The vitamin K debacle: cut the Gordian knot but first do no harm

Abstract

As clinicians who have contributed to the data and the discussions about vitamin K prophylaxis to prevent vitamin K deficiency bleeding (VKDB) in infancy, we are acutely aware that the debate about the advantages and disadvantages of various forms of prophylaxis may undermine public confidence and so put at risk potential health benefit. Echoing Von Kries1 we suggest in this annotation that a radical solution is urgently required and could be introduced. Sadly, the history of vitamin K prophylaxis is replete with examples of medical practice driven by fashion and controversy. For example, over enthusiastic dosing with synthetic vitamin K2 (Synkavit, Roche, Herts, UK) during the 1960s led to complications of haemolysis, hyperbilirubinaemia, and kernicterus, which brought the practice of vitamin K prophylaxis into some disrepute. The most dramatic controversy, still current, originates from reports by Golding and colleagues that intramuscular prophylaxis with vitamin K1may be associated with an increased incidence of childhood leukaemia and cancer.2 These controversies have been extensively reviewed.1 3 The potential for poorly informed public debate to generate anxiety and undermine confidence in preventive procedures was well illustrated in the 1980s by the reported association of pertussis immunisation with an encephalopathy of infancy. Loss of public confidence in the immunisation led to mortality and morbidity among children whose parents declined it,4 5 while many professionals felt unable to recommend it for all infants. The risk of a similar situation arising from reports of an association between measles, mumps, and rubella immunisation and infantile autism resulted in prompt and unequivocal advice from the Chief Medical Officer, which supported public confidence, although there was an increase in immunisation refusals.6 Another example was the increase in unplanned pregnancies that resulted from the inadequately informed debate about the risks of some oral …