Discovering Hope

Vitamin K deficiency on rise

Doctors at Monroe Carell Jr. Children’s Hospital at Vanderbilt have seen a rise in late-onset vitamin K deficiency bleeding in young infants due to parents declining the shot at birth.

Over eight months, Vanderbilt physicians saw and diagnosed seven infants, ages 7 weeks to 20 weeks, with vitamin K deficiency bleeding (VKDB), formerly known as hemorrhagic disease of the newborn. Four of the infants had intracranial hemorrhaging, with two requiring urgent neurosurgical intervention, and another with bleeding from the intestines.

Lead author Robert Sidonio, M.D., M.S., assistant professor of Pediatrics in the Division of Hematology/Oncology, and co-authors published their findings in the journal Pediatric Neurology, and are calling for a state and national tracking system to understand how many infants are not receiving the preventive vitamin K shot at birth and the need for better education and awareness for providers and families. Unfounded fears and misinformation that the shot causes leukemia, is a toxin or is unnecessary in uncomplicated births may be leading some families to turn it down.

Newborns are at risk for VKDB and subsequent bleeding unless given the preventive shot at birth. Vitamin K, needed to help blood clot, is produced naturally by the body within the gut or can be consumed in leafy greens. Due to infants’ immature clotting systems, their bodies are initially unable to produce enough of the vitamin. Also, breast milk alone does not provide sufficient levels, regardless of the mother’s diet.

The American Academy of Pediatrics has recommended the single-dose shot of vitamin K at birth since 1961. Most cases seen today are in infants in the first 6 months of life who did not get the shot and are exclusively breastfed or who have an undiagnosed liver disorder. Symptoms of VKDB can include vomiting, overt bleeding, poor feeding, lethargy, pallor and bruising.

– by Christina Echegaray

 

 

Antibody prevents, treats MPV and RSV

New Vanderbilt-led research published in the Journal of Infectious Diseases has identified an antibody that shows promise in preventing and treating human metapneumovirus (MPV) and respiratory syncytial virus (RSV)—the two leading causes of respiratory infections in young children.

Lead author Jennifer Schuster, M.D., clinical fellow in Pediatric Infectious Diseases, said the identification of the human antibody, known as 54G10, has huge implications, and could pave the way to identify one vaccine for both viruses. Antibodies are produced by the body’s immune system to fight off bacteria and viruses.

“Although MPV and RSV are related and cause identical clinical disease, they are different enough genetically that the immune system doesn’t react to both of them simultaneously. We discovered that they are similar enough that we can find one target to trick the immune system to react to both of them.”

RSV and MPV are No. 1 and No. 2, respectively, for causing lower respiratory infections in infants and children, with high morbidity and mortality in at-risk populations. Currently, no specific treatment or preventative exists for MPV. The medication Synagis can be given to at-risk infants for prevention of RSV, but is not effective as a treatment option.

The study first explored antibody 54G10’s effectiveness in neutralizing the four subgroups of MPV as passive immune prophylaxis and therapy. The 54G10 antibody targets the MPV fusion protein, a viral protein that participates in getting the virus inside cells, and successfully reduced virus and disease in all subgroups.

Further examination showed the antibody also worked to neutralize RSV because one region of the RSV fusion protein was similar to the region of the MPV fusion protein recognized by 54G10.

Funding for the study was provided by the National Institutes of Health (grant R01 AI085062 to J.V.W., grant R01AI072414 to D.R.B., and 5T32HD060554 to J.E.S) and a CTSA award (UL1TR0005445) from the National Center for Advancing Translational Sciences.

– by Christina Echegaray

 

 

Treating neonatal abstinence syndrome

Methadone is associated with a shorter length of treatment and length of stay when compared to other treatment methods for infants with neonatal abstinence syndrome (NAS), according to a study published in the Journal of Perinatology.

NAS, which occurs shortly after birth, is a drug withdrawal syndrome experienced by newborns who are exposed to opiates. Infants with NAS can have seizures, difficulty feeding, respiratory complications and low birth weights.

The study, which was supported by the Robert Wood Johnson Foundation Clinical Scholars Program, is a collaboration between The Children’s Hospital of Philadelphia, Cincinnati Children’s Hospital and the University of Michigan Health System.

Lead author Stephen Patrick, M.D., now an assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt, did the work as a Neonatology fellow at the University of Michigan.

The authors studied data from 1,424 infants with NAS at 14 major children’s hospitals, finding significant variations in treatment for NAS.

The study looked at a combination of hospital administration and pharmacy data to evaluate differences in drug treatment for infants with NAS. Six hospitals primarily utilized methadone, six prescribed morphine and two used phenobarbital with methadone showing the best outcome.

– by Ashley Culver