Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition

  title={Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition},
  author={Walter Mihatsch and Christian P Braegger and Jiř{\'i} Bronsk{\'y} and Cristina Campoy and Magnus Domell{\"o}f and Mary S. Fewtrell and Nata{\vs}a Fidler Mis and Iva Hojsak and Jessie M Hulst and Flavia Indrio and Alexandre Lapillonne and Christian M⊘lgaard and Nicholas D. Embleton and Johannes B. van Goudoever},
  journal={Journal of Pediatric Gastroenterology and Nutrition},
ABSTRACT Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K… 

Belgian Consensus Recommendations to Prevent Vitamin K Deficiency Bleeding in the Term and Preterm Infant

It is recommended to recommend 1 mg IM in preterm <32 weeks, and the same alternative in the case of parental refusal, a step towards harmonizing vitamin K prophylaxis in all newborns.

Vitamin K prophylaxis in newborns

It seems that there is no significant difference between the intramuscular and the oral regimens for preventing classical and late HDN, provided that the oral regimen is duly completed.

Increasing the dose of oral vitamin K prophylaxis and its effect on bleeding risk

A sixfold increase in oral vitamin K prophylaxis was associated with a surprisingly modest reduction in the incidence of intracranial VKDB, indicating that factors other than the dose need addressing to improve efficacy.

Vitamin K deficiency: a case report and review of current guidelines

It is necessary to revise the current guidelines in order to standardize timing and dosage in different clinical conditions for vitamin K deficiency bleeding, as this case developed a VKDB.

Vitamin K deficiency bleeding in an apparently healthy newborn infant: the compelling need for evidence-based recommendation

The described infant did not show any pathological elements in pregnancy history or perinatal life which suggest a possible increased risk of bleeding and the needing of a particular approach in the administration of vitamin K1, but at the end of the first week of life presented an intracranial bleeding with neurological symptoms that required treatment for vitamin K deficiency.


The article presents modern approaches to the prevention of late bleeding associated with vitamin K deficiency, which is based on chronic problems of the digestive system – chronic cholestasis, cystic fibrosis and others.

The challenge to define the optimal prophylactic regimen for vitamin K deficiency bleeding in infants

The introduction of combined proPHylactic strategy with prolonged oral prophylaxes after the intramuscular dose at birth has showed a decrease of the late severe VKDB incidence, Nevertheless, there is still lack of consensus about the administration scheme after the first dose atBirth.

Physicians’ Opinion and Practice of Vitamin K Administration at Birth in Romania

Efforts should be made to address parents’ concerns and to have available alternatives to the intramuscular administration of vitamin K, due to the rising number of refusals by parents of basic interventions in the neonatal period.



Late Vitamin K Deficiency Bleeding in Infants Whose Parents Declined Vitamin K Prophylaxis — Tennessee, 2013

Administration of intramuscular vitamin K at birth to prevent all forms of vitamin K deficiency bleeding has been standard practice since first recommended by the American Academy of Pediatrics in 1961.

Prevention of Vitamin K Deficiency Bleeding in Breastfed Infants: Lessons From the Dutch and Danish Biliary Atresia Registries

A daily dose of 25 μg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia, and one milligram of weekly oral prophylaxis offers significantly higher protection to these infants and is of similar efficacy as 2 mg of intramuscular proPHylaxis at birth.

Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005: evaluation of the current guideline

Doubling the daily dose of vitamin K1 to 50 μg, as is comparable to formula-feeding, may possibly prevent VKDB in this group of breastfed infants; further research is needed to prove this hypothesis.

[New Dutch practice guideline for administration of vitamin K to full-term newborns].

After evaluation of current literature and advice from The Health Council of the Netherlands, vitamin K dosage was adapted for all breastfed infants from day 8 to 3 months (12th week of life) following birth: the daily dose was raised from 25 µg to 150 µg per day.

Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K

The Australian data confirm that three oral doses of 1 mg vitamin K are less effective than i.m. vitamin K prophylaxis, and the effectiveness of the “mixed-micellar” preparation of vitamin K1 needs further study.

Vitamin K deficiency bleeding (VKDB) in early infancy.

Controversies Concerning Vitamin K and the Newborn

Late HDN, a syndrome defined as unexpected bleeding due to severe vitamin K deficiency in infants aged 2 to 12 weeks, occurs primarily in exclusively breast-fed infants who have received no or inadequate neonatal vitamin K prophylaxis.

Weekly oral vitamin K prophylaxis in Denmark

Weekly oral prophylaxis was recommended for all infants as long as they were mainly breastfed, and compliance was good, with 94% of the infants completing the course of pro phytomenadione, followed by weekly oral vitamin K proPHylaxis.

Controversies concerning vitamin K and the newborn.

This revised statement presents updated recommendations for the use of vitamin K in the prevention of early and late VKDB.