PREVENTION OF VITAMIN-K DEFICIENCY BLEEDING - EFFICACY OF DIFFERENT MULTIPLE ORAL DOSE SCHEDULES OF VITAMIN-K

There is consensus that late vitamin K deficiency bleeding (VKDB) shou ld be prevented by vitamin K prophylaxis. One single dose of 1 mg vita min K-1 is effective if given i.m. or s.c., but not if given orally. R epeated oral doses might be as effective as the parenteral dose but th e optimal dose regimen remains to be established. Different oral dose schedules are presently used in different countries. In Australia, Ger many, The Netherlands and Switzerland active surveillance data on late VKDB were collected in a similar manner and failure rates compared. I dentical case definitions were used. There were three basic strategies for oral and one for parenteral vitamin K prophylaxis for healthy new borns in the four countries: (1) daily supplementation of low dose vit amin K (25 mu g) for breast-fed infants (The Netherlands); (2) 3 x 1 m g orally [Australia (January 1993 - March 1994) and Germany (December 1992 December 1994)]; (3) 1 mg vitamin K i.m. (Australia since March 1 994); and (4) 2 x 2 mg vitamin K (new mixed micellar preparation) (Swi tzerland). The respective failure rates per 100,000 live births (inclu ding cases given all recommended doses and those given incomplete prop hylaxis) were for strategy: (1) 0.2 (0-1.3) in The Netherlands; (2) 2. 3 (95% CI 1.6-3.4) in Germany and 2.5 (1.1-4.8) in Australia (oral pro phylaxis); (3) Australia (i.m. prophylaxis) 0 (0-0.9); and (4) 3.6 (0. 7-10.6) in Switzerland. The failure rates for complete prophylaxis onl y were: strategy (1) 0 (0-0.7) in The Netherlands; (2) 1.8 (1.1-2.8) i n Germany and 1.5 (0.5-3.6) in Australia; (3) Australia (i.m.) 0 (0-0. 9); and (4) 1.2 (0-6.5) in Switzerland. Conclusions The Australian dat a confirm that three oral doses of 1 mg vitamin K are less effective t han i.m. vitamin K prophylaxis. A daily low oral dose of 25 mu g vitam in K-1 following an initial oral dose of 1 mg after birth for exclusiv ely breast-fed infants may be as effective as parenteral vitamin K pro phylaxis. The effectiveness of the ''mixed-micellar'' preparation of v itamin K-1 needs further study.