Vitamin K and ethics
With the World Health Organization citing ‘vaccine hesitancy’ as one of the ten threats to global health, how are other interventions affected? George Winter investigates
With the Andrew Wakefield MMR and autism scandal, and the subsequent rise of the anti-vaccination movement, today's patients can now be seen as sceptical consumers keen to assert their autonomy, and no longer passive recipients of medical paternalism.
Another aspect of hitherto accepted medical care that is coming under scrutiny is vitamin K prophylaxis for the newborn. First described in 1894, vitamin K deficiency bleeding (VKDB), or haemorrhagic disease of the newborn, is an acquired coagulopathy in infants characterised by an inability to activate the vitamin K-dependent coagulation factors (II, VII, IX, and X), due to a lack of vitamin K (Schulte et al, 2014).
By 1944, it had been demonstrated that prophylactic vitamin K given at birth reduced VKDB-associated death more than fivefold in the first 2 weeks of life (Schulte et al, 2014); a Cochrane Review found that a single dose of intramuscular vitamin K was effective in preventing VKDB (Puckett and Offringa, 2000); and guidelines from the National Institute for Health and Care Excellence (NICE) (2015) state that parents should be offered vitamin K prophylaxis for their babies, best administered as a single intramuscular dose of 1 mg.
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