Article Text

Download PDFPDF
Delivering neonatal vitamin K prophylaxis: the continuing need for surveillance and vigilance
  1. Martin J Shearer
  1. Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
  1. Correspondence to Dr Martin J Shearer, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK; martin.shearer{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Vitamin K deficiency bleeding (VKDB) is a rare haemostatic disorder that occurs in the first 6 months of life and is subclassified, according to age of presentation, as either early, classical or late VKDB. Late VKDB (day 8 onwards) is the most insidious form, typically presenting between 3 weeks and 8 weeks in exclusively breastfed infants as an intracranial haemorrhage (ICH). Estimations of the prevalence of ICH as the first presenting symptom of late VKDB range from 40% to 80% in different populations1 and so preventing it is a major objective of global healthcare. Vitamin K prophylaxis was first introduced in the 1940s for the treatment and prevention of bleeding in the first week of life (classical VKDB). Because the early use of menadione (vitamin K3) often provoked neonatal haemolytic anaemia and kernicterus, it was replaced in the late 1950s by synthetic phylloquinone (vitamin K1), the major dietary form of vitamin K. By 1961, the American Academy of Pediatrics had concluded that a single intramuscular dose of 0.5–1.0 mg (or oral dose of 1.0–2.0 mg) vitamin K1 was ‘probably adequate for prophylaxis’. In Europe, the 1970s saw a decline in universal vitamin K prophylaxis in favour of selective prophylaxis for infants considered at risk (eg, preterms), a trend no doubt influenced by a supportive 1978 Editorial in the Lancet. This all changed with a spate of case reports from across the world (particularly in the Far East) of what came to be defined as late VKDB …

View Full Text

Linked Articles