Administering Vitamin K to New Born - Essay Example

? Administering Vitamin K to new born First School Affiliation Introduction Vitamin K is very important in the body because it helps in blood clotting. In new born babies, the vitamin K is deficient and hence this has been known to lead to bleeding known as HDN which is the hemorrhagic disease of the newborn. There is very small amount of Vitamin K in the bodies of babies at birth. The reason for this is because Vitamin K is neither transferable through the placenta from the mother nor can it be made by the babies alimentary canal because it lacks any form of bacteria before they are born (Clarke et al, 2006). The Vitamin K in breast milk is also very low and thus after the birth of babies, even though breastfeeding is taking place, Vitamin K is at a low level for several weeks and only attains its required level when the alimentary canal bacteria start generating Vitamin K for the baby. Some babies are fed with infant formula that contains Vitamin K but even though this takes place, the level of Vitamin K remains at a low level for some days (E Hey, 2003). Vitamin k is thus recommended to be administered on the new born babies to increase its levels in their body (American Academy of Pediatrics, Committee on Fetus and Newborn, 2003). The contention now is on how to administer Vitamin K. Which method is safe and well known to have desirable results in preventing hemorrhagic disease of the newborn? The method that has been in use was intramuscular administration or administration through injection. It however has come to be questioned on its safety on babies and its possibility that it would be causing cancer and leukemia in the new born babies who are given vitamin K using the intramuscular administration (American Academy of Pediatrics, Committee on Fetus and Newborn, 2003). This led to the introduction of oral administration in some countries. The decision however on the method to be used has somehow been determined by the consent from the parent. Where the nurse administering Vitamin K is left to decide, then ethical decision making comes in. As a nurse, consideration has to be put on both methods. Their effectiveness and on the safety. This paper, with the help of research by other writers, will show the dilemma faced in making the ethical decision of the method to use in administering Vitamin K. Summary of the Issue Concerns have however been raised on either the safeness or effectiveness of both intramuscular administration and oral administration of Vitamin K. The first that has been in use is the intramuscular administration. This method has been recorded to have good results and according to study in Australia, there was no registered case of bleeding (HDN) in the children who were given Vitamin K using intramuscular administration (Khambalia et al., A.Z., 2012).. A similar test was carried out testing the effectiveness of oral administration. Most of the infant who received Vitamin K were safe from HDN but a number of them were registered to experience bleeding probably because of HDN. From this you can depict that the efficiency of oral administration is not as effective as using intramuscular administration. This can be due to several reasons that would render oral administration non-effective. The first is that in case of vomiting in the child, to whom Vitamin K is administered to, the dose needed will not have been met and hence the child will be prone to bleeding. The other is that this method is dependent on the parent compliance to bring the child back for the second dose 3-5 days after the first dose given after child birth. This would mean that if a parent fails to comply with this say because they forget, then the dosage will not be as expected but when it comes to intramuscular administration, the dosage is given once, immediately after birth of the child. This means that the complete dose is administered at once. These two factors may lead to lack of proper dosage if the oral administration is used and thus full protection from HDN may not be in place. The intramuscular administration has been in use but some effects were cited to come about due to its use. One speculation that was brought forward was that the use of this method to offer Vitamin K was causing cases of cancer and leukemia in the children it is administered to (Blackwell Science Ltd, 1999). This theory led to parents being concerned on how safe intramuscular administration is and thus they started preferring the oral administration where consent of the parent was needed. This led to research being carried out to determine the truthfulness of the link between cancer and injection. No study conducted has found a connected link among this method and cancer and hence parents have been asked not to worry about this being a problem. However, what is evident is that intramuscular administration can cause cutaneous reaction in some children. This can be due to immunity passed on to the child from the mother. Cases have been found where the skin spot where the injection was inserted have changed color to a palpable purple plaque. Approaches by Health Care Providers The first step here when approaching this situation at an ethical point of view is that there is needs to identify the dilemma or issue. In this case, it is on the method to administer Vitamin K (Corey, & Haynes, 1998). The next step is to identify the impact the decision will make and who will be affected by it. There should then be reviewing of the ethical codes set which is followed by understanding the rules and regulations set that affect decision making of the issue at hand. The next step should involve consultation and in this issue, the medical practitioner should consult with fellow colleagues on the method to use when administering Vitamin K on a new born. The next step is to fully learn about the courses of action that can be taken and evaluate the effects (positive and negative) each action has. This is the process of understanding the effects of both oral and intramuscular administration of vitamin K. When a parent is allowed to give consent on the method to use (Autonomy). Beneficence is coming up with the best ethical decision. Justice is where your decision should not vary from a child to another without proper reason. The method used should apply to all children at the time unless a good reason is available. No maleficence should be seen in the decision made. It should not cause harm to any child. Health care providers when it comes to this issue are considerate of the opinion of the parent, who gives the consent. If the parent is not able to make the decision, the PR actioners would choose one by following the steps of coming up with a decision put by the hospital. Using these processes for decision making, will provide a proper channel of coming up with an ethical decision. Personal Reaction to Issue In my point of view, using intramuscular administration to give new born Vitamin K. Intramuscular administration in a study carried out in Australia, registered no death caused by hemorrhagic disease of the newborn but when oral administration was used, there were some children who experienced severe bleeding perhaps due to HDN. Intramuscular administration on the other hand has been speculated to cause cancer but there have been observations of cutaneous reaction to the injections (Stewart & Daly, 2009). This speculation on cancer has not been proven in any study and research has found no link between intramuscular administration and cancer. Cutaneous reaction is only observable in few cases where the child may have acquired immunity from the mother. Using the oral method, allows room for HDN because there is higher risk of improper dosage due to cases of improper absorption of the vitamins in the stomach. Each of these methods is a viable option to offer Vitamin K to new born babies and none has been disregarded by hospital policies or by the legal rules governing any nation hence any of the methods can be chosen with proper understanding of the above material in this paper. Action You Would Take If Confronted With Issue If as a nurse I am confronted with an issue that requires ethical decision making, I would first understand all the important details and then I would consult with colleagues. This way, it would be a good way of coming up with the best decision to use. Following procedure will ensure that I don’t put my patient at risk due to bad decision making. If I am confronted with the dilemma of administering Vitamin K, I would follow the steps above to come up with a decision on the method to use. Conclusion The method to use to administer vitamin K has always caused room for variation in the decision. This depends on the countries policies regarding health where you get that a country like the United States has stuck with intramuscular administration even after some countries have started using oral administration because the American Academy of Pediatrics did not approve the oral method (Jafarzadeh et al., 2008). In Pakistan due to their health status, Administering of Vitamin K is at a low level (Shah et al., 2013). Some of the decision have however been left for the medical practitioners to decide on the right decision to use. This leaves the practitioners with the need to review argumentatively on the effects of the two methods available before making the decision on the method to use. This will enable them come up with an ethical decision that will provide no harm to any child. References Academy of Pediatrics, Committee on Fetus and Newborn (2003). Controversies Concerning Vitamin K and the Newborn. Pediatrics, p. 112; 191. Blackwell Science Ltd (1999). Prevention of vitamin K deficiency bleeding in newborns. British Journal of Hematology, 104, 430–437. Clarke, P., Mitchell, S.J., Wynn, R., Sundaram, S., Speed, V., Gardener, E., Roeves, D., & Shearer, M.J. (2006). Vitamin K Prophylaxis for Preterm Infants: A Randomized, Controlled Trial of 3 Regimens. Pediatrics, 118; e1657. Corey, G., Corey, M, & Haynes, R. (1998). Student workbook for Ethics in Action. Pacific Grove, CA: Brooks/Cole. E Hey (2003). Vitamin K—what, why, and when. Arch Dis Child Fetal Neonatal Ed, 2003; 88:F80–F83. Jafarzadeh, M., Mohammadzadeh, A., Farhat, A., Keramati, M., & Khajedaluei, M. (2008). The Comparison Effect of Oral and Intramuscular Injection vitamin K on PT and APTT in Neonates, 18:75-78. Khambalia, A.Z., Roberts, C.L., Bowen, J.R., & Nassar, N. (2012). Maternal and infant Characteristics by mode of vitamin K prophylaxis administration. Journal of Pediatrics and Child Health, 48: 665–668 Shah, F., Khan, M.A., Khan, J., Munir, A., & Karim, R. (2013). Hemorrhagic disease of the Newborn: clinical presentation and response to treatment with vitamin K. Gomal J Med Sci, 11: 101-4. Stewart, L., & Daly, B. M. (2009). A localized cutaneous reaction to vitamin K injection in a neonate. Clinical and Experimental Dermatology, 34, 939–940. Read More