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Vitamin K deficiency bleeding in Australian infants 1993–2017: an Australian Paediatric Surveillance Unit study
  1. Yvonne Zurynski1,2,
  2. Cameron J Grover3,
  3. Bin Jalaludin4,5,
  4. Elizabeth J Elliott1,6,7
  1. 1Australian Paediatric Surveillance Unit, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Australian Institute of Health Innovation, Partnership Centre in Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
  3. 3Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  4. 4Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
  5. 5School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  6. 6Faculty of Medicine and Health, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
  7. 7Kids Research, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
  1. Correspondence to Professor Elizabeth J Elliott, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales 2006, Australia; elizabeth.elliott{at}health.nsw.gov.au

Abstract

Objective To undertake surveillance of vitamin K deficiency bleeding (VKDB) in Australia from 1993 to 2017, during a time of change to national recommendations and available vitamin K formulations.

Methods Paediatricians reported cases of VKDB in infants aged <6 months and provided demographic, clinical and biochemical information via the Australian Paediatric Surveillance Unit.

Results 58 cases were reported, of which 5 (9%) were early, 11 (19%) classic and 42 (72%) late VKDB. 53 (91%) were exclusively breast fed. Seven (12%) received oral prophylaxis, the majority (86%) of whom did not receive all three recommended doses. The overall reported incidence was 0.84 per 100 000 live births (95% CI: 0.64 to 1.08) and the incidence of late VKDB was 0.61 per 100 000 live births (95% CI: 0.44 to 0.82), which are similar to rates reported by other countries where intramuscular vitamin K is recommended. VKDB rates were significantly higher (2.46 per 100 000 live births; 95% CI: 1.06 to 4.85) between 1993 and March 1994 when oral prophylaxis was recommended (p<0.05). Vitamin K was not given to 33 (57%) cases, primarily due to parental refusal, and the number of parental refusals increased significantly after 2006 (p<0.05). There were six deaths, all due to intracranial haemorrhage, and three associated with home delivery and parental refusal of vitamin K.

Conclusions Incidence rates of VKDB in Australia are among the lowest in the world; however, we have identified an increasing trend of parental refusal. Ongoing surveillance and educational campaigns for health professionals and parents are needed to prevent VKDB.

  • neonatology
  • epidemiology
  • vitamin K deficiency bleeding
  • surveillance
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Footnotes

  • YZ and CJG are joint first authors.

  • Contributors EE and BJ developed the original study protocol and have been involved in collection, analysis and interpretation of data since 1993. CG,YZ and BJ analysed and interpreted data and drafted the manuscript which has had input from all authors.CG and YZ are joint first authors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received approval from the Sydney Children’s Hospitals Network Human Research Ethics Committee (Approval number: 2006–062).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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