Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth.
BACKGROUND
Newborns are at risk for vitamin K deficiency and subsequent bleeding unless supplemented at birth. Vitamin K deficiency bleeding is an acquired coagulopathy in newborn infants because of accumulation of inactive vitamin K-dependent coagulation factors, which leads to an increased bleeding tendency. Supplementation of vitamin K at birth has been recommended in the United States since 1961 and successfully reduced the risk of major bleeding. Refusal or omission of vitamin K prophylaxis is increasing and puts newborn infants at risk for life-threatening bleeding.


METHODS
Over an eight month period, we encountered seven infants with confirmed vitamin K deficiency; five of these patients developed vitamin K deficiency bleeding.


RESULTS
The mean age of the seven infants with vitamin K deficiency was 10.3 weeks (range, 7-20 weeks); manifestations ranged from overt bleeding to vomiting, poor feeding, and lethargy. None of the infants had received vitamin K at birth, and all were found to have profound derangement of coagulation parameters, which corrected rapidly with administration of vitamin K in IV or intramuscular form. Four of the seven infants had intracranial hemorrhage; two of these infants required urgent neurosurgical intervention.


CONCLUSIONS
Supplementation of vitamin K at birth for all newborns prevents major hemorrhagic complications, such as intracranial bleeding, due to vitamin K deficiency. Parental refusal of vitamin K is increasingly common. It is critical that health care providers and the public be made aware of the varied presentation of this preventable acquired coagulopathy.
Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Rachael
R
Schulte
Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Lori C
LC
Jordan
Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Anna
A
Morad
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Robert P
RP
Naftel
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee.
John C
JC
Wellons
Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: robert.sidonio@gmail.com.
Robert
R
Sidonio
D017668:Age of Onset; D001921:Brain / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D008297:Male; D016312:Treatment Refusal; D014812:Vitamin K / Q000008:administration & dosage; D014813:Vitamin K Deficiency / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D006475:Vitamin K Deficiency Bleeding / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control
D014812:Vitamin K
hemorrhagic disease of the newborn; intracranial hemorrhage; vitamin K; vitamin K deficiency bleeding; vitamin K prophylaxis