BMJ 1998;316:189-193 (17 January)

Papers

Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study

L Parker, senior lecturer in epidemiology,a M Cole, research associate,a A W Craft, professor of child health,a E N Hey, retired paediatrician a

a Sir James Spence Institute of Child Health, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

Correspondence to: Dr Parker Louise.Parker@ncl.ac.uk

Objective: To explore the possible association between intramuscular vitamin K given to neonates and the subsequent development of childhood cancer.
Design: Retrospective case-control study on the basis of hospital records.
Setting: The former Northern Health region of England.
Subjects: 685 children who were born and lived in the region and who developed cancer before their 15th birthday, and 3442 controls also born between 1960 and 1991 and matched only for date and hospital of birth. The notes of a further 701 index cases were untraceable.
Main exposure measure: Administration of intramuscular vitamin K versus no exposure to vitamin K.
Results: There was no association between the administration of vitamin K and the development of all childhood cancers (unadjusted odds ratio 0.89; 95% confidence interval 0.69 to 1.15) or for all acute lymphoblastic leukaemia (1.20; 0.75 to 1.92), but there was a raised odds ratio for acute lymphoblastic leukaemia developing 1-6 years after birth (1.79; 1.02 to 3.15). No such association was seen in a separate cohort-based study not dependent on case note retrieval in which the rates of acute lymphoblastic leukaemia in children born in hospital units where all babies received vitamin K were compared with those born in units where less than a third received prophylaxis.
Conclusions: It is not possible, on the basis of currently published evidence, to refute the suggestion that neonatal intramuscular vitamin K administration increases the risk of early childhood leukaemia. Any association may have been masked in earlier studies that did not use controls matched for time and locality by other unidentified factors affecting the spatiotemporal variations in incidence of leukaemia.

Key messages

  • Two studies that used controls matched for date and place of birth have now failed to confirm a 1992 study reporting an increased risk of non-leukaemic childhood cancer in babies given 1 mg of intramuscular vitamin K at birth

  • Three other such studies have failed to confirm the increase in the risk of leukaemia also found in the 1992 study but were not large enough to exclude a near doubling of the odds ratio

  • Three of the four case matched studies now available have found a significant increase in the incidence of acute lymphoblastic leukaemia, first manifesting itself 1-6 years after birth

  • A cohort study has not found any such increase in children born in units where all babies were offered vitamin K at birth compared with units where less than 30% received prophylaxis

  • Regular low dose oral supplementation can be effective, making it unnecessary to give a form of treatment over which doubt still lingers


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Thomas, M. W., Gebara, B. M. (2004). Difficulty Breathing. CLIN PEDIATR 43: 499-502  
  • Cock, H.R., Schapira, A.H.V. (2002). A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM 95: 225-231 [Abstract] [Full text]  
  • Philip, R. K, Gul, R., Dunworth, M., Keane, N. (2001). Ireland lacks consensus on neonatal vitamin K prophylaxis. BMJ 323: 1068-1068 [Full text]  
  • Kumar, D., Greer, F. R., Super, D. M., Suttie, J. W., Moore, J. J. (2001). Vitamin K Status of Premature Infants: Implications for Current Recommendations. Pediatrics 108: 1117-1122 [Abstract] [Full text]  
  • Wariyar, U., Hilton, S., Pagan, J., Tin, W., Hey, E. (2000). Six years' experience of prophylactic oral vitamin K. Arch. Dis. Child. Fetal Neonatal Ed. 82: 64F-68 [Abstract] [Full text]  
  • Greer, F. R, Marshall, S. P, Severson, R. R, Smith, D. A, Shearer, M. J, Pace, D. G, Joubert, P. H (1998). A new mixed micellar preparation for oral vitamin K prophylaxis: randomised controlled comparison with an intramuscular formulation in breast fed infants. Arch. Dis. Child. 79: 300-305 [Abstract] [Full text]  
  • (1998). Which vitamin K preparation for the newborn?. DTB 36: 17-19 [Abstract] [Full text]  
  • (1998). NEONATAL VITAMIN K AND CHILDHOOD MALIGNANCY. JWatch General 1998: 2-2 [Full text]  
  • von Kries, R. (1998). Neonatal vitamin K prophylaxis: the Gordian knot still awaits untying. BMJ 316: 161-162 [Full text]  
  • Passmore, S J., Draper, G., Brownbill, P., Kroll, M. (1998). Case-control studies of relation between childhood cancer and neonatal vitamin K administration. BMJ 316: 178-184 [Abstract] [Full text]  
Access jobs at BMJ Careers
Whats new online at Student BMJ