Can 3 oral 2 mg doses of vitamin K effectively prevent late vitamin K deficiency bleeding?

A 1 mg dose of vitamin K given intramuscularly at birth prevents almost all cases of late VKDB, whereas even two oral doses of 1 mg vitamin K given in the first week and a third given in week 5 to 6 are less effective. Is eff icacy improved by increasing the dose to 3 x 2 mg? For active surveillance of VKDB, monthly postcards which include a nothing-to-report option, were s ent to all heads of pediatric hospitals in Germany from January 1995 to Dec ember 1998. All reports were validated according to a standard case definit ion for late VKDB by means of a questionnaire. The incidence of VKDB with t hree oral doses of 2 mg vitamin K is compared to previously published rates for VKDB on 3 oral 1 mg oral doses, which had been ascertained with the sa me surveillance scheme. The number of cases of VKDB (excluding the failure- of-management cases) in children aged 8 days to 12 completed weeks during t he 4 year period was 23. 14 had intracranial hemorrhage, 22 had been exclus ively breastfed, and in 20 cholestasis was detected after the bleeding epis ode. 14/23 had been given all recommended 2 mg doses for vitamin K prophyla xis. Until 1996 all had been given the cremophor vitamin K preparation, whe reas in 1997 to 1998 two children with late VKBD had received the new mixed micellar (MM) preparation, first licensed in July 1996. The incidence of V KBD per 100,000 live births during the 1995 to 1998 period was 0.72, includ ing children given no vitamin K prophylaxis, and 0.44 for children who had received all age-related recommended vitamin K doses. These incidence rates are significantly lower than those previously publish ed for the 3 x 1 mg dose regimen in Germany (1.8 cases of late VKDB per 100 ,000 live births in children who had received all recommended vitamin K dos es). Not all cases of late VKDB, however, are prevented by the 3 x 2 mg dos e regimen, even if the new mixed micellar preparation is given instead of t he cremophor preparation.