Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e857-e863 (doi:10.1542/peds.2007-1788)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by van Hasselt, P. M. Search for Related Content PubMed PubMed Citation Articles by van Hasselt, P. M. Related Collections Nutrition & Metabolism Social Bookmarking                         What's this?

ARTICLE

Prevention of Vitamin K Deficiency Bleeding in Breastfed Infants: Lessons From the Dutch and Danish Biliary Atresia Registries

Peter M. van Hasselt, MD^a, Tom J. de Koning, MD, PhD^a, Nina Kvist, MD^b, Elsemieke de Vries, BS^c, Christina Rydahl Lundin, BS^d, Ruud Berger, MD, PhD^e, Jan L. L. Kimpen, MD, PhD^a, Roderick H. J. Houwen, MD, PhD^a, Marianne Horby Jorgensen, MD, PhD^d, Henkjan J. Verkade, MD, PhD^c and the Netherlands Study Group for Biliary Atresia Registry

^a Department of Pediatrics, Wilhelmina Children's Hospital
^e Laboratory for Metabolic Diseases, University Medical Center Utrecht, Utrecht, Netherlands
^b Departments of Pediatric Surgery
^d Pediatrics, University Hospital of Copenhagen, Copenhagen, Denmark
^c Department of Pediatrics, University Medical Center Groningen, Groningen, Netherlands

OBJECTIVE. Newborns routinely receive vitamin K to prevent vitamin K deficiency bleeding. The efficacy of oral vitamin K administration may be compromised in infants with unrecognized cholestasis. We aimed to compare the risk of vitamin K deficiency bleeding under different propylactic regimens in infants with biliary atresia.

PATIENTS AND METHODS. From Dutch and Danish national biliary atresia registries, we retrieved infants who were either breastfed and received 1 mg of oral vitamin K at birth followed by 25 µg of daily oral vitamin K prophylaxis (Netherlands, 1991–2003), 2 mg of oral vitamin K at birth followed by 1 mg of weekly oral prophylaxis (Denmark, 1994 to May 2000), or 2 mg of intramuscular prophylaxis at birth (Denmark, June 2000–2005) or were fed by formula. We determined the absolute and relative risk of severe vitamin K deficiency and vitamin K deficiency bleeding on diagnosis in breastfed infants on each prophylactic regimen and in formula-fed infants.

RESULTS. Vitamin K deficiency bleeding was noted in 25 of 30 of breastfed infants on 25 µg of daily oral prophylaxis, in 1 of 13 on 1 mg of weekly oral prophylaxis, in 1 of 10 receiving 2 mg of intramuscular prophylaxis at birth, and in 1 of 98 formula-fed infants (P < .001). The relative risk of a bleeding in breastfed compared with formula-fed infants was 77.5 for 25 µg of daily oral prophylaxis, 7.2 for 1 mg of weekly oral prophylaxis, and 9.3 for 2 mg of intramuscular prophylaxis at birth.

CONCLUSIONS. A daily dose of 25 µg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia. One milligram of weekly oral prophylaxis offers significantly higher protection to these infants and is of similar efficacy as 2 mg of intramuscular prophylaxis at birth. Our data underline the fact that event analysis in specific populations at risk can help to evaluate and improve nationwide prophylactic regimens.

---

Key Words: breastfeeding • liver disease • prophylaxis • surveillance and monitoring • vitamin deficiency

Abbreviations: VKD—vitamin K deficiency • VKDB—vitamin K deficiency bleeding • IM—intramuscular • PR—prothrombin ratio • PT—prothrombin time • RR—relative risk • CI—confidence interval • OR—odds ratio

---

Accepted Sep 17, 2007.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				P M van Hasselt, K Kok, A D M Vorselaars, L van Vlerken, E Nieuwenhuys, T J de Koning, R A de Vries, and R H J Houwen Vitamin K deficiency bleeding in cholestatic infants with alpha-1-antitrypsin deficiency Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2009; 94(6): F456 - F460. [Abstract] [Full Text] [PDF]

				E. Hey Making Life Safe for Canaries Pediatrics, May 1, 2008; 121(5): 1048 - 1049. [Full Text] [PDF]