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

Abstract

A daily dose of 25 microg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia. 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. Our data underline the fact that event analysis in specific populations at risk can help to evaluate and improve nationwide prophylactic regimens.

Prophylactic Dosing of Vitamin K to Prevent Bleeding

“…Previous studies showed that a weekly oral prophylaxis of 1 mg vitamin K in the first 3 months of life was highly effective in preventing VKDB. 13,22 The hypothesis at that time was that a weekly prophylaxis of 1 mg was more effective than 25 μg daily prophylaxis, as the cumulative dose per week was 6-fold higher in the weekly prophylaxis (1.05 vs 0.175 mg). Our present data clearly show that this hypothesis needs to be rejected.…”

“…13,18 In the current study, we used these data, enriched with updated results on the new regimens, to compare the efficacy of the adaptation with regard to protection against VKDB.…”

“…13 Together, these observations underline the need to understand in more detail, the absorption of vitamin K from the infant intestine, to prevent VKDB based on rational arguments.…”

“…In fact, in >80% of infants with biliary atresia (BA), severe late VKDB was the presenting symptom. 13 This observation was in sharp contrast to a very low incidence of VKDB as presenting symptom in BA patients in Denmark, where other prophylactic vitamin K regimens are used. [14][15][16][17] The risk of VKDB in Dutch breastfed BA patients was 8 to 10 times higher than that of Danish BA patients, on either a weekly oral dose of 1 mg vitamin K or a single IM dose of 2 mg vitamin K at birth.…”

Intracerebral Hemorrhage Despite Prophylactic Administration of Vitamin K in Infants -Two Case Reports-

“…Administration method (oral/intramuscular), duration, and dose differ from country to country. 3,4,14,15,18) However, recent epidemiological studies have provided a more reliable prophylactic method. Comparison of the risks of vitamin K deficiency bleeding under different prophylactic regimens in infants with biliary atresia found that a daily dose of 25 mg of vitamin K failed to prevent bleeding, but weekly oral administration of 1 mg of vitamin K offered significantly higher protection to these infants and provided similar efficiency to 2 mg of intramuscular prophylaxis at birth.…”