Controversies Concerning the Prevention of Hemorrhagic Disease of Newborns [Article in Croatian]

Abstract

Hemorrhagic disease of newborns (HDN) is an acquired condition due to vitamin K hypovitaminosis, presenting as early (onset of bleeding in the first 24 hours of life), classic (onset of bleeding from the 1st to the 7th day of life), and late (onset of bleeding from the 2nd week of life throughout the whole infancy) HDN. The prophylaxis of HDN is important because most bleedings in early and late HDN are intracranial. Prevention of HDN has go on for more than fifty years. Although the first written guide­lines date from 1961, the prevention of HDN is still controversial. The first issue is kernicterus after prevention with large doses of menadion. Another issue is whether parenteral or per oral prevention of HDN. The most striking controversy is the increased prevalence of leucosis and other malignancies in 6 year olds given phylloquinone intramuscularly after birth. It was proved that phylloquinone could at the same time play a role as an oxidant and antioxidant, increasing the exchange between sisters cromatides expressing »in vitro« mutagen effect. Concentrations of phylloquinone after parenteral application signifi­cantly exceed its physiological concentrations, while its per oral application is not preventing late HDN. The causative connection between phylloquinone application and increased prevalence of malignancies in infancy was disproved. There are at least two strategies for the prevention of HDN: intramuscular ap­plication of phylloquinone immediately after birth, and daily or weekly per oral application of small doses of phylloquinone. Intramuscular prophylaxis of HDN is safest for the prevention of late HDN.