Vitamin K for neonates: the controversy

Giving neonates vitamin K to prevent vitamin K deficiency bleeding (a more informative and accurate term than the venerable “haemorrhagic disease of the newborn”) has been controversial almost since it began. In the 1950s synthetic menadione (Synkavit, Roche), commonly used in doses of 30 mg or more,1 was linked with haemolysis in premature babies2 and with kernicterus.3 In the 1960s and 1970s, when intramuscular phytomenadione (Konakion, Roche) 1 mg was the standard prophylaxis in Britain, there was argument over whether it should be given selectively or to all babies.4 In the 1980s some babies mistakenly received the injection of ergometrine-oxytocin meant for their mothers with disastrous results,5 and there was debate about whether a single oral dose of vitamin K could give the same protection as an intramuscular dose.6 In the early 1990s cases of vitamin K deficiency bleeding were described in babies who had received a single oral dose of vitamin K, and many were found to have previously unsuspected liver disease.^7,8

Bottle fed babies almost never suffer from vitamin K deficiency bleeding, presumably because they absorb enough of the 25-50 …