Vitamin K deficiency bleeding in Great Britain and Ireland: British Paediatric Surveillance Unit Surveys, 1993 94 and 2001-02.
OBJECTIVE
To conduct and report monitoring of vitamin K deficiency bleeding (VKDB) in Great Britain and Ireland following the 1988-90 survey (VKDB-90).


METHODS
Two 2-year surveys conducted during 1993-4 (VKDB-94) and 2001-02 (VKDB-02).


METHODS
Data collected from all consultant paediatricians in Great Britain and Ireland.


METHODS
All infants presenting with bleeding resulting from vitamin K (VK) deficiency.


METHODS
Incidence of VKDB, related mortality/morbidity and VK prophylaxis recommended/received, noting predisposing features.


RESULTS
Compared with previous studies, VKDB-02 found fewer cases of VKDB (RR: 0.27 (95% CI: 0.12 to 0.59), p<0.001) with no deaths, no long-term morbidity and reduced incidence among those receiving any oral dosing (RR: 0.24 (95% CI: 0.06 to 1.01), p<0.059). Breast-fed infants accounted for the vast majority of cases. The number receiving no prophylaxis fell consecutively over time: 20 of 27 in VKDB-90, 10 of 32 in VKDB-94 and 4 (because of parental refusal) of 7 in VKDB-02. Seven received one oral dose of VK in VKDB-90, 16 in VKDB-94 and none in VKDB-02. Underlying liver disease was found in six cases in VKDB-90, 12 in VKDB-94 and one in VKDB-02.


CONCLUSIONS
In the most recent survey, the incidence of VKDB was about one third that in the two earlier studies. Late onset VKDB remains virtually confined to breast-fed infants who have received either no VK or just one oral dose. The effectiveness of oral prophylaxis regimens has improved over the last 15 years, but parental refusal of prophylaxis has become more problematic.
McNinch
Andrew
A
Royal Devon and Exeter NHSF Trust, Barrack Road, Exeter, UK. awmcninch@doctors.org.uk
Busfield
Alison
A
Tripp
John
J
D017668:Age of Onset; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001724:Birth Weight; D001942:Breast Feeding; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology; D014812:Vitamin K / Q000627:therapeutic use*; D014813:Vitamin K Deficiency / Q000453:epidemiology* / Q000517:prevention & control; D006475:Vitamin K Deficiency Bleeding / Q000453:epidemiology* / Q000517:prevention & control
D000933:Antifibrinolytic Agents; D014812:Vitamin K