Sara Wickham's article missed the info from the UK that is published every year and although there are 2 points of the data that are always visited - cases of confirmed HDN/LHDN and cases that are not - there is a much larger set that remain uninvestigated but reported as HDN/LHDN because they are uninvestigated the are just left out of the stats- but it would put the incidence of vitamin K associated bleeds at a higher rate that is reported- of course there are alot of politics involved for first world countries to actually admit to having flaws in the care they provide-
from 2006-2008 there were 46 reported cases with only 10 confirmed the rest still had outstanding data 11 are from copies of the same case and there are 18% of the units not reporting- the majority of the cases are from babies who do not receive any vitamin K (oral or shot) - there are babies who do receive oral vitamin K and do develop HDN/LHDN and they do have metabolic disorders or another disease state like clinical and subclinical gallbladder or liver disease.
you can download the British Paediatric Surveillance Unit reports and see
the most recent one is on that page and the others are listed under publications--http://bpsu.inopsu.com/
something I find interesting is that they are listing diagnostic criteria their own which is infants under 6 months with 2x the prothombin time and bruising or bleeding or intercrainal hemorrhage but also evaluating their info according to international standard criteria for late bleeds in infants older than 7 days and who have-
4x the prothombin time and one of these
- normal or raised platelet count and normal fibrinogen -
-or they get normal prothombin time after administering vitamin K-- --PIVKA_II levels above normal-- but these take weeks to process and could be used later for information but not for clinical treatment
-----this is how stats can get twisted around a bit --
so if a kid has a bit better prothombin time but is treated with vitamin K and improves they do not dx it as LHDN - so these kids would have low vitamin K but not diagnosed LHDN and those stats do not get compiled -- this is important to me because I have talked with midwives and parents who have treated their babies because of symptoms- bruising/bleeding and most have not had a dx- and I am thinking that none of us want to fulfill the dx criteria if we can avoid it but I also think that somehow that info should be represented so we have a better idea of how many babies have low but do not meet diagnostic standards
in England in the 80's and there was a big push to not supplemental feed any babies intended to be breastfed the rate of low vitamin K bleeds shot up to a rate of 1/1200 babies who were breastfed and did not receive supplemental vitamin K- Mcninch was the author of an article about the cases and then authored several others after trying to figure out what went on- some of his areas of investigation led him to even consider toxin exposure (which does have an effect- furans) and the exclusive breastfeeding that had come into vogue as opposed to the supplemental formula feeds that were common in the early postpartum-even if a mom was intending to breastfeed -- which lead them to recommend vitamin K injections and then later to adding oral vitamin K as a recommendation when the injection under question - the 1/1200 is close to the New York State reports of HDN/LHDN of 1 to 2/1000-- and matches other places in the world where babies don't get vitamin K and are breastfed-- and I would add the studies of those places also has brought out maternal intakes of vitamin K that are 50 micrograms a day or less as a risk factor for her infant.
The thing is the studies on vitamin K intake of women of childbearing age in the US the average intake is 50 micrograms or less a day-- so that puts the majority of our population in the at risk status-- here is a nice web site where you can evaluate your diet and see what your daily intake is-http://nutritiondata.self.com/
90 micrograms a day is the current recommended amount but there are some ongoing studies and some suggestions to up that to 200-300 micrograms/day related to how vitamin K supports bone and circulatory health- beyond clotting factors .
as for what to do the shot would cover all the bases and you would not have to do much beyond that, the thing is that babies who have been resuscited or are bruised or have jaundice are likely to use up their vitamin K and may be a reason to accept a shot instead of going the oral route-( or if you have a metabolic disorder of your own or take certain meds) , oral dosing for the extended period of time is what the Netherlands recommends and is what I would recommend if you go the oral route less likely to have the problems with sub-clinical gallbladder disease and some of the other things reported in other countries that give oral supplements for shorter time periods- and I would say take a look at the studies around women's health in general and vitamin K- issues like prevention of fractures, less hardening of the arteries and better blood sugar regulation in people who eat more green veggies than those who do not- it is probably a life time