Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN Committee on Nutrition

Walter Mihatsch; Christian Braegger; Jiri Bronsky; Cristina Campoy; Magnus Domellöf; Mary Fewtrell; Nataša Fidler Mis; Iva Hojsak; Jessie M Hulst; Flavia Indrio; Alexandre Lapillonne; Christian Mølgaard; Nick Embleton; Johannes B van Goudoever; ESPGHAN Committee on Nutrition

doi:10.1097/MPG.0000000000001232

Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN Committee on Nutrition

Walter Mihatsch, Christian Braegger, Jiri Bronsky, Cristina Campoy, Magnus Domellöf, Mary Fewtrell, Nataša Fidler Mis, Iva Hojsak, Jessie M Hulst, Flavia Indrio, Alexandre Lapillonne, Christian Mølgaard, Nick Embleton, Johannes B van Goudoever, ESPGHAN Committee on Nutrition

Lifecourse Nutrition & Health

36 Citations (Scopus)

Abstract

Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K prophylaxis and the date, dose, and mode of administration should be documented. Parental refusal of vitamin K prophylaxis after adequate information is provided should be recorded especially because of the risk of late VKDB. Healthy newborn infants should either receive 1 mg of vitamin K 1 by intramuscular injection at birth; or 3×2 mg vitamin K 1 orally at birth, at 4 to 6 days and at 4 to 6 weeks; or 2 mg vitamin K 1 orally at birth, and a weekly dose of 1 mg orally for 3 months. Intramuscular application is the preferred route for efficiency and reliability of administration. The success of an oral policy depends on compliance with the protocol and this may vary between populations and healthcare settings. If the infant vomits or regurgitates the formulation within 1 hour of administration, repeating the oral dose may be appropriate. The oral route is not appropriate for preterm infants and for newborns who have cholestasis or impaired intestinal absorption or are too unwell to take oral vitamin K 1, or those whose mothers have taken medications that interfere with vitamin K metabolism. Parents who receive prenatal education about the importance of vitamin K prophylaxis may be more likely to comply with local procedures.

Original language	English
Journal	Journal of Pediatric Gastroenterology and Nutrition
Volume	63
Issue number	1
Pages (from-to)	123-129
Number of pages	7
ISSN	0277-2116
DOIs	https://doi.org/10.1097/MPG.0000000000001232
Publication status	Published - 1 Jul 2016

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Mihatsch, W., Braegger, C., Bronsky, J., Campoy, C., Domellöf, M., Fewtrell, M., Mis, N. F., Hojsak, I., Hulst, J. M., Indrio, F., Lapillonne, A., Mølgaard, C., Embleton, N., van Goudoever, J. B., & ESPGHAN Committee on Nutrition (2016). Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 63(1), 123-129. https://doi.org/10.1097/MPG.0000000000001232

Mihatsch, W, Braegger, C, Bronsky, J, Campoy, C, Domellöf, M, Fewtrell, M, Mis, NF, Hojsak, I, Hulst, JM, Indrio, F, Lapillonne, A, Mølgaard, C, Embleton, N, van Goudoever, JB & ESPGHAN Committee on Nutrition 2016, 'Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN Committee on Nutrition', Journal of Pediatric Gastroenterology and Nutrition, vol. 63, no. 1, pp. 123-129. https://doi.org/10.1097/MPG.0000000000001232

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abstract = "Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K prophylaxis and the date, dose, and mode of administration should be documented. Parental refusal of vitamin K prophylaxis after adequate information is provided should be recorded especially because of the risk of late VKDB. Healthy newborn infants should either receive 1 mg of vitamin K 1 by intramuscular injection at birth; or 3×2 mg vitamin K 1 orally at birth, at 4 to 6 days and at 4 to 6 weeks; or 2 mg vitamin K 1 orally at birth, and a weekly dose of 1 mg orally for 3 months. Intramuscular application is the preferred route for efficiency and reliability of administration. The success of an oral policy depends on compliance with the protocol and this may vary between populations and healthcare settings. If the infant vomits or regurgitates the formulation within 1 hour of administration, repeating the oral dose may be appropriate. The oral route is not appropriate for preterm infants and for newborns who have cholestasis or impaired intestinal absorption or are too unwell to take oral vitamin K 1, or those whose mothers have taken medications that interfere with vitamin K metabolism. Parents who receive prenatal education about the importance of vitamin K prophylaxis may be more likely to comply with local procedures.",

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AU - Campoy, Cristina

AU - Domellöf, Magnus

AU - Fewtrell, Mary

AU - Mis, Nataša Fidler

AU - Hojsak, Iva

AU - Hulst, Jessie M

AU - Indrio, Flavia

AU - Lapillonne, Alexandre

AU - Mølgaard, Christian

AU - Embleton, Nick

AU - van Goudoever, Johannes B

AU - ESPGHAN Committee on Nutrition

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N2 - Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K prophylaxis and the date, dose, and mode of administration should be documented. Parental refusal of vitamin K prophylaxis after adequate information is provided should be recorded especially because of the risk of late VKDB. Healthy newborn infants should either receive 1 mg of vitamin K 1 by intramuscular injection at birth; or 3×2 mg vitamin K 1 orally at birth, at 4 to 6 days and at 4 to 6 weeks; or 2 mg vitamin K 1 orally at birth, and a weekly dose of 1 mg orally for 3 months. Intramuscular application is the preferred route for efficiency and reliability of administration. The success of an oral policy depends on compliance with the protocol and this may vary between populations and healthcare settings. If the infant vomits or regurgitates the formulation within 1 hour of administration, repeating the oral dose may be appropriate. The oral route is not appropriate for preterm infants and for newborns who have cholestasis or impaired intestinal absorption or are too unwell to take oral vitamin K 1, or those whose mothers have taken medications that interfere with vitamin K metabolism. Parents who receive prenatal education about the importance of vitamin K prophylaxis may be more likely to comply with local procedures.

AB - Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K prophylaxis and the date, dose, and mode of administration should be documented. Parental refusal of vitamin K prophylaxis after adequate information is provided should be recorded especially because of the risk of late VKDB. Healthy newborn infants should either receive 1 mg of vitamin K 1 by intramuscular injection at birth; or 3×2 mg vitamin K 1 orally at birth, at 4 to 6 days and at 4 to 6 weeks; or 2 mg vitamin K 1 orally at birth, and a weekly dose of 1 mg orally for 3 months. Intramuscular application is the preferred route for efficiency and reliability of administration. The success of an oral policy depends on compliance with the protocol and this may vary between populations and healthcare settings. If the infant vomits or regurgitates the formulation within 1 hour of administration, repeating the oral dose may be appropriate. The oral route is not appropriate for preterm infants and for newborns who have cholestasis or impaired intestinal absorption or are too unwell to take oral vitamin K 1, or those whose mothers have taken medications that interfere with vitamin K metabolism. Parents who receive prenatal education about the importance of vitamin K prophylaxis may be more likely to comply with local procedures.

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ER -

Prevention of vitamin K deficiency bleeding in newborn infants: a position paper by the ESPGHAN Committee on Nutrition

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