Editor—In March 1998, the Department of Health issued new guidelines for prophylaxis of neonatal vitamin K deficiency bleeding.1 The recommended oral preparation for term infants was Konakion Mixed Micellular Paediatric (Konakion MM Paed). The recommendations did not, however, include specific guidelines for premature infants.

We undertook a survey of Welsh neonatal units one year after publication of these guidelines. We were interested in the formulation of vitamin K being given to term infants and the regimen being used for premature infants. Just over three quarters of the units (11/14) replied to postal or telephone questionnaires (including the regional referral unit and all five subregional units). Of the 10 units that offered oral doses to term infants, only four provided the recommended Konakion MM Paed. Others used injectable Konakion orally (or “Orakay”). Case reports from Germany and Australia show late onset bleeding after three oral doses of injectable vitamin K, which suggests that this preparation does not give adequate protection when given by mouth.2

Ten units responded with information on well preterm infants; nine of these used the intramuscular route (eight Konakion, one Konakion MM Paed). For unwell preterm infants, all 10 respondents used the intramuscular route (nine Konakion, one Konakion MM Paed). The dose of Konakion given to preterm infants varied widely between units (table1).

For extremely premature infants, some units used intravenous vitamin K. However, this route is not effective for long term prophylaxis and the safety of a potentially high peak of serum vitamin K following an intravenous dose has not been assessed.3

Perhaps the reluctance to use the new licensed preparation stems from the lack of long term safety data. There is also a financial disincentive to use Konakion MM Paed rather than older preparations. In order to provide prophylaxis for 1000 term infants (estimating that 20% are exclusively breast fed), at current prices4 the comparison is as follows: oral Konakion MM Paed, £3410; Konakion given orally, £322; Konakion given intramuscularly, £230.

Research is urgently needed to ascertain the most appropriate route, preparation, and dosage schedule for premature infants, who are at high risk of vitamin K deficiency bleeding and resultant intracranial haemorrhage.