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Vitamin K: missed at peril—the case for extra supplementation to prevent deficiency in breastfed preterm infants
  1. Paul Clarke1,2,
  2. Nicholas D Embleton3,4,
  3. Mary Fewtrell5,6,
  4. Dominic J Harrington7,8,
  5. Anne M Kelly9,
  6. Naomi Moris10,
  7. Alexander Patto11,
  8. Vennila Ponnusamy12,
  9. Vimal Vasu13,14,
  10. Martin J Shearer15
  1. 1Neonatal Intensive Care Unit, Norfolk Norwich University Hospital, Norwich, UK
  2. 2Norwich Medical School, University of East Anglia, Norwich, UK
  3. 3Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  5. 5Department of Population, Policy and Practice Research and Teaching, UCL Institute of Child Health, London, UK
  6. 6Department of Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  7. 7The Nutristasis Unit, Synnovis, St Thomas' Hospital, London, UK
  8. 8School of Biosciences and Medicine, University of Surrey, Guildford, UK
  9. 9Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  10. 10The Francis Crick Institute, London, UK
  11. 11NanoPhotonics Centre, University of Cambridge, Cambridge, UK
  12. 12Neonatal Intensive Care Unit, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
  13. 13Department of Neonatal Medicine, William Harvey Hospital, Ashford, UK
  14. 14School of Biosciences, University of Kent, Canterbury, UK
  15. 15Centre for Haemostasis and Thrombosis, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Professor Paul Clarke, Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; paul.clarke{at}nnuh.nhs.uk

https://doi.org/10.1136/archdischild-2023-326737

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    Vitamin K deficiency bleeding (VKDB) is a rare but potentially devastating disease which is essentially preventable by prophylactic vitamin K (VK) at birth, and adequate dietary VK intake thereafter. The ultimate consequence of missing prophylaxis, especially for exclusively breastfed preterm babies, was highlighted by the tragic death of a 34-week gestation boy who suffered catastrophic intracranial VKDB 4 weeks postdischarge.1 The hospital’s omission of VK at birth—despite parental wishes—was deemed ‘gross failure in medical care amounting to neglect’ by the Coroner.1

    Parents have the right to decline VK prophylaxis against medical advice and are not deemed neglectful, even though this places their newborns at risk of serious harm. Parental refusal of VK prophylaxis, and thus number of babies at risk of VKDB, is increasing.2 3 Conflation of the VK ‘shot’ with antivaccine rhetoric on social media may be further contributing.4

    Recognising the devastation caused by late VKDB, we wish to emphasise the importance of assuring both VK prophylaxis at …

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    Footnotes

    • Twitter @drpaulclarke, @DocNila, @vimalvasu

    • Contributors PC wrote the first and last manuscript draft. All authors contributed to manuscript revisions and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AP and NM are the parents of a preterm baby who died due to vitamin K deficiency bleeding after missed prophylaxis at birth. MS has previously acted as an expert witness to the Court in medico-legal cases involving vitamin K deficiency bleeding. PC, DJH and MS have provided intellectual input to AP who is developing a PIVKA-II test which may have diagnostic utility for diagnosis and prevention of vitamin K deficiency. NE and MF previously served on the ESPGHAN Committee on Nutrition and were coauthors of the 2016 ESPGHAN Position Paper ‘Prevention of Vitamin K Deficiency Bleeding in Newborn Infants’. There are no other relevant competing interests or conflicts of interest to declare in relation to this work.

    • Provenance and peer review Not commissioned; externally peer reviewed.