Six years' experience of prophylactic oral vitamin K

Area of Science:

• Neonatal Health
• Pediatric Hematology
• Pharmacology

Background:

• Vitamin K deficiency bleeding (VKDB) is a preventable condition in newborns.
• Oral vitamin K prophylaxis is an alternative to intramuscular administration.
• Ensuring adequate vitamin K levels is crucial for preventing hemorrhagic disease in infants.

Purpose of the Study:

• To evaluate the efficacy of oral vitamin K in preventing VKDB during the first three months of life.
• To assess the safety and parental acceptance of an oral vitamin K regimen.
• To identify factors contributing to breakthrough VKDB cases.

Main Methods:

• A large cohort of 182,000 infants in Northern England received oral vitamin K (phytomenadione) at birth.
• Breastfed infants received additional oral doses at home.
• Data on VKDB incidence and adherence to the dosing schedule were collected.

Main Results:

• Four cases of late VKDB occurred in breastfed infants.
• Two cases were associated with failures in following policy guidelines.
• Two cases were linked to undiagnosed alpha-1 antitrypsin deficiency.
• Audit indicated high adherence (93%) to the prescribed oral vitamin K regimen among breastfed infants.

Conclusions:

• Oral vitamin K shows promise for VKDB prevention, with potential for parental administration.
• The study highlights the need for higher doses or alternative strategies to protect infants with underlying liver conditions.
• Further research is warranted to optimize oral vitamin K prophylaxis protocols.