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Poster Networking

Pediatric Hemostasis and Thrombosis

PB0597 - International Survey and Contemporary Analysis of Vitamin K Deficiency Bleeding in Infants

Monday, June 24, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Nongnuch Sirachainan, MD

    Professor
    Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

    • Co-Author(s)

  • Patcharee Komvilaisak, Associate professor

    Instructor
    Department of Pediatrics, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
    Muang, Khon Kaen, Thailand

  • Heleen Van Ommen, MD, PhD

    Department of Pediatric Hematology
    Erasmus University Medical Center, Sophia Children's Hospital Erasmus MC, Rotterdam, The Netherlands
    Rotterdam, Zuid-Holland, Netherlands

  • Shoshana Revel-Vik, MD, PhD

    Shaare Zedek Medical Center, Yerushalayim, Israel

  • Marisol Betensky, MD MPH

    Assistant Professor of Pediatrics
    Johns Hopkins University

  • Neil Goldenberg, MD,PhD

    Departments of Pediatrics and Medicine
    Johns Hopkins University School of Medicine, Baltimore, MD; Clinical and Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
    Saint Petersburg, Florida, United States

  • AZ

    Ayesha Zia

    Associate Professor
    Department of Pediatrics, University of Texas Southwestern Medical Center
    Dallas, Texas, United States

  • SO

    Shouichi Ohga

    Instructor
    Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University
    Fukuoka, Fukuoka, Japan

  • Masayuki Ochiai, MD, PhD

    Associate Professor
    Research Center for Environmental and Developmental Medical Sciences, Kyushu University
    Fukuoka, Japan

  • DT

    Daijiro Takahashi

    Instructor
    Division of Neonatology, Fukuda hospital
    Fukuoka, Fukuoka, Japan

  • SS

    Shutaro Suga

    Instructor
    Department of Pediatrics, Graduate School of Medicine, Kobe University
    Kobe, Hyogo, Japan

  • Veerle Labarque

    Professor
    Department of Pediatric Hematology and Oncology, University Hospital Leuven Gasthuisberg, Leuven
    ฺฺBrussels, Brussels Hoofdstedelijk Gewest, Belgium

  • BS

    Bounpalisone Souvanlasy

    Instructor
    Department of Pediatrics, National Children Hospital, Vientiane, Lao PDR
    Vientiane, Vientiane, Laos

  • Ampaiwan Chuansumrit, MD

    Professor
    Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

  • Anthony KC Chan, MBBS

    Professor
    McMaster Children’s Hospital, McMaster University, Hamilton, Canada
    Hamilton, Ontario, Canada

  • Madhvi Rajpurkar

    Professor
    Division of Pediatric Hematology Oncology, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, USA
    Detroit, Michigan, United States

Background: Vitamin K (VK) deficiency bleeding (VKDB) may occur in neonates and infants because of low placental transfer and VK storage. Although the incidences of VKDB have significantly decreased due to global nationwide VK prophylaxis at birth, VKDB is still present.

Aims: 1) To demonstrate the magnitude and risk factors of VKDB; 2) To evaluate the barriers to VK prophylaxis globally.

Methods: Survey questionnaires (Survey Monkey®) were circulated to physicians via several societies, such as ISTH, hematology, neonatology, and gastroenterology in various countries, during 2021–2023. Responses were analyzed using a chi-square test. To understand whether identifiable respondents managed VKDB or provided VK prophylaxis in a similar fashion, an unsupervised hierarchical clustering approach was used.

Results: Six hundred eighty-five respondents from 38 countries participated in the study; 574 (83.7%) respondents were providers of either VK prophylaxis or treated VKDB. Mostly 1–5 infants/ year were treated by 289 (42.1%) respondents. Their common age onset was ≤3 months. The hierarchical clustering divided the respondents into four clusters (Figure 1). Their characteristics were: Clusters 1 and 4, mostly from low-middle income countries in Asia, with different training experiences; Cluster 2, mostly from high-income countries in Asia and North America; and Cluster 3, mostly from upper-middle income countries in Asia and Europe. The most common risk factors were no VK prophylaxis at birth in Clusters 1, 2, and 4; and liver diseases in Cluster 3. The most common barriers were parents’ refusal to administer VK in Clusters 1 and 2, and a lack of awareness in Cluster 4.

Conclusion(s): Despite the nationwide provision of VK prophylaxis, most providers report evaluating infants with VKDB annually. The risk factors and barriers to VK prophylaxis varied by continent and income. A VKDB reduction policy should be prioritized and customarily made according to clusters’ characteristics.