Oral neonatal vitamin K deficiency bleeding prophylaxis in Switzerland (2018-2024), still valid guidelines for healthy infants.

UNLABELLED: Vitamin K (VK) deficiency is a condition that puts newborn infants at increased risk of vitamin K deficiency bleeding (VKDB) during the first 6 months of life. In Switzerland, current prophylactic guidelines have been shown to prevent VKDB effectively in healthy infants. They were implemented in 2003 and prescribe oral administration of VK (2 mg oral Konakion® MM (mixt micellar) hour 4, day 4, and week 4). As prophylaxis parental refusal has been increasingly reported, we prospectively tested the Swiss VKDB prophylaxis validity using a nationwide surveillance program (Swiss Paediatric Surveillance Unit) designed to detect all hospitalized VKDB cases. During 6 years (September 1, 2018, until August 31, 2024), nine VKDB cases were reported for 505,708 live births (1.78/105, 95% CI 0.81/105-3.38/105). All infants were exclusively breast fed and had VKDB risk factors such as parental VK refusal and/or cholestasis. Both Swiss VKDB 2018-2024 and 2005-2011 incidences were similar.

CONCLUSION: The Swiss VKDB prophylactic guidelines are still valid and effective for healthy infants if applied appropriately.

WHAT IS KNOWN: • Infantile vitamin K deficiency bleeding (VKDB) can be prevented by either intramuscular or oral VK administration in healthy infants. • Parental VK prophylaxis refusal (reported as increasing in frequency) as well as unrecognized cholestasis are main risk factors for VKDB.

WHAT IS NEW: • Switzerland's 2003 VKDB prophylactic regimen (2 mg oral Konakion® MM (hour 4, day 4, and week 4) remains a valid recommendation for healthy infants. • Again, parental VK prophylaxis refusal and/or unrecognized cholestasis remain risk factors for VKDB.