Late onset haemorrhagic disease in premature infants who received intravenous vitamin K-1

The clinical details are reported of two premature infants who developed late onset haemorrhagic disease after receiving their initial doses of vitamin K-1 prophylaxis intravenously. Both reported infants had received two doses of intravenous vitamin K-1, 0.1 mg, in the Ist week of life, and a further oral dose, 1.0 mg, at 4 weeks. Bleeding due to vitamin K deficiency occurred on days 74 and 84, respectively. Vitamin K deficiency bleeding is rare in low birthweight infants, probably because it has been routine practice to give such infants intramuscular vitamin K-1. One of the reported infants had cytomegalovirus hepatitis, the other did not have liver disease. These findings could be explained if intramuscular vitamin K-1 were to have a longer duration of effect than intravenous vitamin K-1. This may be because intramuscular vitamin K-1 acts as a depot preparation. The findings suggest that intravenous vitamin K-1 is less effective than intramuscular for long-term prophylaxis against late onset haemorrhagic disease. Intravenous vitamin K-1 should not be used for long-term prophylaxis in the prevention of late onset haemorrhagic disease.