title: Prophylactic Dosing of Vitamin K to Prevent Bleeding.
abstract: Based on a high incidence of Vitamin K deficiency bleeding (VKDB) in breastfed infants with thus far unrecognized cholestasis, such as biliary atresia (BA), the Dutch regimen to prevent VKDB in breastfed infants was changed from a daily oral dosage of 25 µg to 150 µg vitamin K. Infants continued to receive 1 mg of vitamin K orally at birth. We compared the efficacy of the 150-µg regimen with the 25-µg regimen and with the Danish regimen of a single intramuscular (IM) dose of 2 mg vitamin K at birth.
  
  
  
  Data were retrieved from the national BA registries: 25 µg group (Netherlands, January 1991 to February 2011); 150 µg group (Netherlands, March 2011 to January 2015); and IM 2 mg group (Denmark, July 2000 to November 2014). We compared the incidence of VKDB in the groups.
  
  
  
  VKDB occurred in 45 of 55 (82%) infants of the 25 µg group, in 9 of 11 (82%) of the 150 µg group, but in only 1 of 25 (4%) of the IM 2 mg group (P < .001). Forty percent of all infants of the 25 µg group had an intracranial hemorrhage as presenting symptom, compared with 27% of the infants of the 150 µg group (P = .43). Intracranial hemorrhage was not observed in the IM 2 mg group (0%; P < .001).
  
  
  
  A vitamin K prophylactic regimen of 1 mg of vitamin K orally at birth followed by a daily oral dosage of either 25 or 150 µg fails to prevent VKDB in breastfed infants with still unrecognized BA. The data support 2 mg vitamin K IM at birth as prophylaxis against VKDB.
authors.affiliation: Department of Pediatric Surgery and.
authors.forename: Mauri
authors.initials: M
authors.lastname: Witt
authors.affiliation: Departments of Pediatric Surgery, and.
authors.forename: Nina
authors.initials: N
authors.lastname: Kvist
authors.affiliation: Pediatrics and Adolescent Medicine, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: Marianne Hørby
authors.initials: MH
authors.lastname: Jørgensen
authors.affiliation: Department of Pediatric Surgery and.
authors.forename: Jan B F
authors.initials: JB
authors.lastname: Hulscher
authors.affiliation: Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; and h.j.verkade@umcg.nl.
authors.forename: Henkjan J
authors.initials: HJ
authors.lastname: Verkade
mesh_terms: D000284:Administration, Oral; D001656:Biliary Atresia / Q000150:complications* / Q000175:diagnosis; D001942:Breast Feeding; D057210:Delayed Diagnosis; D003718:Denmark; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D008297:Male; D009426:Netherlands; D012307:Risk Factors; D014812:Vitamin K / Q000008:administration & dosage* / Q000627:therapeutic use; D006475:Vitamin K Deficiency Bleeding / Q000150:complications* / Q000517:prevention & control*
chemical_list: D014812:Vitamin K