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Updated: Jan 19, 2026
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Published on: September 23, 2020
Vitamin K deficiency bleeding in Australian infants 1993-2017: an Australian Paediatric Surveillance Unit study
Yvonne Zurynski1,2, Cameron J Grover3, Bin Jalaludin4,5
1Australian Paediatric Surveillance Unit, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Vitamin K deficiency bleeding (VKDB) surveillance in Australia revealed low incidence rates, but a concerning rise in parental refusal of vitamin K prophylaxis. Continued monitoring and education are crucial for prevention.
Area of Science:
- Pediatrics
- Public Health
- Neonatal Medicine
Background:
- Vitamin K deficiency bleeding (VKDB) is a preventable condition in infants.
- National recommendations and vitamin K formulations have evolved in Australia.
- Surveillance is essential to monitor VKDB trends and the impact of interventions.
Purpose of the Study:
- To conduct surveillance of VKDB in Australian infants from 1993 to 2017.
- To analyze trends in VKDB incidence, prophylaxis uptake, and parental refusal.
- To assess the effectiveness of national vitamin K recommendations.
Main Methods:
- Utilized the Australian Paediatric Surveillance Unit for case reporting.
- Collected demographic, clinical, and biochemical data for infants <6 months with VKDB.
- Analyzed reported cases (n=58) over a 25-year period.
Main Results:
- The overall reported incidence of VKDB was 0.84 per 100,000 live births.
- Late VKDB accounted for 72% of cases, with exclusively breastfed infants being predominant (91%).
- Parental refusal of vitamin K increased significantly after 2006, with 57% of cases not receiving vitamin K.
Conclusions:
- Australia has among the lowest VKDB incidence rates globally.
- An increasing trend of parental refusal for vitamin K prophylaxis poses a risk.
- Ongoing surveillance and targeted educational campaigns are necessary to prevent VKDB.
Objective:
To undertake surveillance of vitamin K deficiency bleeding (VKDB) in Australia from 1993 to 2017, during a time of change to national recommendations and available vitamin K formulations.
Methods:
Paediatricians reported cases of VKDB in infants aged <6 months and provided demographic, clinical and biochemical information via the Australian Paediatric Surveillance Unit.
Results:
58 cases were reported, of which 5 (9%) were early, 11 (19%) classic and 42 (72%) late VKDB. 53 (91%) were exclusively breast fed. Seven (12%) received oral prophylaxis, the majority (86%) of whom did not receive all three recommended doses. The overall reported incidence was 0.84 per 100 000 live births (95% CI: 0.64 to 1.08) and the incidence of late VKDB was 0.61 per 100 000 live births (95% CI: 0.44 to 0.82), which are similar to rates reported by other countries where intramuscular vitamin K is recommended. VKDB rates were significantly higher (2.46 per 100 000 live births; 95% CI: 1.06 to 4.85) between 1993 and March 1994 when oral prophylaxis was recommended (p<0.05). Vitamin K was not given to 33 (57%) cases, primarily due to parental refusal, and the number of parental refusals increased significantly after 2006 (p<0.05). There were six deaths, all due to intracranial haemorrhage, and three associated with home delivery and parental refusal of vitamin K.
Conclusions:
Incidence rates of VKDB in Australia are among the lowest in the world; however, we have identified an increasing trend of parental refusal. Ongoing surveillance and educational campaigns for health professionals and parents are needed to prevent VKDB.
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