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Over 10 years ago, William Hathaway described the 50-year chequered history of the association between a neonatal bleeding disorder and vitamin K deficiency and its prevention as a splendid example of the cyclical nature of discovery–rediscovery in medical science.1 The lessons that should have been learnt from the extensive body of early work were reiterated in a recent lively review in this journal.2 In the UK these forgotten lessons first resurfaced in a 1983 Lancet article entitled “Haemorrhagic disease of the newborn returns”.3 Of course this rare deficiency syndrome, now more accurately termed vitamin K deficiency bleeding (VKDB), had never gone away but had merely been rediscovered at a time of a progressive trend towards exclusive breast feeding. The latter had long since been established as an important risk factor for neonatal hypoprothrombinaemia.4
The 1983 Lancet paper was the catalyst for three prospective 2-year surveys of VKDB bleeding in the British Isles, with the results from 1993–94 and 2001–02 studies now reported in this issue by McNinch et al.5 In an accompanying paper, the same authors present data from a 2003 survey of prophylaxis practices in the UK and review the efficacy of regimens used.6 These papers are timely because a new 2-year BPSU survey of VKDB commenced in October 2006. This fourth survey was precipitated by the replacement of the phytomenadione formulation, Konakion Neonatal Ampoules, by Konakion MM, which is now the only vitamin K product licensed in the UK for parenteral or oral administration. The difference between the two preparations lies in the nature of the solubilising agent. The original preparation introduced in the 1960s contained the artificial emulsifier polyethoxylated castor oil (Cremophor …
Competing interests: PC received a travel bursary from Roche (UK) Ltd in 2004 to present a research study of Konakion Neonatal in preterm infants at an international meeting. MJS received laboratory funding from F. Hoffmann-La Roche Ltd, Basel, Switzerland for performing analytical assays (vitamin K1 and PIVKA-II) for pre- and post-licensing studies of Konakion MM Paediatric.