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Compliance with recommendations for giving vitamin K to newborn infants

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6933.894 (Published 02 April 1994) Cite this as: BMJ 1994;308:894
  1. C Croucher,
  2. D Azzopardi
  1. Department of Paediatrics and Neonatal Medicine, Queen Charlotte's and Chelsea Hospital, London W6 0XG
  1. Correspondence to Dr Azzopardi.
  • Accepted 14 January 1994

Newborn infants have low plasma concentrations of vitamin K and are at risk of haemorrhagic disease if not given supplemental vitamin K.1 n 1992 an association between intramuscular vitamin K and childhood cancer was reported.2 The British Paediatric Association subsequently recommended that oral vitamin K supplements should be given to newborn infants, with repeat doses for breast fed infants.3 However, the chief medical officer has stated that there is no licensed preparation of vitamin K for oral use available in the United Kingdom.4

The policy regarding vitamin K administration at our hospital was recently changed to follow the British Paediatric Association's recommendations. All infants are given a first oral dose of 0.5 mg of vitamin K within the first 24 hours after birth. A second dose of 0.5 mg vitamin K is dispensed to the mother at discharge from hospital and the community midwife gives it to infants being breast fed at 1 week. The general practitioner is advised by letter to give a further single dose of 0.5 mg oral vitamin K at six weeks to infants who are still breast fed, including those infants receiving supplemental bottle feeds.

This policy was introduced in April 1993, but general practitioners and community midwifes were concerned about giving vitamin K, particularly because the product was not licensed for oral use. We therefore determined compliance with the policy.

Subjects, methods, and results

We attempted to contact by telephone all mothers who delivered live infants at our hospital during June 1993. Mothers whose infants were admitted to the neonatal unit were excluded. We asked mothers about the method of infant feeding, information provided about vitamin K, and administration of vitamin K.

There were 336 deliveries in June 1993 and 348 babies were born. Two of the infants were still-born and 25 required admission to the neonatal unit; 15 mothers did not have a telephone, four had moved, and a further 95 were not contactable. A total of 207 mothers answered the telephone questionnaire. The table shows the results. Two of the 207 mothers refused to allow their children to receive any vitamin K.

Number of women who were breast feeding and the number and proportion of breast fed infants who recevied vitamin K

View this table:

The second dose of vitamin K was administered by the community midwife in 132 out of 143 cases, by the general practitioner in four, at our hospital in six, and by the mother in one. Fifty seven children received the six week dose of vitamin K; it was given by the general practitioner in 38 cases, at our hospital in seven cases, by the community midwife or health visitor in six cases, and by mothers in six cases. Ninety nine women felt they had been given enough information on vitamin K, and 176 had been asked to give oral consent before vitamin K was given to their child.

Comment

Compliance with current recommendations on vitamin K supplementation of newborn infants was poor. More than 10% of breast fed infants did not receive the second dose of vitamin K and less than 40% received a third dose. These infants were therefore at risk of developing late haemorrhagic disease of the newborn. Many mothers reported that the general practitioner or community midwife was reluctant to prescribe and give vitamin K because the preparation was not licensed for oral use. This caused considerable anxiety, and many mothers had contacted the hospital to seek advice.

The association between intramuscular vitamin K and childhood cancer has been questioned.5 Nevertheless, even if the association is disproved, prophylaxis with intramuscular vitamin K may not become routine in the United Kingdom because of the adverse publicity that has arisen. Late haemorrhagic disease has been reported in breast fed infants who received only a single oral dose of vitamin K and therefore repeated doses are necessary. A licensed oral preparation of vitamin K that can be given by parents would improve compliance with current recommendations and is urgently required.

References

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