title: Vitamin K deficiency bleeding after NICE guidance and withdrawal of Konakion Neonatal: British Paediatric Surveillance Unit study, 2006-2008.
abstract: OBJECTIVE
  To survey vitamin K deficiency bleeding (VKDB) and document vitamin K (VK) prophylaxis practice, and compare with findings predating withdrawal of Konakion Neonatal and guidance from the National Institute of Health and Clinical Excellence (NICE), both occurring in 2006.
  
  
  METHODS
  Two-year surveillance of VKDB (2006-2008) using British Paediatric Surveillance Unit methodology. Postal questionnaire to consultant-led maternity units.
  
  
  METHODS
  UK and Irish Republic.
  
  
  METHODS
  All newborns and infants under 6 months with suspected VKDB.
  
  
  METHODS
  VKDB incidence and predisposing factors, VK prophylaxis recommended/received.
  
  
  RESULTS
  Eleven cases of VKDB were found: six (55%) babies received no VK prophylaxis, in five (45.5%) because parents withheld consent; three (27.5%) babies with late VKDB received intramuscular (IM) Konakion MM (two had biliary atresia, and one was delivered preterm); two (18%) babies received incomplete oral prophylaxis. Nine babies (82%) were breast fed. Three (27%) babies had liver disease; four (36%), including all those with liver disease, were jaundiced at presentation after 21 days. Four (36%) babies had intracranial haemorrhage, two probably suffering long-term morbidity. VK prophylaxis practice was defined in 236 (100%) units. All units recommended prophylaxis for every newborn: 169 (72%) IM, 19 (8%) oral, and 48 (20%) offered parental choice. All units that recommended IM prophylaxis used Konakion MM. Oral prophylaxis always involved multidose regimens for breastfed babies; 61 (91%) units used Konakion MM, and six (9%) used unlicensed products suitable for administration by parents.
  
  
  CONCLUSIONS
  IM Konakion MM is efficacious, but parents withholding consent for recommended IM prophylaxis reduces effectiveness. Reappraisal of NICE guidance would be appropriate. Prolonged jaundice demands investigation. Late VKDB occasionally occurs after IM prophylaxis.
authors.affiliation: Child and Women's Health, Royal Devon and Exeter NHS Foundation Trust, UK. alison.busfield@nhs.net
authors.forename: Alison
authors.initials: A
authors.lastname: Busfield
authors.forename: Rebecca
authors.initials: R
authors.lastname: Samuel
authors.forename: Andrew
authors.initials: A
authors.lastname: McNinch
authors.forename: John H
authors.initials: JH
authors.lastname: Tripp
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008297:Male; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D010837:Vitamin K 1 / Q000008:administration & dosage*; D006475:Vitamin K Deficiency Bleeding / Q000188:drug therapy / Q000453:epidemiology*; D028761:Withholding Treatment
chemical_list: D010837:Vitamin K 1