1. There are case reports where late HDN has been described after the
babies have received intramuscular vitamin K (1,2). But there is no
doubt that intramuscular vitamin K given at birth has a significant role
in preventing late HDN(3,4). If vitamin K at birth was not useful in the
prevention of late HDN, we would have seen many more infants with late
HDN being reported in the literature. Giving intramuscular vitamin K at
birth is supposedly to act as a "depot" with slow release of the vitamin
even upto 3 months(1). Therefore we feel that there is no need of an
additional dose at 1 month of age unless there are predisposing factors
like chronic diarrhea, malabsorption and prolonged use of antibiotics.
2. Exclusively breast fed children, being at higher
risk to develop LHDN(1,2) should receive intramuscular vitamin K at
birth and not that exclusive breast feeding needs to be discontinued.
Every effort should be made to continue exclusive breast feeding.
3. We agree that PIVKA-II level measure-ment would
have added greater strength to our study.
Edwin D’Souza,
S.D. Subba Rao,
Department of Pediatrics
St. John’s Medical College Hospital,
Bangalore 560 034, India
1. Zipursky A. Prevention of vitamin K deficiency
bleeding in newborns. Br J Hematol 1999; 104: 430-437.
2. Sutor AH, Dagres N, Niederhoff H. Late form of
vitamin K deficiency bleeding in Germany. Klin Pediatr 1995; 207:
89-97.
3. Vitamin K Ad Hoc Task Force. American Academy of
Pediatrics. Controversies concerning vitamin K and the newborn.
Pediatrics 1993; 91: 1001-1003.
4. McNinch AW, Orne RLE, Tripp JH. Hemmorrhagic disease of the
newborn returns. Lancet 1983; 1: 1089-1090.
