Late form of vitamin K deficiency bleeding in Germany

• Published in: Klinische Pädiatrie Vol. 207; no. 3; p. 89
• Main Authors: Sutor, A H, Dagres, N, Niederhoff, H
• Format: Journal Article
• Language: English
• Published: Germany 01-05-1995
• Subjects: Blood Coagulation Tests; Brain Damage, Chronic - blood; Brain Damage, Chronic - mortality; Brain Damage, Chronic - prevention & control; Breast Feeding; Cerebral Hemorrhage - blood; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - prevention & control; Cross-Sectional Studies; Female; Germany - epidemiology; Humans; Incidence; Infant; Infant, Newborn; Male; Nutritional Requirements; Vitamin K - administration & dosage; Vitamin K - blood; Vitamin K Deficiency - blood; Vitamin K Deficiency - mortality; Vitamin K Deficiency - prevention & control; Vitamin K Deficiency Bleeding - blood; Vitamin K Deficiency Bleeding - mortality; Vitamin K Deficiency Bleeding - prevention & control; Germany
• ISSN: 0300-8630
• DOI: 10.1055/s-2008-1046519

The evaluation of the disease of vitamin K deficiency bleeding (VKDB).
108 reported cases between 1980 and 1990 from Germany.
VKDB occurs preferentially (90%) in fully breastfed infants, males are affected nearly twice as often as females. The peak age is four weeks; the majority (79%) of the infants are between three and seven weeks old. 58% of the patients suffer from intracranial bleeding, which results in a total mortality rate of 19% and in neurological damage in 21%. Generally the VKDB occurred suddenly as no warning signs were noticed or they were so insignificant as not to be heeded. In at least 37% of the patients cholestasis was detected. The Quick value was pathologically low in every case. Vitamin K dependent factors were low and PIVKA was detectable, whereas vitamin K independent hemostatic parameters were normal or even elevated. The combination of low Quick value and normal fibrinogen as well as platelet level is a good diagnostic indicator which can be confirmed by administration of vitamin K, after which the Quick value will rise within 30 minutes. Vitamin K prophylaxis reduces the incidence of VKDB from 5.13 per 100,000 births to a tenth of that; single dose oral prophylaxis reduces the risk by a factor of 3.3 and a single parenteral dose by 14.3. Parenteral prophylaxis is more effective in patients with hepatobiliary disorders. Patients who suffered VKDB despite having received vitamin K prophylaxis are older at onset (without prophylaxis 32 days, with oral prophylaxis 37 days, and with parenteral prophylaxis 63 days) and have less intracranial bleeding (35%) than patients who received none (62%).
Late form of VKDB is a rare but serious disease which can be prevented by VK-prophylaxis.