Guideline:
Controversies concerning vitamin K and the newborn
Bibliographic Source(s)
- Controversies concerning vitamin K and the newborn. American Academy of Pediatrics Committee on Fetus and Newborn. Pediatrics 2003 Jul;112(1 Pt 1):191-2. [16 references] PubMed
Guideline Status
This is the current release of the guideline.
American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body at which time a recommendation is made that the policy be retired revised or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation or retires a statement the current policy remains in effect.
Guideline Category
Prevention
Intended Users
Physicians
Guideline Objective(s)
To present updated recommendations for the use of vitamin K in the prevention of early and late vitamin K deficiency bleeding
Target Population
All newborns particularly newborns who are breastfed exclusively
Interventions and Practices Considered
Intramuscular vitamin K1 administration
Major Outcomes Considered
- Rate of late vitamin K deficiency bleeding
- Relationship between newborn parenteral administration of vitamin K and incidence of childhood cancer
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Not stated
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
Not stated
Major Recommendations
Because parenteral vitamin K has been shown to prevent vitamin K deficiency bleeding (VKDB) of the newborn and young infant and the risks of cancer have been unproven the American Academy of Pediatrics recommends the following:
- Vitamin K1 should be given to all newborns as a single intramuscular dose of 0.5 to 1 mg (American Academy of Pediatrics American College of Obstetricians and Gynecologists 1992).
- Additional research should be conducted on the efficacy safety and bioavailability of oral formulations and optimal dosing regimens of vitamin K to prevent late vitamin K deficiency bleeding.
- Health care professionals should promote awareness among families of the risks of late vitamin K deficiency bleeding associated with inadequate vitamin K prophylaxis from current oral dosage regimens particularly for newborns who are breastfed exclusively.
Clinical Algorithm(s)
None provided
References Supporting the Recommendations
- American Academy of Pediatrics American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 3rd ed. Washington (DC): American College of Obstetricians and Gynecologists; 1992.
Type of Evidence supporting the Recommendations
The type of evidence supporting each recommendation is not specifically stated.
Potential Benefits
Appropriate use of vitamin K in the prevention of early and late vitamin K deficiency bleeding
Potential Harms
Some earlier studies attempted to show an association between intramuscular vitamin K administration and increased incidence of childhood cancer but more recent studies failed to substantiate this concern.
Qualifying Statements
The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations taking into account individual circumstances may be appropriate.
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Bibliographic Source(s)
- Controversies concerning vitamin K and the newborn. American Academy of Pediatrics Committee on Fetus and Newborn. Pediatrics 2003 Jul;112(1 Pt 1):191-2. [16 references] PubMed
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
American Academy of Pediatrics
Guideline Committee
Committee on Fetus and Newborn
Composition of Group that Authored the Guideline
Committee on Fetus and Newborn 2002-2003: Lillian Blackmon MD Chairperson; Daniel G. Batton MD; Edward F. Bell MD; William A. Engle MD; William P. Kanto Jr MD; Gilbert I. Martin MD; Warren Rosenfeld MD; Ann R. Stark MD
*Carol A. Miller MD Past Committee Member
Liaisons: Keith J. Barrington MD Canadian Paediatric Society; Tonse Raju MD DCH National Institutes of Health; Laura E. Riley MD American College of Obstetricians and Gynecologists; Kay M. Tomashek MD Centers for Disease Control and Prevention; Carol Wallman MSN RNC NNP National Association of Neonatal Nurses
Staff: Jim Couto MA
*Lead author
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body at which time a recommendation is made that the policy be retired revised or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation or retires a statement the current policy remains in effect.
Guideline Availability
Electronic copies: Available from the American Academy of Pediatrics (AAP) Web site.
Print copies: Available from American Academy of Pediatrics 141 Northwest Point Blvd. P.O. Box 927 Elk Grove Village IL 60009-0927.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI on February 19 2004. The information was verified by the guideline developer on March 29 2004.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor American Academy of Pediatrics (AAP) 141 Northwest Point Blvd Elk Grove Village IL 60007.
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