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Vitamin K deficiency during the perinatal and infantile period
Insights
Vitamin K deficiency in newborns causes bleeding disorders, particularly in breast-fed infants. Prophylactic vitamin K at birth helps, but late-onset deficiency remains a concern.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Nutrition
Background:
- Coagulation factors are underdeveloped at birth.
- Vitamin K deficiency is a significant cause of neonatal bleeding.
- This deficiency affects vitamin K-dependent procoagulant factors (II, VII, IX, X).
Purpose of the Study:
- To highlight the importance of vitamin K in preventing neonatal hemorrhage.
- To discuss the causes and timing of vitamin K deficiency bleeding.
- To evaluate current prophylactic strategies and identify unmet needs.
Main Methods:
- Review of clinical presentations and risk factors for vitamin K deficiency bleeding.
- Analysis of the efficacy of vitamin K prophylaxis.
- Discussion of pathophysiological mechanisms of neonatal coagulopathy.
Main Results:
- Vitamin K deficiency bleeding (VKDB) presents with prolonged prothrombin times, improving with vitamin K administration.
- Breast-feeding is a common factor, alongside hepatobiliary diseases.
- VKDB can occur within 24 hours, between days 2-7, or late (>1 week to 6 months).
Conclusions:
- Prophylactic vitamin K administration and bottle-feeding can prevent early VKDB.
- Late-onset vitamin K deficiency despite prophylaxis remains a clinical challenge.
- Further research is needed to address the persistent issue of late VKDB.
Abstract:
Coagulation-related plasma proteins develop slowly during the gestational period and are still markedly lower than normal at birth. Great interest exists in the status of the vitamin K-dependent procoagulant factors (factors II, VII, IX and X) because a number of healthy newborns develop postpartum a bleeding tendency that is due to vitamin K deficiency. The most serious cases involve intracranial bleeding with convulsions, coma and potential death. Typically, these infants have markedly prolonged prothrombin times that shorten following the administration of vitamin K. A common feature of these infants is that they are breast-fed, although other factors, especially hepatobiliary diseases, contribute to this disorder. Vitamin K deficiency bleeding can develop as early as in the first 24 hours after birth, but most infants are diagnosed between days 2 and 7 postpartum. Late forms (> 1 week and up to 6 months) are also noted. This deficiency can be compensated for by prophylactically administering vitamin K to the newborns or by bottle-feeding. Although vitamin K2 may pass in small quantities through the placenta, it is insufficient to make up for the deficit. The first dose of vitamin K can also be given orally to the newborn after one or two regular feedings, and the second dose can be administered upon discharge from the hospital. A problem that remains to be solved is the late development of vitamin K deficiency in spite of prophylaxis at birth.