Acta Pædiatrica ISSN 0803-5253
REGULAR ARTICLE
Intracranial haemorrhage is linked to late onset vitamin K deficiency in infants aged 2–24 weeks MS Elalfy ([email protected])1, IA Elagouza1, FA Ibrahim2, SK AbdElmessieh1, M Gadallah3 1.Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt 2.National Research Centre, Cairo, Egypt 3.Department of Community, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Keywords Intracranial haemorrhage, Late vitamin K deficiency bleeding, Vitamin K Correspondence MS Elalfy, Professor of Pediatrics, Ain Shams University, 2 Sayed Zakaria Khalil Street, Heliopolis, Cairo, PO: 1153, Egypt. Tel: +2 02 0100 086 4343 | Fax: +2 02 22694900 | Email: [email protected] Received 3 October 2013; revised 18 November 2013; accepted 10 February 2014. DOI:10.1111/apa.12598
ABSTRACT Aim: Late vitamin K deficiency bleeding (VKDB) can be serious and manifest as early onset intracranial haemorrhage (ICH). This study aimed to determine the frequency of ICH in relation to vitamin K deficiency and the outcome in infants aged two to 24 weeks. Method: A hospital-based study was conducted in two main tertiary hospitals in Cairo, Egypt, from May 2011 to May 2012 with 40 patients with ICH and 50 age-matched controls without ICH. Results: Forty patients with ICH were recruited, 19 were excluded for clinical reasons and the remaining 21 had a significantly low vitamin K level. Exclusive breast feeding (81% of patients), diarrhoea lasting more than 1 week (38.1%) and antibiotic consumption within a week before the development of ICH (57.1%) were more common in the patients than in the control group (p value>0.05, 3 seconds above the high normal) (6). We excluded patients from the study if they had a direct head trauma, a positive family history of confirmed congenital coagulation cofactor deficiency, direct hyperbilirubinaemia, significant hepatomegaly and/ or thrombocytopenia double high normal). Fifty age- and gender-matched infants who came to the emergency department with similar symptoms formed the
Key notes
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e273–e276
This study aimed to discover how common late vitamin K deficiency was in 40 patients aged 2–24 weeks with early onset intracranial haemorrhage (ICH). Nineteen patients were excluded for clinical reasons, and the remaining 21 all had significantly low vitamin K levels. There were clear links between ICH and diarrhoea lasting more than 1 week and antibiotic consumption in the week before the development of the condition.
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Intracranial haemorrhage and vitamin K
Elalfy et al.
control group. Although 90% of these had seizures and various degrees of disturbed level of consciousness, none of them were diagnosed with ICH. After written informed consent was obtained, all the parents were asked to fill in a comprehensive questionnaire asking about relevant family history, maternal diseases, infections and medication history during pregnancy. Postnatal records were reviewed to determine vitamin K administration at birth, neonatal ICU admission, breast or bottle feeding. Vitamin K prophylaxis was considered if 2 mg of vitamin K1 (intramuscular) was administered directly after birth. Patients were followed up every 2 weeks for 3 months for detection of posthaemorrhagic sequels. Data relating to the various risk factors were recorded: diarrhoea for longer than 1 week, use of antibiotics and presence of bleeding or evidence of trauma. Patients were clinically evaluated, and their levels of consciousness were estimated using a Modified Glasgow Coma Scale for Infants (7). In addition, occipito-frontal circumference, level of anterior fontanel, signs of upper motor neuron lesion, lateralisation and cranial nerves affection were examined. At the time of admission, blood was obtained for the measurement of PT, aPTT, and fibrinogen using the Clauss method, complete blood count (CBC) coulter and morphology, serum bilirubin level and alanine transferase (ALT). Vitamin K level was assayed by double-antibody sandwich enzyme-linked immune-absorbent assay (ELISA) kit (Glory Science Co., LTD, Del Rio, TX, USA). VKDB was diagnosed when the serum vitamin K level was below the calculated cut-off value for ICH, which was 0.577 ng/dL. According to the kits used, normal serum vitamin K level is 0.9–4.8 ng/dL. Computed tomography (CT) scans of the brain were used to search for ICH and localise its site (8). Statistical analysis was performed using the SPSS 17.0 statistical package (Chicago, IL, USA). All results were expressed as means, standard deviation (SD) values and medians for quantitative data. The Mann–Whitney test was used for nonparametric quantitative data. Fisher’s exact test and chi-square tests were used for qualitative data.
RESULTS Forty patients diagnosed with ICH were recruited. Of these, 19 infants were excluded from the study because of a positive family history of, or clinical or laboratory data suggestive of, a known haemostatic disorder and/or history of head trauma. The remaining 21 infants were evaluated for VKDB, and all of them proved to have vitamin K deficiency (values
REGULAR ARTICLE
Intracranial haemorrhage is linked to late onset vitamin K deficiency in infants aged 2–24 weeks MS Elalfy ([email protected])1, IA Elagouza1, FA Ibrahim2, SK AbdElmessieh1, M Gadallah3 1.Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt 2.National Research Centre, Cairo, Egypt 3.Department of Community, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Keywords Intracranial haemorrhage, Late vitamin K deficiency bleeding, Vitamin K Correspondence MS Elalfy, Professor of Pediatrics, Ain Shams University, 2 Sayed Zakaria Khalil Street, Heliopolis, Cairo, PO: 1153, Egypt. Tel: +2 02 0100 086 4343 | Fax: +2 02 22694900 | Email: [email protected] Received 3 October 2013; revised 18 November 2013; accepted 10 February 2014. DOI:10.1111/apa.12598
ABSTRACT Aim: Late vitamin K deficiency bleeding (VKDB) can be serious and manifest as early onset intracranial haemorrhage (ICH). This study aimed to determine the frequency of ICH in relation to vitamin K deficiency and the outcome in infants aged two to 24 weeks. Method: A hospital-based study was conducted in two main tertiary hospitals in Cairo, Egypt, from May 2011 to May 2012 with 40 patients with ICH and 50 age-matched controls without ICH. Results: Forty patients with ICH were recruited, 19 were excluded for clinical reasons and the remaining 21 had a significantly low vitamin K level. Exclusive breast feeding (81% of patients), diarrhoea lasting more than 1 week (38.1%) and antibiotic consumption within a week before the development of ICH (57.1%) were more common in the patients than in the control group (p value>0.05, 3 seconds above the high normal) (6). We excluded patients from the study if they had a direct head trauma, a positive family history of confirmed congenital coagulation cofactor deficiency, direct hyperbilirubinaemia, significant hepatomegaly and/ or thrombocytopenia double high normal). Fifty age- and gender-matched infants who came to the emergency department with similar symptoms formed the
Key notes
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e273–e276
This study aimed to discover how common late vitamin K deficiency was in 40 patients aged 2–24 weeks with early onset intracranial haemorrhage (ICH). Nineteen patients were excluded for clinical reasons, and the remaining 21 all had significantly low vitamin K levels. There were clear links between ICH and diarrhoea lasting more than 1 week and antibiotic consumption in the week before the development of the condition.
e273
Intracranial haemorrhage and vitamin K
Elalfy et al.
control group. Although 90% of these had seizures and various degrees of disturbed level of consciousness, none of them were diagnosed with ICH. After written informed consent was obtained, all the parents were asked to fill in a comprehensive questionnaire asking about relevant family history, maternal diseases, infections and medication history during pregnancy. Postnatal records were reviewed to determine vitamin K administration at birth, neonatal ICU admission, breast or bottle feeding. Vitamin K prophylaxis was considered if 2 mg of vitamin K1 (intramuscular) was administered directly after birth. Patients were followed up every 2 weeks for 3 months for detection of posthaemorrhagic sequels. Data relating to the various risk factors were recorded: diarrhoea for longer than 1 week, use of antibiotics and presence of bleeding or evidence of trauma. Patients were clinically evaluated, and their levels of consciousness were estimated using a Modified Glasgow Coma Scale for Infants (7). In addition, occipito-frontal circumference, level of anterior fontanel, signs of upper motor neuron lesion, lateralisation and cranial nerves affection were examined. At the time of admission, blood was obtained for the measurement of PT, aPTT, and fibrinogen using the Clauss method, complete blood count (CBC) coulter and morphology, serum bilirubin level and alanine transferase (ALT). Vitamin K level was assayed by double-antibody sandwich enzyme-linked immune-absorbent assay (ELISA) kit (Glory Science Co., LTD, Del Rio, TX, USA). VKDB was diagnosed when the serum vitamin K level was below the calculated cut-off value for ICH, which was 0.577 ng/dL. According to the kits used, normal serum vitamin K level is 0.9–4.8 ng/dL. Computed tomography (CT) scans of the brain were used to search for ICH and localise its site (8). Statistical analysis was performed using the SPSS 17.0 statistical package (Chicago, IL, USA). All results were expressed as means, standard deviation (SD) values and medians for quantitative data. The Mann–Whitney test was used for nonparametric quantitative data. Fisher’s exact test and chi-square tests were used for qualitative data.
RESULTS Forty patients diagnosed with ICH were recruited. Of these, 19 infants were excluded from the study because of a positive family history of, or clinical or laboratory data suggestive of, a known haemostatic disorder and/or history of head trauma. The remaining 21 infants were evaluated for VKDB, and all of them proved to have vitamin K deficiency (values
