Credit: Petr Kratochvil
Physicians at a Tennessee hospital have seen a rise in late-onset vitamin K deficiency bleeding (VKDB) in young infants, due to parents declining a vitamin K shot at birth.
Over a period of 8 months, 7 infants were diagnosed with vitamin K deficiency, and 5 of them had VKDB.
Four of the infants experienced intracranial hemorrhaging, and 2 required urgent neurosurgical intervention.
These cases were diagnosed at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville.
And they were described in Pediatric Neurology.
Now, the authors are calling for a state and national tracking system to help them determine how many infants are not receiving a vitamin K shot at birth.
“There is no national tracking of this in the US, unfortunately, and cases are rarely reported,” said Robert Sidonio Jr, MD, of Vanderbilt University School of Medicine.
“We are probably just seeing the tip of the iceberg, and I worry that people are missing these cases often and not considering this diagnosis when presented with a sick infant.”
He and his colleagues are also calling for better education on this issue for healthcare providers and families. The group believes misinformation—that the shot causes leukemia, is a toxin, or is unnecessary in uncomplicated births—may be leading some families to decline the shot.
The American Academy of Pediatrics has recommended the single-dose shot of vitamin K at birth since 1961. Most cases of VKDB seen today occur in infants in the first 6 months of life who did not get the shot and are exclusively breastfed or who have an undiagnosed liver disorder.
Following a recent rise in cases in Tennessee, the US Centers for Disease Control and Prevention discovered that 28% (61/218) of parents of children born at private birthing centers in the state declined the shot.
Mark and Melissa Knotowicz declined the shot for their twins, Silas and Abel, following their birth last July at a Nashville hospital.
“From the information we had, we heard the main side effect was a preservative in the shot that could lead to childhood leukemia,” said Mark Knotowicz. “We thought, ‘We don’t want our kids to have childhood leukemia,’ so we declined it without really hearing any of the benefits.”
At about 6 weeks old, Silas was noticeably fussy. He vomited overnight, woke up extremely pale, and wouldn’t nurse.
The twins had a checkup scheduled that day. The pediatrician suspected sepsis and told the Knotowiczes to take Silas to the Emergency Department at Monroe Carell Jr. Children’s Hospital.
Because of a rash of VKBD cases, the staff there had received additional education. After Silas’s parents confirmed that he had not received the vitamin K shot, CT scans and blood work revealed he had suffered multiple brain bleeds.
Silas received a double dose of vitamin K to get the bleeding under control. His twin, Abel, was diagnosed with asymptomatic vitamin K deficiency and received the shot.
Silas spent a week in the hospital. Today, he undergoes physical therapy for neuromuscular development issues. Any effects on cognitive development aren’t yet known.
“The twins’ cases highlight our inability to determine which infants will go on to develop vitamin K deficiency bleeding, as they both had prolonged bleeding times at presentation,” Dr Sidonio said.
Mark Knotowicz wishes medical staff at the birthing hospital had more clearly defined the risks of declining the shot.
“Why didn’t they say, ‘There have been 4 other cases in Nashville, and we’re trying to prevent a lethal brain hemorrhage in your child?’”
Anna Morad, MD, of the Vanderbilt University School of Medicine, has worked to raise awareness about the vitamin K shot and the risk of VKDB, with some success.
“After our educational outreach, we have seen a decrease in our refusal rates [with about 3.4% of parents declining vitamin K],” she said. “Our goal is to fully educate parents on the risk of declining so they can make an informed choice for their baby.”
