ORIGINAL ARTICLE

Intracranial haemorrhage due to late onset vitamin K deficiency bleeding in Hanoi province, Vietnam

N Danielsson¹, D P Hoa², N V Thang³, T Vos⁴ and P M Loughnan⁵

¹ Astrid Lindgren’s Children’s Hospital, Stockholm, Sweden
² Department of Training, Research and Community Health, National Institute of Paediatrics, Hanoi, Vietnam
³ Department of Paediatrics, Hanoi School of Medicine, Hanoi, Vietnam
⁴ School of Population Health, University of Queensland, Brisbane, Australia
⁵ Department of Neonatology, Royal Children’s Hospital, Melbourne, Australia

Correspondence to:
Correspondence to:
Dr Loughnan
Department of Neonatology, Royal Children’s Hospital, Parkville, Victoria 3052, Australia; peter.loughnan{at}rch.org.au

Background: In many developing countries vitamin K prophylaxis is not routinely administered at birth. There are insufficient data to assess the cost effectiveness of its implementation in such countries.

Objective: To estimate the burden of intracranial haemorrhage caused by late onset vitamin K deficiency bleeding in Hanoi, Vietnam.

Methods: Cases of intracranial haemorrhage in infants aged 1–13 weeks were identified in Hanoi province for 5 years (1995–1999), and evidence for vitamin K deficiency was sought. The data were compared with those on vitamin K deficiency bleeding in developed countries and used to obtain an approximation to the incidence of intracranial haemorrhage caused by vitamin K deficiency bleeding in Hanoi.

Results: The estimated incidence of late onset vitamin K deficiency bleeding in infants who received no prophylaxis was unexpectedly high (116 per 100 000 births) with 142 and 81 per 100 000 births in rural and urban areas respectively. Mortality was 9%. Of the surviving infants, 42% were neurologically abnormal at the time of hospital discharge. Identified associations were rural residence, male sex, and low birth weight. A significant reduction in the incidence was observed in urban Hanoi during 1998 and 1999, after vitamin K prophylaxis was introduced at one urban obstetric hospital.

Conclusions: Vitamin K deficiency bleeding is a major public health problem in Hanoi. The results indicate that routine vitamin K prophylaxis would significantly reduce infant morbidity and mortality in Vietnam and, costing an estimated US$87 (£48, 72) per disability adjusted life year saved, is a highly cost effective intervention.

Abbreviations: VKDB, vitamin K deficiency bleeding; ICH, intracranial haemorrhage; QV, Quick prothrombin value; DALY, disability adjusted life year; YLL, years of life lost; YLD, years lived with disability

Keywords: vitamin K deficiency bleeding; vitamin K prophylaxis; intracranial haemorrhage; Vietnam; developing country

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