Vitamin K Deficiency Bleeding and Early Infant Male Circumcision in Africa

Abstract

Background: Early infant (1–60 days of life) male circumcision is being trialed in Africa as a human immuno-deficiency virus prevention strategy. Post circumcision bleeding is particularly concerning where most infants are breastfed, and thus these infants are at increased risk of vitamin K deficiency bleeding. Case: During a circumcision trial, one infant bled for 90 minutes’ post procedure. After discovering he had not received standard prophylactic vitamin K, we gave 2 mg phytomenadione (vitamin K1) intramuscularly; bleeding stopped within 30 minutes. Conclusion: Vitamin K’s extremely rapid action is not commonly appreciated. Neonatal vitamin K has been shown to be cost-effective. To increase availability and promote awareness of its importance, especially in low-resource settings where blood products and transfusions are limited, vitamin K should be included in the World Health Organization’s Model List of Essential Medicines for Children.