Vitamin K deficiency bleeding in infants tied to insufficient parent knowledge of risks



More than a quarter of infants born in Nashville area birthing centers – eight times the rate among infants born in one Nashville area hospital – did not receive vitamin K after birth in 2013 because parents declined it, a study has found.

The findings resulted from an investigation following four Nashville cases of late vitamin K deficiency bleeding in infants whose parents declined postpartum vitamin K administration, reported Dr. Michael Warren and his colleagues at the Centers for Disease Control and Prevention (MMWR 2013;62:901-2). No cases were found from 2007 to 2012 among Tennessee hospital discharge data.

Dr. Warren’s team found, based on random sampling, that 3.4% of 3,080 infants born in one of three Nashville area hospitals surveyed and 28% of 218 infants born in four Tennessee nonhospital birthing centers did not receive intramuscular vitamin K after birth.

The parents of these children identified "concern about an increased risk for leukemia when vitamin K is administered, an impression that the injection was unnecessary, and a desire to minimize the newborn’s exposure to ‘toxins’ " as reasons for declining vitamin K administration after birth.

The survey of Nashville neonates was initiated after four confirmed cases of late vitamin K deficiency bleeding were diagnosed between February and September 2013 at a Nashville children’s hospital.

"The four infants had laboratory-confirmed coagulopathy, defined as elevation of prothrombin time greater than or equal to four times the laboratory limit of normal, correctable by vitamin K administration, and symptomatic bleeding," the report noted.

Among the infants, diagnosed between 6 and 15 weeks old, one had gastrointestinal bleeding and three had diffuse intracranial hemorrhage. All survived, but one with intracranial hemorrhage has an apparent gross motor deficit, and all three with hemorrhage are being followed by neurologists. The parents had been unaware of vitamin K deficiency bleeding risks.

Intramuscular vitamin K injections have been recommended by the American Academy of Pediatrics since 1961 to prevent vitamin K deficiency bleeding.

Early vitamin K deficiency bleeding occurs within 24 hours of birth, primarily in infants whose mothers took medication that inhibits vitamin K, such as antiepileptics or isoniazid, during pregnancy. Classic cases can occur within the first week of life as a result of natural vitamin K level decreases, and late cases generally occur between 2 and 24 weeks after birth, primarily in infants with liver disease or related conditions. Classic cases occur in 0.25%-1.7% of births without vitamin K administration. Late vitamin K deficiency bleeding occurs among 4.4-7.2 per 100,000 infants without vitamin K administration.

Other than one 1992 report in the British Medical Journal, whose findings have not been replicated, no other studies have found an association between vitamin K injections and childhood cancer (BMJ 1992;305:341-6).

Funding for the current report came from the Centers for Disease Control and Prevention.

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