Darlow Brian A, Phillips Amanda A, Dickson Nigel P
Department of Paediatrics, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
J Paediatr Child Health. 2011 Jul;47(7):460-4. doi: 10.1111/j.1440-1754.2010.01995.x. Epub 2011 Feb 18.
To undertake surveillance of vitamin K deficiency bleeding (VKDB) from 1998, through the transition to a new single licensed vitamin K preparation in 2001, to 2008.
VKDB was listed with other rare conditions on the card sent monthly to registered specialist paediatricians by the New Zealand Paediatric Surveillance Unit with a request to indicate whether or not a case had been seen in the previous month. Those notifying a case were sent a two-page questionnaire. The main outcome measures were incidence of VKDB of early (first day of life), classic (days 2-7) and late-onset (day 8 to 6 months) type; related morbidity and mortality; receipt of vitamin K; and predisposing factors.
Response rate of return of surveillance cards was high, averaging 94.5%. There were 35 notifications of which 23 were valid cases. Seventeen cases met criteria for confirmed VKDB, two for 'probable' and four for 'possible'. There were eight confirmed classic cases with an overall incidence of 1.24 (95% confidence interval 0.54-2.45) per 100,000 births; none had received vitamin K prophylaxis, seven were fully breastfed and all fully recovered. There were nine confirmed late-onset cases with an overall incidence of 1.40 (95% confidence interval 0.64-2.65) per 100,000 births; eight had received no vitamin K, eight were fully breastfed, six had liver disease, four suffered an intracranial haemorrhage and one died.
In New Zealand, VKDB is virtually confined to fully breastfed infants not given vitamin K at birth. Late-onset cases were frequently associated with liver disease.
对1998年至2008年期间维生素K缺乏性出血（VKDB）进行监测，此期间经历了向单一新许可维生素K制剂的转变（2001年）。
新西兰儿科监测单位每月向注册的儿科专科医生发送卡片，将VKDB与其他罕见病症列在一起，并要求注明上个月是否见过病例。通知病例的医生会收到一份两页的问卷。主要观察指标为早发型（出生第一天）、经典型（出生第2至7天）和晚发型（出生第8天至6个月）VKDB的发病率；相关的发病率和死亡率；维生素K的使用情况；以及诱发因素。
监测卡片的回收率很高，平均为94.5%。共收到35份通知，其中23例为有效病例。17例符合确诊VKDB的标准，2例为“可能”病例，4例为“疑似”病例。有8例确诊的经典型病例，每10万例出生的总体发病率为1.24（95%置信区间0.54 - 2.45）；无一例接受过维生素K预防，7例为纯母乳喂养，所有病例均完全康复。有9例确诊的晚发型病例，每10万例出生的总体发病率为1.40（95%置信区间0.64 - 2.65）；8例未接受维生素K，8例为纯母乳喂养，6例有肝脏疾病，4例发生颅内出血，1例死亡。
在新西兰，VKDB几乎仅限于出生时未接受维生素K的纯母乳喂养婴儿。晚发型病例常与肝脏疾病有关。
