International Perspectives on Vitamin K Deficiency Bleeding in Infants: A Cross-Sectional Questionnaire-Based Survey

Abstract

Purpose: Vitamin K deficiency bleeding (VKDB) can occur in neonates and infants due to low placental transfer and storage of VK. Although the incidence has decreased with global VK prophylaxis at birth, VKDB remains a concern. This study aimed to assess the recent magnitude, risk factors, and outcomes of VKDB and barriers/limitations to VK prophylaxis. Patients and Methods: From 2021 to 2023, a survey questionnaire was distributed to physicians managing VKDB or administering VK prophylaxis through various international and national societies. Responses were analyzed using a chi-square test and unsupervised hierarchical clustering. Results: Among 685 respondents from 38 countries, 289 (42.1%) reported treating 1–5 VKDB cases annually. Key risk factors included the lack of VK at birth and liver disease. Hierarchical clustering of survey responses identified three groups with shared characteristics based on geographical location and country economic status: Cluster 1 consisted of high-income countries in Europe and North America; Cluster 2 included upper- to middle-income countries in Asia; and Cluster 3 comprised low- to lower-middle-income countries in Asia. In all clusters, the lack of VK prophylaxis at birth was the most common risk factor; however, liver disease was more highly reported in Cluster 2 when compared to the other clusters. The most frequent barriers to VK prophylaxis included parental refusal of intramuscular injections in high-income countries and limited availability of VK in low- to lower-middle-income countries. Conclusions: Despite the implementation of VK prophylaxis, VKDB remains a global issue. Guidelines for prophylaxis in infants with liver disease should be established, and comprehensive education on VKDB complications for parents and communities is essential. The limited availability of VK in certain parts of the world should be further explored and addressed to improve the management of this preventable disease in infants.