{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:10:52Z","timestamp":1788585052770,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Vitamin K deficiency bleeding (VKDB) can occur in neonates and infants due to low placental transfer and storage of VK. Although the incidence has decreased with global VK prophylaxis at birth, VKDB remains a concern. This study aimed to assess the recent magnitude, risk factors, and outcomes of VKDB and barriers\/limitations to VK prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>From 2021 to 2023, a survey questionnaire was distributed to physicians managing VKDB or administering VK prophylaxis through various international and national societies. Responses were analyzed using a chi\u2010square test and unsupervised hierarchical clustering.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 685 respondents from 38 countries, 289 (42.1%) reported treating 1\u20135 VKDB cases annually. Key risk factors included the lack of VK at birth and liver disease. Hierarchical clustering of survey responses identified three groups with shared characteristics based on geographical location and country economic status: Cluster 1 consisted of high\u2010income countries in Europe and North America; Cluster 2 included upper\u2010 to middle\u2010income countries in Asia; and Cluster 3 comprised low\u2010 to lower\u2010middle\u2010income countries in Asia. In all clusters, the lack of VK prophylaxis at birth was the most common risk factor; however, liver disease was more highly reported in Cluster 2 when compared to the other clusters. The most frequent barriers to VK prophylaxis included parental refusal of intramuscular injections in high\u2010income countries and limited availability of VK in low\u2010 to lower\u2010middle\u2010income countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite the implementation of VK prophylaxis, VKDB remains a global issue. Guidelines for prophylaxis in infants with liver disease should be established, and comprehensive education on VKDB complications for parents and communities is essential. The limited availability of VK in certain parts of the world should be further explored and addressed to improve the management of this preventable disease in infants.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31889","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T12:59:04Z","timestamp":1752065944000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["International Perspectives on Vitamin K Deficiency Bleeding in Infants: A Cross\u2010Sectional Questionnaire\u2010Based Survey"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-5476","authenticated-orcid":false,"given":"Nongnuch","family":"Sirachainan","sequence":"first","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine Ramathibodi Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6804-9121","authenticated-orcid":false,"given":"Patcharee","family":"Komvilaisak","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Srinagarind Hospital Faculty of Medicine Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9036-039X","authenticated-orcid":false,"given":"C. Heleen","family":"van Ommen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology Sophia Children's Hospital Erasmus MC  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9151-0337","authenticated-orcid":false,"given":"Shoshana","family":"Revel\u2010Vilk","sequence":"additional","affiliation":[{"name":"Pediatric Hematology\/Oncology Unit Department of Pediatrics Faculty of Medicine Hebrew University  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5810-6906","authenticated-orcid":false,"given":"Shouichi","family":"Ohga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3283-0415","authenticated-orcid":false,"given":"Ayesha","family":"Zia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\u2010Oncology Department of Pediatrics University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7169-3690","authenticated-orcid":false,"given":"Masayuki","family":"Ochiai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0921-3240","authenticated-orcid":false,"given":"Daijiro","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Division of Neonatology Fukuda Hospital  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4257-2109","authenticated-orcid":false,"given":"Shutaro","family":"Suga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics School of Medicine University of Occupational and Environmental Health  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5052-9274","authenticated-orcid":false,"given":"Veerle","family":"Labarque","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7054-9400","authenticated-orcid":false,"given":"Ernest K.","family":"Amankwah","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Oncology School of Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bounpalisone","family":"Souvanlasy","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology Children's Hospital  Vientiane Capital Lao People's Democratic Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6725-3035","authenticated-orcid":false,"given":"Marisol","family":"Betensky","sequence":"additional","affiliation":[{"name":"Department of Pediatrics School of Medicine, Johns Hopkins University  Baltimore Maryland USA"},{"name":"Cancer and Blood Disorders Institute Johns Hopkins All Children's Hospital  Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6380-3124","authenticated-orcid":false,"given":"Anthony KC","family":"Chan","sequence":"additional","affiliation":[{"name":"McMaster Children's Hospital McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1230-1591","authenticated-orcid":false,"given":"Ampaiwan","family":"Chuansumrit","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine Ramathibodi Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2785-1852","authenticated-orcid":false,"given":"Neil","family":"Goldenberg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics School of Medicine, Johns Hopkins University  Baltimore Maryland USA"},{"name":"Institute of Clinical and Translational Research Johns Hopkins All Children's Hospital  Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5884-6776","authenticated-orcid":false,"given":"Madhvi","family":"Rajpurkar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology Oncology, Carman and Ann Adams Department of Pediatrics Central Michigan University, Wayne State University School of Medicine, Children's Hospital of Michigan  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0268\u2010960x(92)90011\u2010e"},{"key":"e_1_2_11_3_1","first-page":"501","article-title":"Report of the Committee on Nutrition: Vitamin K Compounds and the Water\u2010Soluble Analogs","volume":"28","author":"American Academy of Pediatrics","year":"1961","journal-title":"Pediatrics"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12030780"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001232"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102516.2004.01008.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1614494"},{"key":"e_1_2_11_8_1","first-page":"501","article-title":"Vitamin K Compounds and the Water\u2010Soluble Analogues: Use in Therapy and Prophylaxis in Pediatrics","volume":"28","author":"American Academy of Pediatrics Committee on Nutrition","year":"1961","journal-title":"Pediatrics"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2016.30"},{"key":"e_1_2_11_10_1","first-page":"363","article-title":"Idiopathic Vitamin K Deficiency in Infants: Its Roles in Infant Morbidity and Childhood Handicaps","volume":"62","author":"Isarangkura P. B.","year":"1989","journal-title":"Thrombosis and Haemostasis"},{"key":"e_1_2_11_11_1","first-page":"417","article-title":"Incidence of Idiopathic Vitamin K Deficiency in Infants: A National, Hospital Based, Survey in Thailand 1983","volume":"71","author":"Ungchusak K.","year":"1988","journal-title":"Journal of the Medical Association of Thailand"},{"key":"e_1_2_11_12_1","first-page":"649","article-title":"Vitamin K Deficiency Bleeding in Thailand: A 32\u2010Year History","volume":"29","author":"Chuansumrit A.","year":"1998","journal-title":"Southeast Asian Journal of Tropical Medicine and Public Health"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00441969"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442\u2010200X.2011.03392.x"},{"key":"e_1_2_11_15_1","first-page":"305","article-title":"An Epidemiological Study on Vitamin K Deficiency Bleeding in Infants Under Six Months","volume":"36","author":"Zhou F.","year":"2002","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi [Chinese Journal of Preventive Medicine]"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20103016.1992.tb00736.x"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.303.6810.1105"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild\u20102018\u2010316424"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021\u2010056036"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1990.283"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2014.02.013"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309233291301"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13114109"},{"key":"e_1_2_11_24_1","unstructured":"The World Bank.World Bank Country and Lending Groups[Internet]; 2023 [cited 2024 August 12] https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups."},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003830050033"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15048"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.14598"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.2004.04972.x"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2019\u20100219"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6600007"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.112.1.191"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015\u20104222"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2019\u20100228"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.2147\/RRN.S154652"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17057"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.36518\/2689\u20100216.1289"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.31889","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T03:44:57Z","timestamp":1756179897000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.31889"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":35,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/pbc.31889"],"URL":"https:\/\/doi.org\/10.1002\/pbc.31889","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,8]]},"assertion":[{"value":"2025-03-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e31889"}}