Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth

Pediatr Neurol. 2014 Jun;50(6):564-8. doi: 10.1016/j.pediatrneurol.2014.02.013. Epub 2014 Feb 28.


Background: Newborns are at risk for vitamin K deficiency and subsequent bleeding unless supplemented at birth. Vitamin K deficiency bleeding is an acquired coagulopathy in newborn infants because of accumulation of inactive vitamin K-dependent coagulation factors, which leads to an increased bleeding tendency. Supplementation of vitamin K at birth has been recommended in the United States since 1961 and successfully reduced the risk of major bleeding. Refusal or omission of vitamin K prophylaxis is increasing and puts newborn infants at risk for life-threatening bleeding.

Patients: Over an eight month period, we encountered seven infants with confirmed vitamin K deficiency; five of these patients developed vitamin K deficiency bleeding.

Results: The mean age of the seven infants with vitamin K deficiency was 10.3 weeks (range, 7-20 weeks); manifestations ranged from overt bleeding to vomiting, poor feeding, and lethargy. None of the infants had received vitamin K at birth, and all were found to have profound derangement of coagulation parameters, which corrected rapidly with administration of vitamin K in IV or intramuscular form. Four of the seven infants had intracranial hemorrhage; two of these infants required urgent neurosurgical intervention.

Conclusion: Supplementation of vitamin K at birth for all newborns prevents major hemorrhagic complications, such as intracranial bleeding, due to vitamin K deficiency. Parental refusal of vitamin K is increasingly common. It is critical that health care providers and the public be made aware of the varied presentation of this preventable acquired coagulopathy.

Keywords: hemorrhagic disease of the newborn; intracranial hemorrhage; vitamin K; vitamin K deficiency bleeding; vitamin K prophylaxis.

Publication types

  • Case Reports

MeSH terms

  • Age of Onset
  • Brain / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Intracranial Hemorrhages / drug therapy
  • Intracranial Hemorrhages / epidemiology
  • Intracranial Hemorrhages / pathology
  • Intracranial Hemorrhages / prevention & control
  • Male
  • Treatment Refusal*
  • Vitamin K / administration & dosage
  • Vitamin K Deficiency / drug therapy
  • Vitamin K Deficiency / epidemiology*
  • Vitamin K Deficiency / pathology
  • Vitamin K Deficiency / prevention & control
  • Vitamin K Deficiency Bleeding / drug therapy
  • Vitamin K Deficiency Bleeding / epidemiology*
  • Vitamin K Deficiency Bleeding / pathology
  • Vitamin K Deficiency Bleeding / prevention & control


  • Vitamin K