Noteworthy Professional News
Laura A. Stokowski

Advances in Neonatal Care
April 2014 
Volume 14  Number 2
Pages 75 - 77
  PDF Version Available!

Late last year, the Centers for Disease Control and Prevention reported1 a cluster of cases of late-onset vitamin K-deficiency bleeding (VKDB) that occurred in 4 infants born in Nashville, Tennessee, whose parents had declined routine vitamin K prophylaxis in the newborn period.Late-onset VKDB is a coagulopathy that can occur in exclusively breastfed infants between the ages of 2 and 24 weeks, resulting in potentially life-threatening hemorrhage. The clinical presentation is severe, with intracranial hemorrhaging in 50%, and persistent neurological damage is common in survivors. Mortality rate is reported to be 20%.2 Like classic VKDB, late-onset VKDB is preventable with the administration of a single dose of parenteral (but not oral) vitamin K after birth.In the Tennessee cluster, the infants all had been developing normally until they exhibited sudden symptomatic bleeding at the age of 6 to 15 weeks. One of the 4 infants suffered a gastrointestinal hemorrhage, and the other 3 infants were diagnosed with diffuse intracranial hemorrhages. One of these infants is already showing signs of a gross motor deficit.The parents of the 4 infants with late-onset VKDB were asked why they declined vitamin K prophylaxis for their babies. Their reasons included concern about an increased risk for leukemia when vitamin K is administered, an impression that the injection was unnecessary, and a desire to minimize their newborn's exposure to "toxins."1 Most claimed to be unaware of the delayed risk for bleeding.Vitamin K administration has been a routine practice in newborn care since 1961. A records review conducted in 2013 showed that 3.4% of neonates were discharged from a Tennessee hospital and 28% from a Tennessee birth center without receiving vitamin K.1 It is tempting to speculate that parental refusal of vitamin K administration was responsible for these omissions; however, nationwide shortages of phytonadione were ongoing in 2013. Still, research suggests that even well-educated

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