Scolaris Content Display Scolaris Content Display

PRISMA flow diagram
Figuras y tablas -
Figure 1

PRISMA flow diagram

Forest plot of comparison: 1 Intravenous versus intramuscular vitamin K, outcome: 1.3 Presence of PIVKA II at day 5.
Figuras y tablas -
Figure 2

Forest plot of comparison: 1 Intravenous versus intramuscular vitamin K, outcome: 1.3 Presence of PIVKA II at day 5.

Forest plot of comparison: 2 Vitamin K dosage, outcome: 2.3 Presence of PIVKA II at day 5.
Figuras y tablas -
Figure 3

Forest plot of comparison: 2 Vitamin K dosage, outcome: 2.3 Presence of PIVKA II at day 5.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 1 Bleeding complications.
Figuras y tablas -
Analysis 1.1

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 1 Bleeding complications.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 2 Intraventricular hemorrhage > Grade II.
Figuras y tablas -
Analysis 1.2

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 2 Intraventricular hemorrhage > Grade II.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 3 Presence of PIVKA II at day 5.
Figuras y tablas -
Analysis 1.3

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 3 Presence of PIVKA II at day 5.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 4 Presence of PIVKA II at day 25.
Figuras y tablas -
Analysis 1.4

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 4 Presence of PIVKA II at day 25.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 5 Prolonged PT at day 5.
Figuras y tablas -
Analysis 1.5

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 5 Prolonged PT at day 5.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 6 Vitamin K1 epoxide detected (≥ 10 ng/mL on day 5).
Figuras y tablas -
Analysis 1.6

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 6 Vitamin K1 epoxide detected (≥ 10 ng/mL on day 5).

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 7 Vitamin K1 epoxide detected (≥ 0.3 ng/mL on day 25).
Figuras y tablas -
Analysis 1.7

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 7 Vitamin K1 epoxide detected (≥ 0.3 ng/mL on day 25).

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 8 Necrotizing enterocolitis.
Figuras y tablas -
Analysis 1.8

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 8 Necrotizing enterocolitis.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 9 Sepsis.
Figuras y tablas -
Analysis 1.9

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 9 Sepsis.

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 10 Mortality (all infants).
Figuras y tablas -
Analysis 1.10

Comparison 1 Intravenous versus intramuscular vitamin K, Outcome 10 Mortality (all infants).

Comparison 2 Vitamin K dosage, Outcome 1 Bleeding complications.
Figuras y tablas -
Analysis 2.1

Comparison 2 Vitamin K dosage, Outcome 1 Bleeding complications.

Comparison 2 Vitamin K dosage, Outcome 2 Intraventricular hemorrhage > Grade II.
Figuras y tablas -
Analysis 2.2

Comparison 2 Vitamin K dosage, Outcome 2 Intraventricular hemorrhage > Grade II.

Comparison 2 Vitamin K dosage, Outcome 3 Presence of PIVKA II at day 5.
Figuras y tablas -
Analysis 2.3

Comparison 2 Vitamin K dosage, Outcome 3 Presence of PIVKA II at day 5.

Comparison 2 Vitamin K dosage, Outcome 4 Presence of PIVKA II at day 25.
Figuras y tablas -
Analysis 2.4

Comparison 2 Vitamin K dosage, Outcome 4 Presence of PIVKA II at day 25.

Comparison 2 Vitamin K dosage, Outcome 5 Prolonged PT at day 5.
Figuras y tablas -
Analysis 2.5

Comparison 2 Vitamin K dosage, Outcome 5 Prolonged PT at day 5.

Comparison 2 Vitamin K dosage, Outcome 6 Vitamin K1 epoxide detected (≥ 10 ng/mL on day 5).
Figuras y tablas -
Analysis 2.6

Comparison 2 Vitamin K dosage, Outcome 6 Vitamin K1 epoxide detected (≥ 10 ng/mL on day 5).

Comparison 2 Vitamin K dosage, Outcome 7 Vitamin K1 epoxide detected (≥ 0.3 ng/mL on day 25).
Figuras y tablas -
Analysis 2.7

Comparison 2 Vitamin K dosage, Outcome 7 Vitamin K1 epoxide detected (≥ 0.3 ng/mL on day 25).

Comparison 2 Vitamin K dosage, Outcome 8 Necrotizing enterocolitis.
Figuras y tablas -
Analysis 2.8

Comparison 2 Vitamin K dosage, Outcome 8 Necrotizing enterocolitis.

Comparison 2 Vitamin K dosage, Outcome 9 Sepsis.
Figuras y tablas -
Analysis 2.9

Comparison 2 Vitamin K dosage, Outcome 9 Sepsis.

Comparison 2 Vitamin K dosage, Outcome 10 Mortality (all infants).
Figuras y tablas -
Analysis 2.10

Comparison 2 Vitamin K dosage, Outcome 10 Mortality (all infants).

Summary of findings for the main comparison. Intramuscular vitamin K versus intravenous vitamin K

Intramuscular vitamin K versus intravenous vitamin K

Patient or population: preterm infants
Setting: neonatal intensive care units
Intervention: prophylactic intravenous (IV) vitamin K
Comparison: prophylactic intramuscular (IM) vitamin K

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Risk with prophylactic IV vitamin K treatment

Risk with prophylactic IM vitamin K

Bleeding complications:
0.2 mg IV versus 0.2 mg IM

Study population

RR 7.00
(0.38 to 129.11)

52
(1 RCT)

⊕⊕⊝⊝
low1

0 per 1000

0 per 1000
(0 to 0)

Bleeding complications:
0.2 mg IV versus 0.5 mg IM

Study population

RR 0.81
(0.20 to 3.27)

54
(1 RCT)

⊕⊕⊝⊝
low1

143 per 1000

116 per 1000
(29 to 467)

Intraventricular hemorrhage > Grade II:
0.2 mg IV versus 0.2 mg IM

Study population

RR 2.00
(0.19 to 20.72)

52
(1 RCT)

⊕⊕⊝⊝
low1

38 per 1000

77 per 1000
(7 to 797)

Intraventricular hemorrhage > Grade II:
0.2 mg IV versus 0.5 mg IM

Study population

RR 0.72
(0.13 to 3.96)

54
(1 RCT)

⊕⊕⊝⊝
low1

107 per 1000

77 per 1000
(14 to 424)

Presence of PIVKA II at day 5:
0.2 mg IV versus 0.2 mg IM

Study population

RR 1.52
(0.37 to 6.23)

60
(1 RCT)

⊕⊕⊝⊝
low1

94 per 1000

143 per 1000
(35 to 584)

Presence of PIVKA II at day 5:
0.2 mg IV versus 0.5 mg IM

Study population

RR 2.07
(0.41 to 10.43)

57
(1 RCT)

⊕⊕⊝⊝
low1

69 per 1000

143 per 1000
(28 to 719)

Presence of PIVKA II at day 25:
0.2 mg IV versus 0.2 mg IM

Study population

RR 1.08
(0.07 to 16.36)

52
(1 RCT)

⊕⊕⊝⊝
low1

37 per 1000

40 per 1000
(3 to 606)

Presence of PIVKA II at day 25 ‐ 0.2 mg IV versus 0.5 mg IM

Study population

RR 1.04
(0.07 to 15.74)

51
(1 RCT)

⊕⊕⊝⊝
low1

38 per 1000

40 per 1000
(3 to 605)

Necrotizing enterocolitis ‐ 0.2 mg IV versus 0.2 mg IM

Study population

RR 1.00
(0.15 to 6.57)

52
(1 RCT)

⊕⊕⊝⊝
low1

77 per 1000

77 per 1000
(12 to 505)

Necrotizing enterocolitis:

0.2 mg IV versus 0.5 mg IM

Study population

RR 1.08
(0.16 to 7.10)

54
(1 RCT)

⊕⊕⊝⊝
low1

71 per 1000

77 per 1000
(11 to 507)

Sepsis:

0.2 mg IV versus 0.2 mg IM

Study population

RR 1.00
(0.28 to 3.58)

52
(1 RCT)

⊕⊕⊝⊝
low1

154 per 1000

154 per 1000
(43 to 551)

Sepsis:

0.2 mg IV versus 0.5 mg IM

Study population

RR 0.86
(0.26 to 2.86)

54
(1 RCT)

⊕⊕⊝⊝
low1

179 per 1000

154 per 1000
(46 to 511)

Mortality (all infants):
0.2 mg IV versus 0.2 mg IM

Study population

RR 1.32
(0.56 to 3.14)

67
(1 RCT)

⊕⊕⊝⊝
low1

206 per 1000

272 per 1000
(115 to 646)

Mortality (all infants):

0.2 mg IV versus 0.5 mg IM

Study population

RR 2.82
(0.84 to 9.46)

64
(1 RCT)

⊕⊕⊝⊝
low1

97 per 1000

273 per 1000
(81 to 915)

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Abbreviations: CI: confidence interval; intravenous: IV; intramuscular: IM; RR: risk ratio; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1We downgraded by two levels due to the small sample size from one included trial.

Figuras y tablas -
Summary of findings for the main comparison. Intramuscular vitamin K versus intravenous vitamin K
Summary of findings 2. Higher dose vitamin K compared to lower dose vitamin K for preterm infants

Higher dose vitamin K compared to lower dose vitamin K for preterm infants

Patient or population: preterm infants
Setting: neonatal intensive care unit
Intervention: higher dose intramuscular (IM) vitamin K
Comparison: lower dose IM vitamin K

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with lower dose vitamin K

Risk with higher dose vitamin K

Bleeding complications:
0.2 mg IM versus 0.5 mg IM

Study population

RR 0.12
(0.01 to 2.11)

54
(1 RCT)

⊕⊕⊝⊝
low1

143 per 1000

17 per 1000
(1 to 301)

Intraventricular hemorrhage > Grade II:
0.2 mg IM versus 0.5 mg IM

Study population

RR 0.36
(0.04 to 3.24)

54
(1 RCT)

⊕⊕⊝⊝
low1

107 per 1000

39 per 1000
(4 to 347)

Presence of PIVKA II at day 5:
0.2 mg IM versus 0.5 mg IM

Study population

RR 1.36
(0.24 to 7.57)

61
(1 RCT)

⊕⊕⊝⊝
low1

69 per 1000

94 per 1000
(17 to 522)

Presence of PIVKA II at day 25:
0.2 mg IM versus 0.5 mg IM

Study population

RR 0.96
(0.06 to 14.60)

53
(1 RCT)

⊕⊕⊝⊝
low1

38 per 1000

37 per 1000
(2 to 562)

Necrotizing enterocolitis:
0.2 mg IM versus 0.5 mg IM

Study population

RR 1.08
(0.16 to 7.10)

54
(1 RCT)

⊕⊕⊝⊝
low1

71 per 1000

77 per 1000
(11 to 507)

Sepsis:
0.2 mg IM versus 0.5 mg IM

Study population

RR 0.86
(0.26 to 2.86)

54
(1 RCT)

⊕⊕⊝⊝
low1

179 per 1000

154 per 1000
(46 to 511)

Mortality (all infants):
0.2 mg IM versus 0.5 mg IM

Study population

RR 2.13
(0.60 to 7.51)

65
(1 RCT)

⊕⊕⊝⊝
low1

97 per 1000

206 per 1000
(58 to 727)

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Abbreviations: CI: confidence interval; intravenous: IV; intramuscular: IM; RR: risk ratio; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

1We downgraded by two levels due to the small sample size from one included trial.

Figuras y tablas -
Summary of findings 2. Higher dose vitamin K compared to lower dose vitamin K for preterm infants
Comparison 1. Intravenous versus intramuscular vitamin K

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Bleeding complications Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 0.2 mg IV versus 0.2 mg IM

1

52

Risk Ratio (M‐H, Fixed, 95% CI)

7.0 [0.38, 129.11]

1.2 0.2 mg IV versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.20, 3.27]

1.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.38, 6.46]

2 Intraventricular hemorrhage > Grade II Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 0.2 mg IV versus 0.2 mg IM

1

52

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.19, 20.72]

2.2 0.2 mg IV versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.13, 3.96]

2.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.20, 5.31]

3 Presence of PIVKA II at day 5 Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 0.2 mg IV versus 0.2 mg IM

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [0.37, 6.23]

3.2 0.2 mg IV versus 0.5 mg IM

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

2.07 [0.41, 10.43]

3.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

1.74 [0.51, 6.00]

4 Presence of PIVKA II at day 25 Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 0.2 mg IV versus 0.2 mg IM

1

52

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.07, 16.36]

4.2 0.2 mg IV versus 0.5 mg IM

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.07, 15.74]

4.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

78

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.10, 11.15]

5 Prolonged PT at day 5 Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 0.2 mg IV versus 0.2 mg IM

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.24, 1.76]

5.2 0.2 mg IV versus 0.5 mg IM

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.30, 2.90]

5.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.30, 1.93]

6 Vitamin K1 epoxide detected (≥ 10 ng/mL on day 5) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 0.2 mg IV versus 0.2 mg IM

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

9.9 [0.56, 176.29]

6.2 0.2 mg IV versus 0.5 mg IM

1

58

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.19, 1.74]

6.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.38, 3.78]

7 Vitamin K1 epoxide detected (≥ 0.3 ng/mL on day 25) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 0.2 mg IV versus 0.2 mg IM

1

52

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.82]

7.2 0.2 mg IV versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.01, 2.11]

7.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 3.23]

8 Necrotizing enterocolitis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 0.2 mg IV versus 0.2 mg IM

1

52

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.57]

8.2 0.2 mg IV versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.16, 7.10]

8.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.20, 5.31]

9 Sepsis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 0.2 mg IV versus 0.2 mg IM

1

52

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.28, 3.58]

9.2 0.2 mg IV versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.26, 2.86]

9.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.31, 2.72]

10 Mortality (all infants) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 0.2 mg IV versus 0.2 mg IM

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.56, 3.14]

10.2 0.2 mg IV versus 0.5 mg IM

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

2.82 [0.84, 9.46]

10.3 Any IV Vitamin K (0.2 mg) versus any IM Vitamin K (0.2 mg and 0.5 mg)

1

98

Risk Ratio (M‐H, Fixed, 95% CI)

1.77 [0.80, 3.93]

Figuras y tablas -
Comparison 1. Intravenous versus intramuscular vitamin K
Comparison 2. Vitamin K dosage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Bleeding complications Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 0.2 mg IM versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.01, 2.11]

2 Intraventricular hemorrhage > Grade II Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 0.2 mg IM versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.04, 3.24]

3 Presence of PIVKA II at day 5 Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 0.2 mg IM versus 0.5 mg IM

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [0.24, 7.57]

4 Presence of PIVKA II at day 25 Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 0.2 mg IM versus 0.5 mg IM

1

53

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.06, 14.60]

5 Prolonged PT at day 5 Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 0.2 mg IM versus 0.5 mg IM

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.53, 3.93]

6 Vitamin K1 epoxide detected (≥ 10 ng/mL on day 5) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 0.2 mg IM versus 0.5 mg IM

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

0.06 [0.00, 1.02]

7 Vitamin K1 epoxide detected (≥ 0.3 ng/mL on day 25) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 0.2 mg IM versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.03, 2.25]

8 Necrotizing enterocolitis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 0.2 mg IM versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.16, 7.10]

9 Sepsis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 0.2 mg IM versus 0.5 mg IM

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.26, 2.86]

10 Mortality (all infants) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 0.2 mg IM versus 0.5 mg IM

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.13 [0.60, 7.51]

Figuras y tablas -
Comparison 2. Vitamin K dosage