title: Vitamin K deficiency bleeding and early infant male circumcision in Africa.
abstract: BACKGROUND
  Early infant (1-60 days of life) male circumcision is being trialed in Africa as a human immunodeficiency virus prevention strategy. Postcircumcision bleeding is particularly concerning where most infants are breastfed, and thus these infants are at increased risk of vitamin K deficiency bleeding.
  
  
  METHODS
  During a circumcision trial, one infant bled for 90 minutes postprocedure. After discovering he had not received standard prophylactic vitamin K, we gave 2 mg phytomenadione (vitamin K1) intramuscularly; bleeding stopped within 30 minutes.
  
  
  CONCLUSIONS
  Vitamin K's extremely rapid action is not commonly appreciated. Neonatal vitamin K has been shown to be cost-effective. To increase availability and promote awareness of its importance, especially in low-resource settings where blood products and transfusions are limited, vitamin K should be included in the World Health Organization's Model List of Essential Medicines for Children.
authors.affiliation: Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts; Botswana-Harvard Partnership for HIV Research and Education, Gaborone, Botswana; the Department of Public Policy, Duke University, Durham, North Carolina; the Clinical Sciences Department, FHI 360, Durham, North Carolina; the Haemostasis Research Unit, Centre for Haemostasis & Thrombosis, St. Thomas' Hospital, London, United Kingdom; and the Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Rebeca M
authors.initials: RM
authors.lastname: Plank
authors.forename: Tara
authors.initials: T
authors.lastname: Steinmetz
authors.forename: David C
authors.initials: DC
authors.lastname: Sokal
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shearer
authors.forename: Santorino
authors.initials: S
authors.lastname: Data
mesh_terms: D000349:Africa; D002944:Circumcision, Male / Q000009:adverse effects*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010837:Vitamin K 1 / Q000627:therapeutic use*; D014813:Vitamin K Deficiency / Q000150:complications*; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D010837:Vitamin K 1