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J Pediatr Gastroenterol Nutr. 2016 Jul;63(1):123-9. doi: 10.1097/MPG.0000000000001232.

Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition.

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*Department of Pediatrics, Harlaching, Munich Municipal Hospitals, Munich, Germany†Department of Pediatric Gastroenterology, University Children's Hospital, Zurich, Switzerland‡Department Pediatrics, University Hospital Motol, Prague, Czech Republic§Department of Pediatrics, University of Granada, Granada, Spain||Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden¶Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK#Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia**University Children's Hospital Zagreb, Zagreb, Croatia††Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands‡‡Department of Pediatrics, University Hospital Giovanni XXIII, University Aldo Moro, Bari, Italy§§APHP Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France||||CNRC, Baylor College of Medicine, Houston, TX¶¶Department of Nutrition, Exercise and Sports, University of Copenhagen, K⊘benhavn##Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark***Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK†††Department of Pediatrics, VU University Medical Center‡‡‡Department of Pediatrics, Emma Children's Hospital-AMC, Amsterdam, The Netherlands.


Vitamin K deficiency bleeding (VKDB) due to physiologically low vitamin K plasma concentrations is a serious risk for newborn and young infants and can be largely prevented by adequate vitamin K supplementation. The aim of this position paper is to define the condition, describe the prevalence, discuss current prophylaxis practices and outcomes, and to provide recommendations for the prevention of VKDB in healthy term newborns and infants. All newborn infants should receive vitamin K prophylaxis and the date, dose, and mode of administration should be documented. Parental refusal of vitamin K prophylaxis after adequate information is provided should be recorded especially because of the risk of late VKDB. Healthy newborn infants should either receive 1 mg of vitamin K1 by intramuscular injection at birth; or 3 × 2 mg vitamin K1 orally at birth, at 4 to 6 days and at 4 to 6 weeks; or 2 mg vitamin K1 orally at birth, and a weekly dose of 1 mg orally for 3 months. Intramuscular application is the preferred route for efficiency and reliability of administration. The success of an oral policy depends on compliance with the protocol and this may vary between populations and healthcare settings. If the infant vomits or regurgitates the formulation within 1 hour of administration, repeating the oral dose may be appropriate. The oral route is not appropriate for preterm infants and for newborns who have cholestasis or impaired intestinal absorption or are too unwell to take oral vitamin K1, or those whose mothers have taken medications that interfere with vitamin K metabolism. Parents who receive prenatal education about the importance of vitamin K prophylaxis may be more likely to comply with local procedures.

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