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Vitamin K1 levels and K1-dependent coagulation factors II and X in preterm and small-for-date neonates
A L Pietersma-de Bruyn1, P J van der Straaten, P M van Haard
1Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands.
Insights
In formula-fed preterm and small-for-date infants, vitamin K1 levels rise significantly after birth, but this does not correlate with increased vitamin K-dependent coagulation factors II and X. Extra vitamin K1 did not accelerate factor activity.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Nutritional Science
Background:
- Vitamin K is crucial for synthesizing blood coagulation factors.
- Preterm and small-for-date neonates may have altered vitamin K metabolism.
- Vitamin K-dependent coagulation factors II and X are essential for hemostasis.
Purpose of the Study:
- To investigate the relationship between serum vitamin K1 levels and plasma levels of vitamin K-dependent coagulation factors II and X in formula-fed preterm and small-for-date neonates.
- To assess the impact of supplemental parenteral vitamin K1 on coagulation factor levels in preterm infants.
Main Methods:
- Measurement of serum vitamin K1 and plasma coagulation factors II and X in formula-fed preterm and small-for-date neonates over 28 days.
- Administration of a 1 mg dose of parenteral vitamin K1 (Konakion) to a subgroup of preterm neonates for comparison.
Main Results:
- Formula-fed preterm and small-for-date neonates showed a significant increase in serum vitamin K1 levels from birth to 28 days.
- Plasma levels of coagulation factors II and X remained stable at approximately 45% of adult values throughout the study period.
- Parenteral administration of 1 mg vitamin K1 resulted in very high serum vitamin K1 levels but did not significantly increase coagulation factor II and X levels.
Conclusions:
- There is no correlation between serum vitamin K1 levels and plasma levels of coagulation factors II and X in healthy preterm and small-for-date neonates.
- A single 1 mg dose of parenteral vitamin K1 does not accelerate the increase in coagulation factor activities in these infants.
Abstract:
In 17 preterm neonates and 7 small-for-date neonates, all formula-fed, vitamin K-dependent coagulation factors II and X remained near 45% of adult values from the moment of birth until 28 days postnatally. Vitamin K1 levels, however, showed a remarkable rise from below the detection limit of 0.022 ng/ml in umbilical cord blood, to serum levels with a range of 0.99-7.29 ng/ml vitamin K1 on day 3, with a further rise on days 7 and 28 postnatally. Vitamin K1 (Konakion) parenterally given to a third group of four preterm neonates as a 1 mg dose resulted in very high serum levels of vitamin K1 (64.08-157.10 ng/ml), but without any significant increase in plasma levels of vitamin K-dependent coagulation factors II and X, compared to the group without any extra vitamin K1. It is concluded that in healthy preterm and small-for-date neonates no correlation is seen between serum levels of vitamin K1 and plasma levels of coagulation factors II and X. After administration of 1 mg Konakion no accelerated increase is seen in coagulation factor activities.