Photo by Bertrand Devouard
The Centers for Disease Control and Prevention (CDC) has identified a
small group of newborns in Tennessee with late vitamin K deficiency
bleeding (VKDB).
The agency reported 4 cases of late VKDB, a
serious but preventable bleeding disorder that can cause intracranial
hemorrhage, neurological deficits, and death.
In each case, the newborn’s parents
declined a vitamin K injection at birth, mainly because they were
uninformed about the risk of late VKBD.
Preliminary findings of the CDC’s investigation, in collaboration with the Tennessee Department of Health, appear in the current issue of the Morbidity and Mortality Weekly Report.
“Not giving vitamin K at birth is an emerging trend that can have devastating outcomes for infants and their families,” said CDC Director Tom Frieden, MD. “Ensuring that every newborn receives a vitamin K injection at birth is critical to protect infants.”
Between February and September of this year, 4 cases of late VKDB were diagnosed at a hospital in Nashville, Tennessee.
Three of the infants experienced intracranial hemorrhage, and the fourth had gastrointestinal bleeding. None of the patients had received a vitamin K injection at birth.
Fortunately, all of the infants survived. The patient with gastrointestinal bleeding has made a full recovery. And the 3 infants with intracranial hemorrhage are being followed by neurologists.
One patient has an apparent gross motor deficit, but it seems the others do not. However, all of the patients are still less than 1 year of age, so the full impact of VKDB might only become apparent with time.
The infants’ parents said they declined vitamin K prophylaxis for a number of reasons, including concern about an increased risk of leukemia, the belief that the injection was unnecessary, and a desire to minimize the newborn’s exposure to “toxins.”
Concern about the increased risk of leukemia associated with vitamin K prophylaxis was initially generated by a report published in 1992, but the finding has not been replicated in subsequent studies.
In all cases, parents were uninformed or insufficiently informed about the risk of late VKDB. Most parents only learned about the possibility of late VKDB after their infants developed the condition.
These findings illustrate the importance of educating parents about vitamin K prophylaxis, said Lauren Marcewicz, MD, of the CDC’s National Center on Birth Defects and Developmental Disabilities.
A vitamin K injection at birth has been standard practice in the US since it was first recommended as prophylaxis for late VKDB by the American Academy of Pediatrics in 1961.
The late form of VKDB can develop in infants 2 weeks to 6 months of age who did not receive a vitamin K injection and do not have enough vitamin K-dependent proteins in their bodies to allow normal blood clotting. If untreated, this can cause intracranial hemorrhage, which may lead to neurological problems and can be fatal.
The risk for developing late VKDB has been estimated at 81 times greater among infants who do not receive a vitamin K injection at birth than in infants who do receive it.
The CDC said it is currently working with the Tennessee Department of Health to determine if other cases of late VKDB occurred in the state in recent years.
In addition, a case-control study is underway to assess whether any additional risk factors might contribute to the development of late VKDB in children who do not receive vitamin K prophylaxis.
