Late Vitamin K Deficiency Bleeding Cluster Detected in Tennessee

Counseling Parents About Vitamin K Prophylaxis is 'Critical,' Says CDC

November 20, 2013 11:00 am Matt Brown

The CDC has identified a cluster of late vitamin K deficiency bleeding(www.cdc.gov) (VKDB) cases involving four Tennessee infants whose parents declined vitamin K prophylaxis. The CDC is investigating the cases in collaboration with the Tennessee Department of Health.

According to a Nov. 15 report(www.cdc.gov) in the CDC's Morbidity and Mortality Weekly Report (MMWR), four separate VKDB cases were diagnosed at a hospital in Nashville between February and September of this year. Three of the infants had bleeding within the brain; the fourth presented with gastrointestinal bleeding. In each case, parents had declined the vitamin K injection at birth, according to the MMWR report.

"Not giving vitamin K at birth is an emerging trend that can have devastating outcomes for infants and their families," CDC Director Tom Frieden, M.D., M.P.H., said in a Nov. 14 press release. "Ensuring that every newborn receives a vitamin K injection at birth is critical to protect infants."

The American Academy of Pediatrics (AAP) first recommended(pediatrics.aappublications.org) vitamin k prophylaxis in newborns in 1961. Since then, the AAP has fine-tuned its recommendation(pediatrics.aappublications.org), and now calls for a single, intramuscular dose of 0.5 to 1 mg to be administered to all newborns.

In a phone briefing with AAFP News Now, Lauren Marcewicz, M.D., an Epidemic Intelligence Service officer with the CDC's National Center on Birth Defects and Developmental Disabilities, said it is important that family physicians and other health care professionals talk with parents to educate them about the health benefits of the vitamin K birth dose.

"We have talked to a number of parents (during the Tennessee investigation) who have opted out of their newborn getting the injection," Marcewicz said. "And though it is anecdotal, it seems clear that parents aren't getting the full story.

"They understand that vitamin K is important for clotting and that a deficiency can lead to a bleeding disorder, but they are under the impression that this risk ends seven days after the birth. They're not aware how severe this issue is or the fact that it can still be an issue six months out. So parents are making this opt-out decision without all of the information, without the full risk story."

Marcewicz said this issue might be behind the gap in the percentage of parents who opt out of the vitamin K injection at hospitals versus those who decline the injection at birthing centers that investigators uncovered during the Tennessee investigation.

"In one Nashville hospital that is tracking parent opt-outs, 3.4 percent of healthy infants are not receiving the injection," said Marcewicz. "According to the data we have from area birthing centers -- and this is only for 218 births, mind you -- 28 percent of newborns didn't receive vitamin K because a parent opted out. That is worrisome."

Additional Resources

Pediatrics: "Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence"(pediatrics.aappublications.org)

The Cochrane Library: "Prophylactic vitamin K for vitamin K deficiency bleeding in neonates"(onlinelibrary.wiley.com)


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