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Late Vitamin K Deficiency Bleeding in Infancy: The Time to Ensure Effective Prevention
Serafina Perrone1,2, Virginia Beretta1,2, Chiara Petrolini1
1Neonatology Unit, Pietro Barilla Children's Hospital, Parma, 43126, Italy.
Nutrition Reviews
|November 16, 2025
Summary
Vitamin K (VK) deficiency bleeding (VKDB) is preventable in newborns. Breastfed infants require ongoing VK supplementation beyond birth doses to prevent late-onset VKDB.
Area of Science:
- Pediatrics
- Neonatology
- Nutritional Science
Background:
- Vitamin K deficiency bleeding (VKDB) results from insufficient VK-dependent coagulation factors, causing bleeding from mild to severe intracranial hemorrhages.
- Current VK prophylaxis at birth (IM or oral) prevents early VKDB but offers incomplete protection against late-onset VKDB, particularly in breastfed infants.
Purpose of the Study:
- To discuss evidence necessitating broader practice changes in vitamin K supplementation for all breastfed infants.
- To highlight the inadequacy of current VK prophylaxis in preventing late-onset VKDB in exclusively breastfed infants.
Main Methods:
- Review of recent prospective, observational clinical studies on term and preterm infants.
- Analysis of serum vitamin K levels, PIVKA-II concentrations, and under-γ-carboxylated osteocalcin percentages.
Main Results:
- Exclusively breastfed infants, including preterm infants, show vitamin K insufficiency post-discharge despite IM VK at birth.
- Breastfed infants without continued supplementation exhibit higher PIVKA-II concentrations compared to formula-fed or supplemented infants.
Conclusions:
- Ongoing vitamin K prophylaxis for the first 3 months of life is crucial for preventing late-onset VKDB in breastfed infants.
- Current evidence supports a need for revised VK supplementation strategies to ensure adequate protection for all infants.
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