Prevention of vitamin K deficiency bleeding with oral mixed micellar phylloquinone: results of a 6-year surveillance in Switzerland

Abstract

two oral doses of 2 mg of a mixed micellar vitamin K preparation failed to abolish VKDB. The recommendations for vitamin K prophylaxis in Switzerland have therefore been changed to include a third dose at 4 weeks of age. Starting on January 1, 2004, the incidence of vitamin K deficiency bleeding will again be monitored prospectively by the Swiss Paediatric Surveillance Unit.

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

“…3,9,15 The method presented here, comparison of well-delineated and homogeneous risk populations, may be very helpful in this respect. In contrast to nationwide surveillance studies, which are sensitive to underreporting, 3,12 it seems to be a reliable method to detect prophylactic failures.…”

“…[12][13][14] However, prophylactic failures have continued to occur, mostly in infants who later proved to have a cholestatic liver disease. 3,9,[15][16][17][18] Cholestatic infants are especially sensitive to suboptimal vitamin K availability, because the absence of intestinal bile greatly reduces the absorption of vitamin K and other fat-soluble vitamins. 19,20 The repeated occurrence of prophylactic failures in infants with unrecognized cholestatic liver disease warrants careful evaluation of the efficacy of vitamin K prophylactic regimens in these infants.…”

Vitamin K deficiency bleeding in cholestatic infants with alpha-1-antitrypsin deficiency

“…However, the formulation which significantly11 protected cholestatic infants is no longer commercially available. As surveillance data indicate that a mixed micellar formulation is equally effective,5 7 we suggest using this.…”

“…However, ongoing vitamin K supplementation is necessary to prevent VKD bleeding after the first week of life (late VKDB) in breastfed babies having oral prophylaxis. Even with these regimens some infants do develop late VKD bleeding, usually due to unrecognised cholestasis causing vitamin K malabsorption 5 6 7 8. As late VKD bleeding is associated with intracranial haemorrhage (ICH)—resulting in significant mortality and long term morbidity—in approximately 50% of cases,9 10 11 it is especially important to prevent this complication.…”

“…VKD bleeding has also been described in infants with various other forms of neonatal cholestasis,5 6 7 8 but it is unknown whether the risk of VKD bleeding in these forms is equally high. In these other causes of cholestasis (and contrary to BA) obstruction of bile flow is generally incomplete, allowing some bile to enter the duodenal lumen.…”