Vitamin K prophylaxis in the neonates by oral route with different dosages.

This paper evaluated the effect of VKP in the neonates by oral route with different dosages compared to the standard parenteral route giving a single dose at birth. Two hundred and thirty-six healthy, breast-fed infants were divided into 4 groups receiving vitamin K1 1 mg intramuscularly and 2, 3, 5 mg orally during 2-4 hours after birth. The vitamin K dependent clotting factors were measured by the thrombotest at the age of 2 weeks and 4-6 weeks. The result showed no statistical differences among these 4 groups regarding the mean prothrombin complex level and the number of PC deficient subjects. Vitamin K prophylaxis in the newborn babies by 2 mg oral route would be benefit and can be applied routinely as well as 1 mg parenteral route to prevent both HDN and APCD syndrome particularly in breast fed infants. The routine practice of giving vitamin K1 prophylaxis 2 mg orally or 0.5-1 mg intramuscularly should be recommended to all newborn infants. Giving VKP by oral route is practical for developing countries because of simple way of administration, low cost, low toxicity, as well as high efficacy.

Fresh dried plasma: a solution for the shortage of blood products in developing countries.

The availability of blood products for replacement therapy of hemophilia and allied disorders is still a formidable problem in most developing countries which consist of 80% of the world population. Fresh dried plasma (FDP) is a lyophilized form of fresh frozen plasma which can be stored at 4 degrees C, whereas fresh frozen plasma must be stored at -20 degrees C. A large-scale production of FDP from single units of fresh frozen plasma was achieved by the National Red Cross Blood Center in Thailand. This paper describes the method of preparation, biochemical and blood coagulation properties of FDP during one-year storage as well as its clinical usefulness. A batch of 179 bottles of FDP stored at 4 degrees C for one week, 3, 6, 9 and 12 months was studied in order to determine the biochemical and blood coagulation parameters. FDP has pH higher than that of fresh frozen plasma, but its value is within the safety range for infusion. Electrolyte and protein levels were comparable with those of fresh frozen plasma. Coagulant activities of factors I, II, V, VII, VIII, IX and X were about 10% lower than those of fresh frozen plasma; however, they are in the acceptable therapeutic range and all were stable during storage at 4 degrees C for up to one year. Over 4,000 bottles of FDP were used with good clinical and laboratory response and no series side effects were observed in the treatment of bleeding in blood coagulation disorders and home care therapy of hemophilia.

Hemostatic derangement in dengue haemorrhagic fever.

Forty children, aged 1/2-14 years, with serologically proven dengue haemorrhagic fever were daily studied for hemostatic tests. There were 4, 20 and 16 cases of grade I, II III respectively. Hemostatic derangements in DHF is a multifactorial mechanism. Vasculopathy, thrombocytopenia, platelet dysfunction were found in most cases. Mild to moderate degree of prothrombin complex deficiency was observed in 15% and 50% of grade II and grade III respectively while laboratory evidence of consumptive coagulopathy was noted in 30% of shock cases and 10% of non-shock cases. Hypofibrinogenemia and increased PTT are commonly seen in grade III reflect the presence of stimulation of intrinsic coagulation pathway probably from immunologic reaction. Frank DIC is very rarely observed. FDP is slightly increased but not as high as in classical DIC. Further study on the role of platelet-endothelial interaction should be elucidated including the efficient management to stop bleeding in severe shock cases.

Vitamin K prophylaxis in the neonate by the oral route and its significance in reducing infant mortality and morbidity.

PIP: Vitamin K in oral drops and intramuscular injection given at birth to Thai infants were compared to determine whether these routes and doses would influence prothrombin complex activity, mortality or morbidity at 0.5, 1 and 2 months of age. The infants were 321 normal fullterm babies born at Bangkok Adventist Hospital in 1983, exclusively breastfed during the study. Prothrombin complex (PC) was measured by the Owren capillary thrombotest method using a reagent from Nyegaard Co., Oslo. Vitamin K was given in single 1 or 2 mg oral doses, or 1 mg im, within 12 hours of delivery. Judging by the number of PC deficient children, the 1 mg im and 2 mg oral doses of vitamin K maintained clotting factors best at 2 months of age. All formulations were significantly better than no treatment at 1 month at age. No toxicity or side effects were seen. Vitamin K deficiency is a known cause of bleeding disorders, particularly fatal and handicapping intracranial hemorrhage in newborns, in developing countries where injections cannot be given by midwives. These inexpensive oral pediatric drops may provide a practical form of primary health care for routine vitamin K prophylaxis in newborns.^ieng