Current practice of neonatal vitamin K prophylaxis in Irish hospitals - A survey

Objective: To compare the variation in the dose, route, number of doses and frequency of Vitamin K administration in newborns as a prophylaxis against haemorrhagic disease of newborn (HDN) practiced nationwide in the Republic of Ireland. Method: We collected information using a simple questionnaire from 23 maternity units regarding the dose, frequency, route and time of administration of Vitamin K for neonatal prophylaxis and compared the range of practices and policies as applied in the different Irish Hospitals. Data was collected during February and March of 2001. Results: Response rate to the survey was 100%. This reflects approximately 53,600 infants born annually in Ireland. In all the 23 maternity units we have surveyed, Vitamin K is administered routinely to all newborns. However for term infants 47.8% administer 1mg (intra-muscular) while 0.5mg (intra-muscular) & 2mg (oral) are being administered in 30.4% & 21.7% units respectively. 78.3% of the Hospitals prefer the intra-muscular (IM) route while only 21.7% preferred oral administration. There was no difference in regime depending on whether an infant was breast or bottle-fed among the term neonates. Among the preterm infants 0.5mg is administered by 61% of the units for breastfed while 65.2% hospitals give 0.5 mg to bottle-fed. 1 mg (total dose) and 0.4 mg / kg is preferred by 21.7% and 13.0% of the Hospitals respectively for both breast & bottle fed preterms and 4.3% Hospitals give 2mg (oral) to breastfed preterms. The preferred route of administration for breastfed preterms is IM in 87% of the surveyed units and oral in 13.0%. Among the bottle-fed preterms and mode of administration is IM in 91.3% of the units and oral in 8.7%. Conclusion: The survey highlights the lack of nationwide consensus on the dose, route, number of doses and dose frequencies regarding Vitamin K administration as a prophylaxis for the haemorrhagic disease of newborn. There is a need for a single guideline to be followed as in countries like UK, so that every baby born in Ireland gets similar benefit from prophylaxis based on the best available evidence.