Vitamin K

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Does prenatal vitamin K supplementation reduce the risk of hemorrhagic disease in the newborns of WWE taking AEDs？（产前补充VitK是否能降低服用AEDs的WWE所生新生儿患出血性疾病的风险？） 结论：没有足够的证据能够证明WWE产前补充VitK可减少新生儿发生出血性疾病的风险。但对于宫内暴露于酶诱导AEDs的新生儿，应常规在分娩时接受VitK治疗。 建议：没有足够的证据能够证明WWE产前补充VitK可减少新生儿发生出血性疾病的风险（Level U）。 Conclusion: Evidence is inadequate to determine if prenatal vitamin K supplementation in WWE reduces neonatal hemorrhagic complications. Recommendation:There is insufficient evidence to support or refute a benefit of prenatal vitamin K supplementation for reducing the risk of hemorrhagic complications in the newborns of WWE (Level U). Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, Hopp J, Ting TY, Hauser WA, Thurman D, Kaplan PW, Robinson JN, French JA, Wiebe S, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Shafer PO, Le Guen C; American Academy of Neurology; American Epilepsy Society. Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009 Jul 14;73(2):142-9. doi: 10.1212/WNL.0b013e3181a6b325. Epub 2009 Apr 27. PMID: 19398680; PMCID: PMC3475193.

新生儿出生后，足月儿立即予1 mg维生素K。肌注。对体质量<1.5 kg的早产儿，剂量可减至0.5 mg，并在第3-5天、4周时再次重复予维生素K1肌注，以减少新生儿发生出血性疾病风险。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. 卡马西平、奥卡西平、苯巴比妥、苯妥英钠、托吡酯等肝微粒体酶诱导的AEDs，可透过胎盘促进胎儿体内维生素K1氧化降解，导致新生儿出血性疾病的风险增加。建议患者在妊娠最后一个月，每日口服20 mg维生素K1，以减少胎儿发生出血性疾病的风险。 中国医师协会神经内科分会癫(癎)专委会. "妊娠期女性抗癫(癎)药物应用中国专家共识." 中国医师杂志 17.7(2015):969-971. AEDs致维生素K缺乏：服用酶诱导型AEDs的癫痫孕妇的产儿易出现新生儿维生素K缺乏，建议癫痫女性在妊娠最后1个月每天口服维生素K 10 mg，并应在新生儿出生后立即肌内注射维生素K以避免新生儿出血。 "关于成人癫痫患者长程管理的专家共识." 中华神经科杂志 .07(2013):496-499.

孕前咨询：告知患者癫痫发作及AEDs对妊娠及胎儿风险。妊娠期使用AEDs可能对癫痫女性后代智力发育造成影响，尤其是苯巴比妥和丙戊酸。目前尚无足够的证据来评估新型AEDs（加巴喷丁、左乙拉西坦、噻加宾、托吡酯、氨己烯酸）的致畸性。大剂量丙戊酸（超过800mg/天）以及联合丙戊酸的多药治疗的致畸风险明显增加；告知患者补充叶酸和维生素K的必要性。如果孕妇或者配偶有癫痫疾病，尤其是有特发性癫痫及癫痫及相关遗传病家族史者，应当进行遗传咨询。 Li, S. and Hong, Z., 2015. Lin chuang zhen liao zhi nan. Beijing: Ren min wei sheng chu ban she.

维生素K

Vitamin K

A lipid cofactor that is required for normal blood clotting. Several forms of vitamin K have been identified: VITAMIN K 1 (phytomenadione) derived from plants, VITAMIN K 2 (menaquinone) from bacteria, and synthetic naphthoquinone provitamins, VITAMIN K 3 (menadione). Vitamin K 3 provitamins, after being alkylated in vivo, exhibit the antifibrinolytic activity of vitamin K. Green leafy vegetables, liver, cheese, butter, and egg yolk are good sources of vitamin K.

The term \"vitamin K\" refers to a group of chemically similar fat-soluble compounds called naphthoquinones: vitamin K1 (phytonadione) is found in plants and is the primary source of vitamin K for humans through dietary consumption, vitamin K2 compounds (menaquinones) are made by bacteria in the human gut, and vitamin K3 (menadione) is a water-soluble preparation available for adults only. Vitamin K is necessary for the liver to produce the coagulation factors II, VII, IX, and X, as well as the clotting factors protein C, protein S, and protein Z; vitamin K deficiency can result in deficiencies of these coagulation factors and excess bleeding. An injection of vitamin K is routinely given to newborn infants to prevent vitamin K deficiency bleeding, also known as hemorrhagic disease of the newborn. Vitamin K deficiency is rare in adults but may result from chronic malnutrition or an inability to absorb dietary vitamins.

All children born to mothers taking enzyme-inducing AEDs should be given 1 mg of vitamin K parenterally at delivery. [2004] 所有服用酶诱导型抗癫痫药物的母亲所生的孩子都应在分娩时肠胃外给予 1 mg 维生素 K。 [2004] nice.org.uk/guidance/cg137

Vitamin K

What is the role of vitamin K in preventing haemorrhagic disease of the newborn and maternal haemorrhage in WWE taking AEDs? 对于服用AEDs的WWE，VitK在预防新生儿出血性疾病和母体出血方面的作用 All babies born to WWE taking enzyme-inducing AEDs should be offered 1 mg of intramuscular vitamin K to prevent haemorrhagic disease of the newborn. 所有服用酶诱导AEDs的WWE所生产儿都应进行1mg VitK肌肉注射以预防新生儿出血性疾病。 [GRADES OF RECOMMENDATION:D] There is insufficient evidence to recommend routine maternal use of oral vitamin K to prevent haemorrhagic disease of the newborn in WWE taking enzyme-inducing AEDs. 【推荐等级：D】没有充分的证据显示孕妇常规口服VitK可预防服用酶诱导AEDs的WWE所生新生儿的出血性疾病。 There is insufficient evidence to recommend giving vitamin K to WWE to prevent postpartum haemorrhage. 没有足够的证据建议WWE服用VitK可预防产后出血。 https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/epilepsy-in-pregnancy-green-top-guideline-no-68/

[GRADES OF RECOMMENDATION:D]If there are additional risk factors for haemorrhagic disease of the newborn (for example maternal liver disease, anticipated premature delivery) consideration should be given to the maternal administration of oral vitamin K1(phytomenadione 10 mg daily) in the third trimester of pregnancy. D级推荐：如果还有其他新生儿出血性疾病的危险因素（如产妇肝脏疾病、预期早产等），孕妇在妊娠晚期即开始口服VitK1（phytomenadione 10mg/d）。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

[GRADES OF RECOMMENDATION:D] All infants of women with epilepsy should be offered vitamin K1,1 mg intramuscularly at birth,unless there are contraindications. D级推荐：在没有禁忌证的情况下，所有女性癫痫患者的产儿在出生时都应肌肉注射注射1mg VitK1。 Scottish Intercollegiate Guidelines Network.Diagnosis and management of epilepsy in adults. SIGN 143. Edinburgh, SIGN, 2015. Available at: www.sign.ac.uk/guidelines/fulltext/143/index.html

vitamin K 2-methyl-3-(371115-tetramethylhexadec-2-enyl)naphthalene-14-dione Vitamin K Drug Class

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