IN BRIEF

An Unwelcome Blast from the Past

November 10, 2014

Physicians in Tennessee reported a rash of cases of VKDB last year. Now, the CDC wants to know if it’s a sign of a national trend.

Most pediatric specialists who began practicing medicine in the mid-1960s have probably never seen a case of vitamin K deficiency bleeding. Robert Sidonio, MD, had seen just one, and that was during his fellowship. And then, in February 2013, an infant came in to the emergency room with bleeding in the brain, one of the most lethal problems of VKDB.

“One case was surprising, but nothing to get alarmed about,” says Dr. Sidonio, a pediatric hematologist/oncologist at Vanderbilt University Medical Center.  “But then a few months later, we saw another one, then another one, and I knew something wasn’t right.”

Reports of VKDB in the United States have been rare since the American Academy of Pediatrics issued a recommendation in 1961 that newborns receive vitamin K shots shortly after birth to protect against bleeding disorders. Studies had shown that the body doesn’t manufacture enough of the vital clotting agent until around 6 months of age, leaving infants vulnerable to VKDB, which can cause bleeding in the brain and other organs. Vitamin K isn’t transferred easily from mother to child in breast milk or from the placenta, so supplementing at birth or using infant formula — which is fortified with the nutrient — are the only ways to lower the bleeding risk.

Each of the families of infants with VKDB diagnosed by Dr. Sidonio last year had declined the vitamin K booster after birth and exclusively breastfed. Concerned that their refusal may signal a growing trend, he asked the Centers for Disease Control and Prevention for guidance. Working with the Tennessee Department of Health and Dr. Sidonio, the CDC launched an investigation that uncovered a total of seven cases of VKDB, five of which included brain bleeds. Four of those children demonstrated cognitive and developmental delays and at least one will have lifelong disabilities as a result.

Because the condition is rare, VKDB could be easily misdiagnosed, Dr. Sidonio says. So to spread the word, Dr. Sidonio published an article in June in Pediatric Neurology, detailing the cases at Vanderbilt and urging clinicians to advocate for newborn vitamin K supplementation.

Later this year, the CDC and the American Society of Pediatric Hematology/Oncology will conduct a nationwide survey to see if the increase in VKDB is confined to Tennessee or is more widespread.

Join the conversation. Do you emphasize the importance of vaccinations and preventive shots to parents who express hesitancy or resistance?

 

References:

  1. Schulte R, Jordan LC, Morad A, Naftel RP, Wellons JC 3rd, Sidonio R. Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth. Pediatric Neurology. 2014 Jun, 50(6):564-8.
  2. Warren M, Miller A, Traylor J, Sidonio R, et al. Notes from the field: Late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis — Tennessee, 2013. Morbidity and Mortality Weekly Report. 2013 Nov 15, 62(45):901-902.