Prophylactic Dosing of Vitamin K to Prevent Bleeding

BACKGROUND AND OBJECTIVES: Based on a high incidence of Vitamin K deficiency bleeding (VKDB) in breastfed infants with thus far unrecognized cholestasis, such as biliary atresia (BA), the Dutch regimen to prevent VKDB in breastfed infants was changed from a daily oral dosage of 25 mu g to 150 mu g vitamin K. Infants continued to receive 1 mg of vitamin K orally at birth. We compared the efficacy of the 150-mu g regimen with the 25-mu g regimen and with the Danish regimen of a single intramuscular (IM) dose of 2 mg vitamin K at birth. METHODS: Data were retrieved from the national BA registries: 25 mu g group (Netherlands, January 1991 to February 2011); 150 mu g group (Netherlands, March 2011 to January 2015); and IM 2 mg group (Denmark, July 2000 to November 2014). We compared the incidence of VKDB in the groups. RESULTS: VKDB occurred in 45 of 55 (82%) infants of the 25 mu g group, in 9 of 11 (82%) of the 150 mu g group, but in only 1 of 25 (4%) of the IM 2 mg group (P<.001). Forty percent of all infants of the 25 mu g group had an intracranial hemorrhage as presenting symptom, compared with 27% of the infants of the 150 mu g group (P=.43). Intracranial hemorrhage was not observed in the IM 2 mg group (0%; P<.001). CONCLUSIONS: A vitamin K prophylactic regimen of 1 mg of vitamin K orally at birth followed by a daily oral dosage of either 25 or 150 mu g fails to prevent VKDB in breastfed infants with still unrecognized BA. The data support 2 mg vitamin K IM at birth as prophylaxis against VKDB.