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.


OBJECTIVE
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.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to September 2000.


METHODS
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.


METHODS
Eligibility, trial quality assessment and data extraction were done independently by two reviewers.


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.


CONCLUSIONS
Vitamin K administered to women prior to very preterm birth has not been shown to significantly prevent periventricular haemorrhages in preterm infants.
Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, South Australia, AUSTRALIA, SA 5006. caroline.crowther@adelaide.edu.au
C A
CA
Crowther
D J
DJ
Henderson-Smart
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D002552:Cerebral Ventricles; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014812:Vitamin K / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014812:Vitamin K