Vitamin K Deficiency Bleeding in Tennessee Newborn Cluster

Laurie Barclay, MD

November 15, 2013

The Centers for Disease Control and Prevention (CDC) and the Tennessee Department of Health have found a cluster of newborns in Tennessee with late vitamin K deficiency bleeding (VKDB), according to a report published in the November 15 issue of the Morbidity and Mortality Weekly Report.

VKDB is a coagulopathy that can cause brain hemorrhage and is preventable by intramuscular vitamin K injection, given routinely at birth. In every case in the cluster, the parents had refused this intervention, mostly because they were not aware of the potential benefit.

"Not giving vitamin K at birth is an emerging trend that can have devastating outcomes for infants and their families," CDC Director Tom Frieden, MD, MPH, said in a CDC news release. "Ensuring that every newborn receives a vitamin K injection at birth is critical to protect infants."

Of 4 cases of late VKDB diagnosed at a Nashville, Tennessee, hospital between February and September 2013, 3 had diffuse intracranial hemorrhage and 1 had gastrointestinal bleeding, which began suddenly at age 6 to 15 weeks. None of the infants had received a vitamin K injection at birth.

"Fortunately all of the infants survived," Lauren Marcewicz, MD, EIS officer with the CDC's National Center on Birth Defects and Developmental Disabilities, said in the release. "It is important for health professionals to educate parents about the health benefits of vitamin K at birth."

All 4 infants and the asymptomatic twin of 1 of the patients had laboratory-confirmed coagulopathy, defined as prothrombin time elevation greater than or equal to 4 times the laboratory limit of normal.

Vitamin K administration corrected the laboratory abnormalities and stopped the bleeding. Although the infant with gastrointestinal bleeding recovered fully, the 3 with brain bleeding are being followed-up by neurologists, and one has an apparent gross motor deficit.

Routine Vitamin K Injection Recommended for Newborns

The American Academy of Pediatrics first recommended giving newborns a vitamin K injection to prevent VKDB in 1961, and this has been standard US practice ever since.

Infants aged from 2 weeks to 6 months can develop the late form of VKDB if they are not given a vitamin K injection at birth and if they have insufficient vitamin K–dependent proteins in their bodies to allow normal blood clotting. Untreated VKDB can cause cerebral hemorrhage, with associated neurological complications and even death.

Compared with infants who receive a vitamin K injection at birth, those who do not have an estimated 81 times greater risk of developing late VKDB, according to the report.

The CDC and the Tennessee Department of Health are continuing to search for any other recent cases of late VKDB within the state in recent years. A case-control study is ongoing to determine whether any additional risk factors could contribute to the development of late VKDB among children who do not receive vitamin K at birth.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2013;62:901-902. Full text

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