Vitamin K prior to preterm birth for preventing neonatal periventricular haemorrhage.

BACKGROUND Preterm infants are at risk of periventricular haemorrhage. This can be a sign of brain damage that might lead to neurodevelopmental abnormalities, including cerebral palsy. It has been suggested that vitamin K might improve coagulation in preterm infants. OBJECTIVES The objective of this review was to assess the effects of vitamin K administered to women at risk of imminent very preterm birth to prevent periventricular haemorrhage and associated neurological injury in the infant. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to September 2000. SELECTION CRITERIA Randomised or quasi-randomised trials of vitamin K administered parenterally or orally to women at risk of imminent preterm birth. The primary outcomes were neonatal mortality, neonatal neurological morbidity, as measured by the presence of periventricular haemorrhage (PVH) on ultrasound during the first week of life, and long term neurodevelopment. Secondary outcomes included other neonatal morbidity and any maternal side effects. DATA COLLECTION AND ANALYSIS Eligibility, trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS Five trials were included, involving more than 420 women. The trials were of variable quality. Antenatal vitamin K was associated with a non-significant trend to a reduction in all grades of periventricular haemorrhage (relative risk (RR) 0.82, 95% confidence interval (CI) 0.67-1.00) and in severe PVH (grades 3 and 4) (RR 0.75, 95% CI 0.45-1.25) for babies receiving prenatal vitamin K compared with control babies. This trend disappeared when poorer quality trials were excluded. Information on neurodevelopment was only given for a small sample of children in one trial with discrepancy in results given in the two reports. REVIEWER'S CONCLUSIONS Vitamin K administered to women prior to very preterm birth has not been shown to significantly prevent periventricular haemorrhages in preterm infants.

[1]  J. Thorp,et al.  Effects of Phenobarbital and Multiple‐Dose Corticosteroids on Developmental Outcome at Age 7 Years , 2003, Obstetrics and gynecology.

[2]  D. Henderson-smart,et al.  Phenobarbital prior to preterm birth for preventing neonatal periventricular haemorrhage. , 2010, The Cochrane database of systematic reviews.

[3]  Douglas G. Altman,et al.  Systematic reviews in health care : meta-analysis in context , 2008 .

[4]  J. Thorp,et al.  42 Effects of phenobarbital and multiple-dose antenatal/postnatal steroid on developmental outcome at age 7 years , 2001 .

[5]  B. Vohr,et al.  Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. , 2000, Pediatrics.

[6]  R. Haslam,et al.  Prenatal thyrotropin-releasing hormone for preterm birth. , 1999, The Cochrane database of systematic reviews.

[7]  J. Thorp,et al.  Does perinatal phenobarbital exposure affect developmental outcome at age 2? , 1999, American journal of perinatology.

[8]  J. Thorp,et al.  Antenatal phenobarbital therapy and neonatal income. , 1997, Pediatrics.

[9]  J. Thorp,et al.  The Effect of Combined Antenatal Vitamin K and Phenobarbital Therapy on Umbilical Blood Coagulation Studies in Infants Less Than 34 Weeks' Gestation , 1995, Obstetrics and gynecology.

[10]  J. Thorp,et al.  Combined Antenatal Vitamin K and Phenobarbital Therapy for Preventing Intracranial Hemorrhage in Newborns Less Than 34 Weeks' Gestation , 1995, Obstetrics and gynecology.

[11]  S. Ramin,et al.  A randomized controlled study of the management of asthma complicating pregnancy , 1995 .

[12]  I. Tager,et al.  Maternal smoking, breast feeding and environmental tobacco smoke (ETS) in the home: Effects on infant urine cotinine levels , 1995 .

[13]  J. Thorp,et al.  Antepartum Vitamin K and Phenobarbital for Preventing Intraventricular Hemorrhage in the Premature Newborn: A Randomized, Double-Blind, Placebo-Controlled Trial , 1994, Obstetrics and gynecology.

[14]  R. Dickson,et al.  Antenatal vitamin K therapy of the low-birth-weight infant , 1994 .

[15]  I. Miyakawa,et al.  Can Prenatal Vitamin K1 (Phylloquinone) Supplementation Replace Prophylaxis at Birth? , 1993, Obstetrics and gynecology.

[16]  M. Shearer.  Vitamin K metabolism and nutriture. , 1992, Blood reviews.

[17]  John C. Sinclair,et al.  Effective care of the newborn infant , 1992 .

[18]  Y. Brans,et al.  Placental Transfer of Vitamin K1 in Preterm Pregnancy , 1990, Obstetrics and gynecology.

[19]  N. Simon,et al.  Maternal-fetal transport of vitamin K1 and its effects on coagulation in premature infants. , 1989, The Journal of pediatrics.

[20]  R. Poland,et al.  Maternal administration of vitamin K does not improve the coagulation profile of preterm infants. , 1989, Pediatrics.

[21]  R. Knuppel,et al.  The use of antenatal vitamin K in the prevention of early neonatal intraventricular hemorrhage. , 1988, American journal of obstetrics and gynecology.

[22]  S. Brown,et al.  Maternally Administered Antenatal Vitamin K1: Effect on Neonatal Prothrombin Activity, Partial Thromboplastin Time, and Intraventricular Hemorrhage , 1987, Obstetrics and gynecology.