Of note, many of the signs and symptoms of late-onset VKDB were very concerning and included bulging fontanelles (70 percent), irritability (50 percent), convulsions (49 percent), and bleeding and ecchymosis (47 percent). Also, intracranial bleeding occurred in 73 percent of the infants with late VKDB, and the mortality for those who had intracranial hemorrhage was 31 percent.
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ACEP Now: September 2025So, in infants with late VKDB, intracranial hemorrhage is common, and the mortality rate is high. This just emphasizes how concerning this entity can be, why we should keep it on our differential diagnosis, and that we should ask about vitamin K in any young infant, particularly with bleeding or bruising. Regarding our question, though, we can only really say that it occurred up to three months after birth. The onset, though, was likely later.
How Late is Late?
A retrospective study that included 3,080 births identified 104 (3.4 percent) families at a tertiary care center who declined vitamin K administration after birth .3 Late VKDB was identified in seven of these children (five definite and two highly suspicious by laboratory values). The mean age at presentation was 10.3 weeks, but the range of ages extended from seven to 20 weeks. So, in short, there was a 5-month-old (20 weeks) who presented with late VKDB. This study shows that late VKDB can extend all the way up to five months of age, emphasizing the importance of inquiring about a perinatal vitamin K shot (see sidebar). Intracranial hemorrhage was also common in these children (57 percent) with late VKDB.
Policy Statement from the American Academy of Pediatrics
Vitamin K should be administered to all newborn infants—whether breastfed or formula-fed—weighing greater than 1,500 g as a single, intramuscular dose of 1 mg within six hours of birth.
Preterm infants weighing 1,500 g or less 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.
Pediatricians and other health care practitioners must be aware of the benefits of vitamin K administration as well as the risks of refusal and convey this information to the infant’s caregivers.
VKDB should be considered when evaluating bleeding in the first six months of life, even in infants who received prophylaxis, and especially in exclusively breastfed infants.
Reference
- Hand I, Noble L, Abrams SA, et al. Vitamin K and the Newborn Infant. Pediatrics. 2022 Mar 1;149(3):e2021056036.
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