Assistant Professor University of Missouri-Columbia School of Medicine Columbia, Missouri, United States
Background: Vitamin K is the second oldest routine preventive treatment in neonatal care, after the prophylaxis for ophthalmia neonatorum. Despite its decades-long use and proven efficacy, the rate of Vitamin K refusal is rising. This phenomenon, newer than the vaccination refusal, shares with it common parental concerns, like safety and mistrust in the medical system. Similarly, one can find historical roots for both vaccination and Vitamin K hesitancy. Objective: We describe two moments in the history of Vitamin K prophylaxis, with lasting impact on its acceptance. Design/Methods: We reviewed primary and secondary historical sources, written and online. Results: Vitamin K's role in the prevention of VKDB was first described in 1939. By 1944, a study of 13,000 infants confirmed its efficacy in reducing bleeding in neonates the first 2-8 days of life. Consequently, vitamin K prophylaxis became commonly accepted, primarily using 1 to 5 mg of menadiol, a synthetic, water-soluble form (Synkavit™). Shortly after, practice evolved to include much higher doses (up to 30-50 mg daily). The reasons for this "therapeutic drift" are unclear, one could only speculate about the lack of efficacy in infants at higher risk for bleeding, or the same attitude of “more is better” , responsible for retrolental fibroplasia in preterm infants treated with oxygen. In 1955, research identified significant dangers associated with these higher doses, particularly in premature infants, including hemolysis, hyperbilirubinemia, and kernicterus. As a result, Synkavit was withdrawn from the market and phytonadione became the drug of choice. The next boost to Vitamin K opposition came in 1990. Professor Jean Golding, a British epidemiologist, founder of the Children of the 90’s Birth Cohort, found a significant association between IM administration of Vitamin K and childhood cancer. Two months before the actual publication, the findings were leaked to mass media, generating a large public debate and widespread panic. The results were never replicated in following studies and analysis of large data bases did not confirm the association. Nevertheless, the fear of cancer (especially leukemia), remains one of the most frequent reasons for Vitamin K refusal.
Conclusion(s): As learned from the vaccine hesitancy literature, a decrease in Vitamin K refusal can only be accomplished by a sensitive and respectful approach. Examining historical facts allows for a better understanding of some of the misapprehensions and helps finding appropriate methods to address parental concerns.
