Ecological studies of relation between hospital policies on neonatal vitamin K administration and subsequent occurrence of childhood cancer

BMJ 1998;316:184-189 (17 January)

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Ecological studies of relation between hospital policies on neonatal vitamin K administration and subsequent occurrence of childhood cancer

S Jane Passmore, research officer,^a Gerald Draper, director,^a Pat Brownbill, research programmer,^a Mary Kroll, statistician ^a

^a Childhood Cancer Research Group, Oxford, OX2 6HJ

Correspondence to: Dr Draper gjd@ccrg.ox.ac.uk

Objective: To investigate the possible link between neonataladministration of intramuscular vitamin K and childhood cancer.
Design: Ecological studies comparing incidence of cancer ingroups of children classified by the vitamin K policy in operationat their hospital of birth.
Setting: Selected large maternity units in England, Scotland,and Wales.
Subjects: Children born in these units in varying periods between1966 and 1991.
Main outcome measures: Cancer occurring among these childrenbefore age 15 years identified by using the National Registryof Childhood Tumours. Ratios of observed to expected numbersof these conditions calculated for hospitals where the policywas to give all babies intramuscular vitamin K (non-selective)and where the policy was to use this treatment only for a selectedminority of babies at increased risk of vitamin K deficiencybleeding (selective).
Results: These ratios were calculated for children born in 94hospitals with varying vitamin K policies. A raised risk wasoccasionally associated with vitamin K, but the overall resultswere not significant, and there was no evidence to support thepreviously suggested doubling of the risk of childhood cancer.
Conclusions: On the basis of the results reported here it isunlikely that there is a greatly increased risk of childhoodcancer attributable to intramuscular vitamin K given to newborns,if indeed there is any.

Key messages

Intramuscular vitamin K given to babies is known to be effective in the prevention of vitamin K deficiency bleeding but it has been suggested that these preparations, or one of their constituents, may increase the risk of childhood cancer
Most studies have not shown a significant association between childhood cancer and vitamin K but are unable to exclude the possibility that its use increases the risk of childhood cancer by up to 10%
Intramuscular vitamin K has been given to "high risk" babies as part of all the various prophylaxis policies in the United Kingdom; this should continue
As a small risk cannot at present be excluded it seems prudent to recommend a policy of giving intramuscular vitamin K only to those babies at particularly high risk and giving it orally to others
It is essential that a record should be made of whether or not vitamin K is given and of the preparation, route of administration, and dose

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