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Editor,—I would like to raise two points about the editorial by Tripp and McNinch.1 First, they quote the incidence of vitamin K deficiency bleeding among babies given no prophylaxis as 10/1000 live births, citing the findings of the 1991 British Paediatric Surveillance Unit study.2 Table III of that paper quoted a “derived rate” for haemorrhagic disease of the newborn of > 8.63/100 000 newborn infants, or approximately 0.1/1000. Admittedly the possibility of underreporting makes this a minimum estimate, but it does not approach 10/1000. Was this an error, or have I misunderstood?
The second point relates to the sentence: “Breast feeding mothers are already advised to provide supplements of vitamins A, B, C, and D for their infants from the age of two months.” This is not supported by any citation and I am not aware of its origin. Recommendation 10 of the Department of Health’s publication Weaning and the weaning diet states “Breast fed infants under six months do not need vitamin supplementation provided the mother had an adequate vitamin status during pregnancy”.3 Supplementary vitamins A and D are recommended thereafter, and I know no evidence to support the routine use of vitamins B and C if the weaning diet is adequate.
Finally, I find it puzzling to argue that giving 25 μg phytomenadione daily must be safe purely because it is the dose in an infant formula. Is that really sufficient evidence? I also believe they considerably underestimate the likely effect of recommending daily vitamin supplements on uptake of breast feeding and so find an irony in their caveat “...but first do no harm”.