Six years' experience of prophylactic oral vitamin K

Abstract

Aims-The ability of oral vitamin K to eliminate all risk of vitamin K deficiency bleeding during the first three months of life was studied. Methods-Babies (n=182 000) in the north of England judged well enough to be oVered milk within 12 hours of birth were given 1 mg of phytomenadione (vitamin K 1 ) suspended in a medium chain triglyceride oil by mouth at delivery between 1993 and 1998. The parents of those who were breastfed were given a further three doses to give to the baby once every two weeks after discharge. Results-Four breastfed babies developed late vitamin K deficiency bleeding. In two, staV failed to follow policy guidelines, and in two there was undiagnosed 1 antitrypsin deficiency. Audit suggested that 93% of breastfed babies had all four doses, as advised. Conclusions-An oral product that parents can administer themselves would be popular if licensed, but the total dose oVered may need to be more than in this study if babies with undiagnosed liver disease are to be protected.

Prevention of Vitamin K Deficiency Bleeding in Breastfed Infants: Lessons From the Dutch and Danish Biliary Atresia Registries

“…3,9,15 The method presented here, comparison of well-delineated and homogeneous risk populations, may be very helpful in this respect. In contrast to nationwide surveillance studies, which are sensitive to underreporting, 3,12 it seems to be a reliable method to detect prophylactic failures.…”

“…[12][13][14] However, prophylactic failures have continued to occur, mostly in infants who later proved to have a cholestatic liver disease. 3,9,[15][16][17][18] Cholestatic infants are especially sensitive to suboptimal vitamin K availability, because the absence of intestinal bile greatly reduces the absorption of vitamin K and other fat-soluble vitamins. 19,20 The repeated occurrence of prophylactic failures in infants with unrecognized cholestatic liver disease warrants careful evaluation of the efficacy of vitamin K prophylactic regimens in these infants.…”

Vitamin K and childhood cancer: a report from the United Kingdom Childhood Cancer Study

“…route is known to be effective in preventing both early haemorrhagic disease in neonates and late-onset bleeding in older babies (Dam et al, 1952;McNinch and Tripp, 1991;Zipursky, 1999). The efficacy of oral vitamin K is less certain as there is a recognised problem of absorption in some babies, and additional difficulties in compliance with multiple-dose oral regimens (Zipursky, 1999;Wariyar et al, 2000;von Kries et al, 2003).…”

Hemothorax as presentation of late vitamin-K-deficient bleeding in a 1-month-old infant with homozygous alpha-1-antitrypsin deficiency

“…There were 22 cases of α1-antitrypsin deficiency, 11 biliary atresia and 22 other liver diseases. Wariyar et al reported four cases of late VKDB among 182,000 babies with oral vitamin K prophylaxis [7]. Two had undiagnosed α1-antitrypsin deficiency.…”