Parenteral vitamin K most effective to prevent vitamin K deficiency bleeding in newborns: AAP

USA: In a new study conducted by Ivan Hand and team, it was shown that parenteral vitamin K is the most effective strategy to avoid vitamin K deficiency bleeding (VKDB) in newborns and young infants. The findings of this study were published in the American Academy of Pediatrics.

Since the American Academy of Pediatrics suggested it in 1961, intramuscular vitamin K injection for the prevention of vitamin K deficiency bleeding has been a standard of therapy. Despite the efficacy of vitamin K therapy in preventing VKDB, the incidence of VKDB appears to be increasing. This rise in VKDB incidence is due to parental rejection as well as the decreased efficacy of other ways of administration. The purpose of this statement is to convey current understanding of VKDB prophylaxis in term and preterm infants, as well as to address parental concerns about vitamin K supplementation.

Early-onset VKDB manifests itself within the first 24 hours of life. It is more common in moms who are taking drugs that interfere with vitamin K metabolism. Anticonvulsants, antibiotics, anti tuberculosis medicines, and warfarin are examples of these drugs. All of these drugs function by activating the CYP450 enzymes in the fetal liver. These newborns may exhibit symptoms ranging from cutaneous bruises to life-threatening cerebral bleeding.

The American Academy of Pediatrics (AAP) endorsed the use of vitamin K to prevent VKDB in 2003, recommending that all newborn newborns get a single IM dosage of 0.5 to 1.0 mg of vitamin K. While oral vitamin K appears to be beneficial in preventing typical VKDB, its potential to prevent late-onset VKDB is being questioned. Despite the use of multiple-dose oral regimens, failure to prevent late-onset VKDB remains a concern with oral prophylaxis. Late-onset VKDB was rare but nevertheless occurred in a Swiss trial utilizing two oral doses of 2 mg of vitamin K on day 1 and day 4, with an incidence of 3.79 per 100 000, and a three-dose strategy was later suggested.

Because of hematologic and hepatic immaturity, as well as a lack of appropriate gut microbial colonization, preterm newborns are possibly at the highest risk for VKDB. For preterm newborns weighing less than 1000 g, the AAP recommends a single IM dosage of vitamin K ranging from 0.3 to 0.5 mg/kg. Assessing and reacting to parenteral vitamin K problems are critical duties for paediatric providers. To make an educated decision concerning their newborn, parents must grasp the importance of vitamin K and have a fundamental understanding of its function. The Centers for Disease Control and Prevention has an outstanding information page about vitamin K. The dialogue should be tailored to the parent's level of comprehension, and it should include a discussion of both known advantages and potential hazards.

In conclusion, all newborn newborns weighing more than 1500 g should get a single intramuscular dosage of 1 mg of vitamin K within 6 hours after birth. Preterm newborns weighing 1500 g should get a single intramuscular dosage of vitamin K ranging from 0.3 mg/kg to 0.5 mg/kg. For premature newborns, a single intravenous dosage of vitamin K is not indicated for prophylaxis. Pediatricians and other health care professionals must be aware of the advantages of vitamin K delivery as well as the hazards of rejection and must notify the infant's carers of this information. Even in babies who received prophylaxis, and especially in exclusively breastfed infants, VKDB should be addressed when examining bleeding in the first 6 months of life.

Reference:

Hand I, Noble L, Abrams SA. Vitamin K and the Newborn Infant. Pediatrics. 2022 Mar 1;149(3):e2021056036. doi:10.1542/peds.2021-056036. PMID: 35190810.