[The importance of administering vitamin K intramuscularly in neonates]. / Het belang van intramusculaire vitamine K-toediening bij pasgeborenen.

BACKGROUND: Infants who are born in The Netherlands receive oral vitamin K to prevent bleeding due to a vitamin K deficiency. However the incidence of such bleedings are higher compared to other European countries. Therefore, the Dutch Health Council advised in 2017 to change this guideline from oral to intramuscular administration. CASE DESCRIPTION: A 2 months old girl presented with a fatal intracranial hemorrhage. A day before she developed a hematoma on her foot and orbit. Despite daily oral vitamin K, blood results revealed a severe vitamin K deficiency-related bleeding. Postmortem liver biopsy and genetic studies showed cholestasis as the most likely cause of malabsorption of fat soluble vitamins due to a heterozygous pathogenic variant in the ABCB11 gene, which could possibly be transient. CONCLUSION: Our case illustrates the importance of revising the national guideline for vitamin K prophylaxis to intramuscular administration, according to the recommendation of the Dutch Health Council.

Dynamic head-neck stabilization in cervical dystonia.

BACKGROUND: Effective sensorimotor integration is essential to modulate (adapt) neck stabilization strategies in response to varying tasks and disturbances. This study evaluates the hypothesis that relative to healthy controls cervical dystonia patients have an impaired ability to modulate afferent feedback for neck stabilization with changes in the frequency content of mechanical perturbations. METHODS: We applied anterior-posterior displacement perturbations (110s) on the torso of seated subjects, while recording head-neck kinematics and muscular activity. We compared low bandwidth (0.2-1.2Hz) and high bandwidth (0.2-8Hz) perturbations where our previous research showed a profound modulation of stabilization strategies in healthy subjects. Cervical dystonia patients and age matched controls performed two tasks: (1) maintain head forward posture and (2) allow dystonia to dictate head posture. FINDINGS: Patients and controls demonstrated similar kinematic and muscular responses. Patient modulation was similar to that of healthy controls (P>0.05); neck stiffness and afferent feedback decreased with high bandwidth perturbations. During the head forward task patients had an increased neck stiffness relative to controls (P<0.05), due to increased afferent feedback. INTERPRETATION: The unaffected modulation of head-neck stabilization (both kinematic and muscular) in patients with cervical dystonia does not support the hypothesis of impaired afferent feedback modulation for neck stabilization.