American Academy of Pediatrics Policy Statement: Newborns Require Vitamin K Shortly After Birth to Prevent Bleeding Disease

The American Academy of Pediatrics reinforces the benefits of administering vitamin K to newborns shortly after birth to prevent a life-threatening disease that causes bleeding in otherwise healthy infants.

In an updated policy statement, “Vitamin K and the Newborn Infant,” published in the March 2022 Pediatrics (published online Tuesday, Feb. 22) notes that, in recent years, more parents have refused the vitamin K shots for their newborn infants, resulting in an increase in the numbers of late-onset vitamin K deficiency bleeding (VKDB).

Administration of vitamin K to prevent bleeding has been a standard of care since the AAP first recommended it in 1961, resulting in a decline in cases and medical breakthrough to prevent a disease reported as far back as the 1800s.

“This illness is relatively rare in the United States today because we have offered this dose of vitamin K to infants,” said Ivan Hand, MD, FAAP, an author of the statement, written by the AAP Committee on Fetus and Newborn, Section on Breastfeeding, and Committee on Nutrition. “This bleeding disease can be devastating and is totally preventable, and so we urge parents to ask questions if they have concerns.”

Vitamin K deficiency bleeding is characterized by its time of presentation— early onset, classic, or late-onset – each of which are associated with various forms of illness. Early-onset VKDB begins within a baby’s first 24 hours of life, typically to those whose mothers are taking medications such as anticonvulsants, antibiotics, antituberculosis agents, and warfarin, which can affect vitamin K absorption. Infants may show signs of the disease through bruising or life-threatening intracranial hemorrhage.

Classic vitamin K deficiency bleeding typically occurs between 2 days and 1 week of life. Late-onset presentation of the disease is most often seen between 2 and 8 weeks but can also be diagnosed as late as six months. Late-onset VKDB is usually associated with exclusively breastfed infants who did not receive vitamin K prophylaxis at birth, and can result in liver dysfunction and intracranial bleeding, among other complications.

• The AAP recommends:
  Vitamin K should be administered to all newborn infants weighing >1500 g as a single, intramuscular dose of 1 mg within six hours of birth.
• Preterm infants weighing ≤1500 g should receive a vitamin K dose of 0.3 mg/kg to 0.5 mg/kg as a single, intramuscular dose.
• Pediatricians and other health care providers must be aware of the benefits of vitamin K administration as well as the risks of refusal and convey this information to the infant’s caregivers.
• Vitamin K deficiency bleeding should be considered when evaluating bleeding in the first six months of life, even in infants who received prophylaxis, and especially in exclusively breastfed infants.

“We understand parents want the best for their children, and we, as pediatricians, share that goal,” Dr. Hand said. “We strongly recommend that parents bring their questions to us and help us understand any concerns.”

Additional resource for parents

HealthyChildren.org: Why Your Newborn Needs a Vitamin K Shot

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.