Throughout Japan a total of 543 cases of vitamin K deficiency occurring in infants over 2 weeks of age were reported from January 1981 to June 1985. Of these cases, 427 showed no obvious reasons for vitamin K deficiency; this sort of case is known as "idiopathic vitamin K deficiency in infancy". Another 57 cases had bleeding episodes due to vitamin K deficiency associated with obvious hepatobiliary lesions, chronic diarrhoea, long-term antibiotic therapy, etc; this sort is called "secondary vitamin K deficiency in infancy". The third group, consisting of 59 cases, was made up of the so-called "near miss" type, in which a haemorrhagic tendency, without any obvious clinical haemorrhage, was discovered by Normotest, at the time of mass screening in most cases. In the idiopathic group, 269 cases (63.0%) developed bleeding episodes between the 1st and 2nd months of age, and 387 cases (90.0%) were entirely breast-fed. Intracranial haemorrhage was observed in 353 cases (82.7%) of this group. Moreover, slight elevation of serum transaminase and direct type bilirubin levels were observed in the idiopathic group. Liver dysfunction of unknown origin may play some role in the onset of vitamin K deficiency in infancy.
Questionnaires were sent to 1,218 hospitals with more than 200 beds, in order to know the incidence of hemorrhagic disease due to vitamin K deficiency in infancy beyond 2 weeks after birth, during 4 and a half years, i.e. from January 1981 to June 1985. Out of the 534 cases reported, 407 had no obvious reasons for vitamin K deficiency: "idiopathic vitamin K deficiency in infancy". Other 68 cases had bleedingepisodes due to vitamin K deficiency associated with hepatobiliary lesions (e.g.congenital bile duct atresia), chronic diarrhea, long term antibiotic therapy and so on: "secondary vitamin K deficiencyin infancy". The third group consisting of 59 cases was so called "near miss" type, in which hemorrhagic tendency was discovered at the time of mass screening tests for vitamin K deficiency or by chance withoutany clinical hemorrhage. In the idiopatic group, 345 cases (84.8%) developed their bleeding episodes between 21 and 59 days of age, and 368 cases (90.4%) were wholly breast-fed. Intracranial hemorrhage was seen in 338 cases (83.0%) of this group. In most cases of this series (97.3%),no vitamin K was supplemented after birth. Administration of vitamin K is an urgent routine procedure during the first one or two months of life for all newbornbabies, although the incidence of the idiopathic vitamin K deficiency in infancyhas not decreased significantly comparedto the results of the first nation-wide survey (Jan. 1978 - Dec. 1980). This study was sponsored by the Ministry of Health and Welfare of Japan.
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