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Medicines update
Fifteen-minute guide: Vitamin K administration in neonates: the challenges clinicians face
  1. Anne Haddick,
  2. Sarah Berry,
  3. David G Sweet
  1. Neonatal Unit, Royal Jubilee Maternity Service, Belfast, UK
  1. Correspondence to Dr Anne Haddick, Neonatal Unit, Royal Jubilee Maternity Service, Belfast, UK; annehaddick18{at}gmail.com

https://doi.org/10.1136/archdischild-2020-321388

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    Scenario

    A mother of a baby boy born at 36 weeks’ gestation is declining vitamin K administration. The baby is well and has no family history. The mother says that there is not enough evidence to prove that vitamin K works and is worried about the risk of cancer. The clinician’s job is to present and weigh up the current evidence on neonatal administration of vitamin K.

    Introduction

    Vitamin K deficiency bleeding (VKDB) is a rare but potentially fatal haemostatic disorder. It manifests as bleeding at multiple sites in otherwise healthy infants.1 It occurs in the first 6 months of life and is almost entirely preventable by administration of vitamin K prophylaxis at birth. As bleeding can occur until 6 months of age, the previous term haemorrhagic disease of new-born was replaced by VKDB.2 It is subclassified according to the age of onset of bleeding; early (within the first 24 hours), classical (days 1–7) and late (week 1–6 months of age).1

    Pathophysiology

    Vitamin K represents a group of essential cofactors for the activation of proteins which are involved in blood coagulation, including factor II, VII, IX, X, protein C, protein S and protein Z.3 Vitamin K is necessary for the synthesis of coagulation factors in the liver.4

    Babies are deficient in vitamin K at birth, therefore leading to the increased risk of bleeding. Most vitamin K in adults and children is sourced through the diet, for example, leafy green vegetables.3 Neonates acquire their vitamin K by transfer through the placenta. The rate of this transfer is extremely low.5 Preterm infants are at an even greater risk of vitamin K deficiency due to various factors, including delayed feeding and therefore delayed gastric colonisation with microflora which produce vitamin K.4 The immature …

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    Footnotes

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    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.