Per AAP: VKDB is characterized by its time of presentation, namely early-onset, classic, or late-onset. Early-onset VKDB begins within the first 24 hours of age. It usually occurs in women who are taking medications that affect vitamin K metabolism. These medications include anticonvulsants, antibiotics, antituberculosis agents, and warfarin. These infants may present with a spectrum of disease from cutaneous bruising to life-threatening intracranial hemorrhage. Prenatal vitamin K supplementation has not been shown to reduce early-onset VKDB. Classic VKDB occurs between 2 days and 1 week of life. Although some cases may occur in infants whose mothers were taking medications affecting vitamin K metabolism, most cases are idiopathic. Late-onset VKDB occurs between 1 week and 6 months of age, with a peak incidence between 2 and 8 weeks.10 Late-onset VKDB is usually associated with exclusively breastfed infants who did not receive vitamin K prophylaxis at birth. It may also be associated with liver dysfunction secondary to neonatal hepatitis, bile duct atresia, or intestinal malabsorption. Late-onset VKDB most commonly presents with evidence of intracranial bleeding in 30% to 60% of cases. In recent years, there has been an increase in the number of parents who refuse IM vitamin K for their newborn infants and a resultant increase in the number of cases of late-onset VKDB. Pediatricians and all health care providers to newborn infants should strongly advocate for vitamin K prophylaxis. Births not attended by a physician also have been associated with parental refusal of vitamin K. Vitamin K should be administered to all newborn infants weighing >1500 g as a single, intramuscular dose of 1 mg within 6 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. A single intravenous dose of vitamin K for preterm infants is not recommended for prophylaxis. VKDB should be considered when evaluating bleeding in the first 6 months of life, even in infants who received prophylaxis, and especially in exclusively breastfed infants.
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