bleeding (VKDB) in Infancy
Vitamin K Deficiency Bleeding (VKDB) in Infancy
复制标题
婴儿期维生素 K 缺乏性出血 (VKDB)
DOI：
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发表时间：
1999
影响因子：
6.7
通讯作者：
Maureen E. Andrew
中科院分区：
文献类型：
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作者：
A. Sutor;R. von Kries;M. Cornelissen;A. Mcninch;Maureen E. Andrew
术语摘要。将术语“新生儿出血性疾病”(HDN) 替换为“维生素 K 缺乏性出血”(VKDB)，因为新生儿出血通常不是由于 VK 缺乏所致，VKDB 可能在 4 周新生儿期后发生。定义。 VKDB 是由于 VK 依赖性凝血因子（II、VII、IX、X）活性不足导致的出血，可通过 VK 替代来纠正。诊断。对于出血婴儿，延长的 PT 以及正常的纤维蛋白原水平和血小板计数几乎可以诊断 VKDB；给予 VK 后 PT 的快速纠正和/或出血的停止是确诊的。警告标志。通过及早识别诱发因素的体征（黄疸时间延长、生长迟缓）并及时调查“警告性出血”，可以降低颅内 VKDB 的发病率。分类。 VKDB 可按发病年龄分为早期（<24 小时）、经典型（第 1-7 天）和晚期（>1 周<6 个月），按病因可分为特发性和继发性。在继发性 VKDB 中，除了母乳喂养外，其他诱发因素也很明显，例如 VK 的摄入或吸收不良。 VK-预防：好处。口服和肌肉注射 VK（一剂 1 毫克）对预防经典 VKDB 具有同等效果，但肌肉注射 VK 在预防晚期 VKDB 方面更有效。三倍剂量而非单剂量以及使用 2 毫克维生素 K 而非 1 毫克剂量可提高口服预防的功效。每天或每周重复口服剂量的保护作用可能与肌肉注射相同。 VK。 VK-预防：风险。 VK 参与凝血蛋白和多种其他蛋白质的羧化。由于极高水平的 VK 存在潜在风险以及注射损伤的可能性，肌肉注射 VK 作为常规预防选择受到质疑。通过重复（每天或每周）小剂量口服而不是通过肌内注射，应能以较低的峰值 VK 水平实现预防出血。剂量。母乳喂养的母亲服用香豆素。不应拒绝母乳喂养。儿科医生的监督是谨慎的。建议每周给婴儿口服补充 1 mg VK，并偶尔监测 PT。结论。 VKDB 的定义是一种罕见但严重的出血性疾病（颅内出血发生率高），可以通过肌内注射或注射注射来预防。或多次口服 VK 剂量。
Summary Terminology. Replace the term “Hemorrhagic Disease of the Newborn” (HDN) by “Vitamin K Deficiency Bleeding” (VKDB), as neonatal bleeding is often not due to VK-deficiency and VKDB may occur after the 4-week neonatal period. Definition. VKDB is bleeding due to inadequate activity of VK-dependent coagulation factors (II, VII, IX, X), correctable by VK replacement. Diagnosis. In a bleeding infant a prolonged PT together with a normal fibrinogen level and platelet count is almost diagnostic of VKDB; rapid correction of the PT and/or cessation of bleeding after VK administration are confirmative. Warning signs. The incidence of intracranial VKDB can be reduced by early recognition of the signs of predisposing conditions (prolonged jaundice, failure to thrive) and by prompt investigation of “warning bleeds”. Classification. VKDB can be classified by age of onset into early (<24 h), classical (days 1-7) and late (>1 week <6 months), and by etiology into idiopathic and secondary. In secondary VKDB, in addition to breast feeding, other predisposing factors are apparent, such as poor in-take or absorption of VK. VK-Prophylaxis: Benefits. Oral and intramuscular VK (one dose of 1 mg) protect equally well against classical VKDB but intramuscular VK is more effective in preventing late VKDB. The efficacy of oral prophylaxis is increased with a triple rather than single dose and by using doses of 2 mg vitamin K rather than 1 mg. Protection from oral doses repeated daily or weekly may be as high as from i.m. VK. VK-Prophylaxis: Risks. VK is involved in carboxylation of both the coagulation proteins and a variety of other proteins. Because of potential risks associated with extremely high levels of VK and the possibility of injection injury, intramuscular VK has been questioned as the routine prophylaxis of choice. Protection against bleeding should be achievable with lower peak VK levels by using repeated (daily or weekly) small oral doses rather than by using one i.m. dose. Breast feeding mothers taking coumarins. Breast feeding should not be denied. Supervision by pediatrician is prudent. Weekly oral supplement of 1 mg VK to the infant and occasional monitoring of PT are advisable. Conclusion. VKDB as defined is a rare but serious bleeding disorder (high incidence of intracranial bleeding) which can be prevented by either one i.m. or multiple oral VK doses.