Australian Paediatric Surveillance Unit, The University of Sydney, Sydney, New South Wales, Australia.
Australian Institute of Health Innovation, Partnership Centre in Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia.
Arch Dis Child. 2020 May;105(5):433-438. doi: 10.1136/archdischild-2018-316424. Epub 2019 Sep 13.
To undertake surveillance of vitamin K deficiency bleeding (VKDB) in Australia from 1993 to 2017, during a time of change to national recommendations and available vitamin K formulations.
Paediatricians reported cases of VKDB in infants aged <6 months and provided demographic, clinical and biochemical information via the Australian Paediatric Surveillance Unit.
58 cases were reported, of which 5 (9%) were early, 11 (19%) classic and 42 (72%) late VKDB. 53 (91%) were exclusively breast fed. Seven (12%) received oral prophylaxis, the majority (86%) of whom did not receive all three recommended doses. The overall reported incidence was 0.84 per 100 000 live births (95% CI: 0.64 to 1.08) and the incidence of late VKDB was 0.61 per 100 000 live births (95% CI: 0.44 to 0.82), which are similar to rates reported by other countries where intramuscular vitamin K is recommended. VKDB rates were significantly higher (2.46 per 100 000 live births; 95% CI: 1.06 to 4.85) between 1993 and March 1994 when oral prophylaxis was recommended (p<0.05). Vitamin K was not given to 33 (57%) cases, primarily due to parental refusal, and the number of parental refusals increased significantly after 2006 (p<0.05). There were six deaths, all due to intracranial haemorrhage, and three associated with home delivery and parental refusal of vitamin K.
Incidence rates of VKDB in Australia are among the lowest in the world; however, we have identified an increasing trend of parental refusal. Ongoing surveillance and educational campaigns for health professionals and parents are needed to prevent VKDB.
在国家建议和可用维生素 K 制剂发生变化的情况下，对 1993 年至 2017 年澳大利亚的维生素 K 缺乏性出血（VKDB）进行监测。
儿科医生通过澳大利亚儿科监测单位报告年龄<6 个月的婴儿的 VKDB 病例，并提供人口统计学、临床和生化信息。
报告了 58 例病例，其中 5 例（9%）为早期，11 例（19%）为经典，42 例（72%）为晚期 VKDB。53 例（91%）为纯母乳喂养。7 例（12%）接受了口服预防，其中大多数（86%）未接受全部 3 剂推荐剂量。报告的总发病率为每 10 万活产儿 0.84 例（95%CI：0.64 至 1.08），晚期 VKDB 的发病率为每 10 万活产儿 0.61 例（95%CI：0.44 至 0.82），与其他推荐肌内维生素 K 的国家报告的发病率相似。1993 年至 1994 年 3 月口服预防建议期间（p<0.05），VKDB 发病率（2.46 例/10 万活产儿；95%CI：1.06 至 4.85）显著更高。33 例（57%）未给予维生素 K，主要是由于家长拒绝，2006 年后家长拒绝的数量显著增加（p<0.05）。有 6 例死亡，均为颅内出血，其中 3 例与家庭分娩和家长拒绝维生素 K 有关。
澳大利亚的 VKDB 发病率处于世界最低水平之一；然而，我们已经发现家长拒绝的趋势在增加。需要对卫生专业人员和家长进行持续的监测和教育活动，以预防 VKDB。
