Prophylactic use of vitamin k in special neonatal populations: a quality assessment of clinical guidelines.

Vitamin K deficiency bleeding (VKDB) is a serious neonatal condition. Despite widespread prophylaxis, a unified and explicit prevention strategy remains lacking for special neonatal populations. This study systematically searched the PubMed and CNKI databases, along with the websites of relevant guideline-issuing organizations. Clinical practice guidelines published up to June 30, 2025, were included, excluding outdated versions superseded by updated guidelines and documents not published in English or Chinese. Methodological quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, while reporting quality was evaluated using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. Key data on dosage frequency, amount, route, and timing were extracted. A total of 14 eligible guidelines were included, covering Asia, Europe, the Americas, Oceania, and international organizations, published between 2000 to 2025. The overall methodological and reporting quality of the included guidelines was relatively low. Considerable variability was observed in the recommendations for vitamin K prophylaxis among special neonatal populations, such as preterm infants, low birth weight infants, those with maternal medication exposure, hepatobiliary disease, gastrointestinal malabsorption, birth trauma, surgical needs, or exclusive breastfeeding. These differences were reflected in the route of administration, dosage, timing, and frequency. Most guidelines recommended intramuscular injection with weight-based dosing, while a few provided oral regimens as an alternative.

conclusionsClinical practice guidelines for vitamin K prophylaxis in special neonatal populations show poor quality and inconsistency. There is a need for high-quality research to clarify individualized supplementation strategies. WHAT IS KNOWN: • Vitamin K deficiency bleeding (VKDB) is a serious but preventable neonatal hemorrhagic disorder. Prophylactic vitamin K administration has been widely adopted, significantly reducing VKDB incidence. WHAT IS NEW: • Certain special neonatal populations-such as those born prematurely, with low birth weight, exposed to interfering maternal medications, or with gastrointestinal/hepatobiliary disorders, etc.-are at high risk for VKDB. Current recommendations vary markedly in dosage, route, and timing, and lack consistent methodological rigor. There is an urgent need for individualized, evidence-based strategies tailored to these vulnerable populations.