Belgian Consensus Recommendations to Prevent Vitamin K Deficiency Bleeding in the Term and Preterm Infant

Neonatal vitamin K prophylaxis is essential to prevent vitamin K deficiency bleeding (VKDB) with a clear benefit compared to placebo. Various routes (intramuscular (IM), oral, intravenous (IV)) and dosing regimens were explored. A literature review was conducted to compare vitamin K regimens on VKDB incidence. Simultaneously, information on practices was collected from Belgian pediatric and neonatal departments. Based on the review and these practices, a consensus was developed and voted on by all co-authors and heads of pediatric departments. Today, practices vary. In line with literature, the advised prophylactic regimen is 1 or 2 mg IM vitamin K once at birth. In the case of parental refusal, healthcare providers should inform parents of the slightly inferior alternative (2 mg oral vitamin K at birth, followed by 1 or 2 mg oral weekly for 3 months when breastfed). We recommend 1 mg IM in preterm <32 weeks, and the same alternative in the case of parental refusal. When IM is perceived impossible in preterm <32 weeks, 0.5 mg IV once is recommended, with a single additional IM 1 mg dose when IV lipids are discontinued. This recommendation is a step towards harmonizing vitamin K prophylaxis in all newborns.

Vitamin K prophylaxis in newborns

We looked at existing recommendations and supporting evidence on the effectiveness of vitamin K given after birth in preventing the haemorrhagic disease of the newborn (HDN).We conducted a literature search up to the 10th of December 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported.All newborns should receive vitamin K prophylaxis, as it has been proven that oral and intramuscular prophylactic vitamin K given after birth are effective for preventing classical HDN. There are no randomized trials looking at the efficacy of vitamin K supplement on late HDN. There are no randomized trials comparing the oral and intramuscular route of administration of prophylactic vitamin K in newborns. From older trials and surveillance data, it seems that there is no significant difference between the intramuscular and the oral regimens for preventing classical and late HDN, provided that the oral regimen is duly completed. Evidence assessing vitamin K prophylaxis in preterm infants is scarce.

INTRACEREBRAL BLEEDING IN LATE HEMORRHAGIC DISEASE OF THE NEWBORN

1 Vitamin K Ad Hoc Task Force. Controversies concerning vitamin K and the newborn. Pediatrics 1993; 91: 1001-1003. 2. Isarangkura PB, Pintadit P, Tejavej A, Siripoonya P. Chulajata C, Green GM. Vitamin K prophylaxis in the neonate by oral route and its significance in reducing infant mortality and morbidity. J Med Assoc Thai 1986; 69: 56-61. 3. Ijland MM, Pereira RR, Cornelissen EA. Incidence of late vitamin K deficiency bleeding in new-borns in the Netherlands in 2005: Evaluation of the current guideline. Eur J Paediatr 2008; 167: 165-169. 4. Waseem M. Vitamin K and hemorrhagic disease of new-borns. South Med J 2006; 99: 1199. 5. Lane PA, Hathaway WE. Vitamin K in infancy. J Pediatr 1985; 106: 351-359. 6. Singh M. Vitamin K during infancy: Current status and recommendations.Indian Pediatr 1997; 34: 708-712. 7. Bor O, Akgun N, Yakut A, et al. Late hemorrhagic disease of the new-born.Paediatr Int 2000; 42: 64-66. 8. D?Souza IE, Rao SD. Late hemorrhagic disease of new-born. Indian Paediatr 2003; 40: 226-229. 9. Flood VH, Galderisi FC, Lowas SR, et al. Hemorrhagic disease of the new-born despite vitamin K prophylaxis at birth. Paediatr Blood Cancer 2008; 50: 1075-1077. 10. Zengin E, Sarper N, Türker G, et al. Late haemorrhagic disease of the new- born. Ann Trop Paediatr 2006; 26: 225-231. 11. Sutor AH, Dagres N, Niederhoff H. Late form of vitamin K deficiency bleeding in Germany. KlinPediatr 1995; 207: 89-97