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Vitamin K deficiency bleeding in the Great Britain and Ireland; British Paediatric Surveillance Unit Surveys, 1993 – 94 and 2001 – 02.
  1. Andrew McNinch (andrew.mcninch{at}rdeft.nhs.uk)
  1. Royal Devon & Exeter NHS Foundation Trust, United Kingdom
    1. Alison Busfield (alison.busfield{at}rdehc-tr.swest.nhs.uk)
    1. Royal Devon and Exeter NHSFT, United Kingdom
      1. John H Tripp (jhtripp{at}ex.ac.uk)
      1. Peninsula Medical School, United Kingdom

        Abstract

        Objective: To conduct and report monitoring of vitamin K deficiency bleeding (VKDB) in Great Britain and Ireland as follow-up to 1988-90 survey (VKDB-90).

        Design: Two further 2-year surveys conducted using BPSU methodology during 1993-4 (VKDB-94) and 2001-02 (VKDB-02).

        Setting: Data collected from all consultant paediatricians in Great Britain and Ireland

        Patients: All infants presenting with bleeding resulting from deficiency of vitamin K (VK)

        Main outcome measures: Incidence of VKDB, related mortality/morbidity and VK prophylaxis recommended/received, noting predisposing features.

        Results: Compared with the previous studies, VKDB-02 found fewer cases of VKDB (RR: 0.27(CI: 0.12-0.59) P < 0.001) with no deaths, no long-term morbidity and a reduced incidence among those receiving any oral dosing (RR: 0.24(CI:0.06-1.01) P<0.059). As before, breast fed infants accounted for the vast majority of cases. In the three studies the number of cases who had received no prophylaxis fell consecutively: 20 of 27 in VKDB-90, 10 of 32 in VKDB-94 and 4 of 7 in VKDB-02. In all the latter 4 the reason for receiving no prophylaxis was parental refusal. Those who had received just one oral dose of VK numbered 7 in VKDB-90, 16 in VKDB-94 and none in VKDB-02. Underlying liver disease likely to be relevant was found in 6 cases in VKDB-90, 12 in VKDB-94 and one in VKDB-02.

        Conclusions: In the most recent survey the incidence of VKDB was about one third that in the two earlier studies. Late onset VKDB remains virtually confined to breast fed infants who have received either no VK or, historically, just one oral dose. Effectiveness of oral prophylaxis regimens, even in the presence of liver disease, has improved over the last 15 years but parental refusal of prophylaxis has become more problematic.

        • bleeding
        • infants
        • intracranial haemorrhage
        • prevention
        • vitamin-K-deficiency

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