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Screening for late neonatal vitamin K deficiency by acarboxyprothrombin in dried blood spots
Insights
Vitamin K deficiency in infants can be detected using protein induced by vitamin K absence or antagonist-II (PIVKA-II) testing. Prophylaxis at birth did not fully prevent deficiency, highlighting the need for continued monitoring.
Area of Science:
- Biochemistry
- Neonatal Medicine
- Pediatric Nutrition
Background:
- Vitamin K deficiency can lead to serious bleeding issues in newborns.
- Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is a biomarker for vitamin K status.
- Dried blood spot testing offers a convenient method for neonatal screening.
Purpose of the Study:
- To assess vitamin K deficiency in a large infant cohort using PIVKA-II concentrations.
- To evaluate the effectiveness of different vitamin K prophylaxis regimens.
- To determine the incidence of PIVKA-II positivity in relation to feeding type and prophylaxis.
Main Methods:
- Dried blood spots were collected from 19,029 infants around 1 month of age.
- PIVKA-II concentrations were measured to identify vitamin K deficiency.
- Infants were categorized by feeding method (breast milk vs. formula) and vitamin K prophylaxis received.
Main Results:
- 51 infants (0.27%) had elevated PIVKA-II levels, with 9 showing very high concentrations.
- Solely breastfed infants without prophylaxis had a significantly higher incidence of positive PIVKA-II tests (0.51%) compared to formula-fed infants (0.18%).
- Vitamin K prophylaxis at birth did not completely prevent deficiency at 1 month, with incidences of 0.14%, 0.04%, and 0.03% for different prophylaxis groups among exclusively breastfed infants.
Conclusions:
- Vitamin K prophylaxis administered at birth is not completely effective in preventing vitamin K deficiency at one month of age.
- Breastfeeding is associated with a higher risk of vitamin K deficiency in infants not receiving adequate prophylaxis.
- Therapeutic vitamin K administration to infants with positive PIVKA-II tests resulted in only one case of intracranial hemorrhage.
Abstract:
Acarboxyprothrombin (protein induced by vitamin K absence or antagonist-II (PIVKA-II] concentrations in dried blood spots were determined in 19,029 infants at about 1 month of age as an indicator of vitamin K deficiency. We observed 51 cases with raised blood concentrations of PIVKA-II (greater than 4 AU/ml), nine of whom showed very high concentrations (greater than 20 AU/ml). For infants who did not receive vitamin K prophylaxis at birth, the incidence of the PIVKA-II test yielding positive results was significantly higher in those solely breast fed (0.51%) compared with those fed formula milk (0.18%). Among solely breast fed infants, the incidence of a very high result of the PIVKA-II test was 0.14% in those who had not received vitamin K prophylaxis at birth, 0.04% in those who received 2 mg orally, and 0.03% in those who received 2 mg orally plus a further dose of 2-4 mg orally at 7 days. Thus vitamin K prophylaxis at birth did not completely prevent vitamin K deficiency at 1 month. We administered vitamin K therapeutically to all infants whose PIVKA-II test yielded a positive result at 1 month. Only one infant with a positive result developed late neonatal intracranial haemorrhage.