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Vitamin K insufficiency and the prophylaxis strategy in term healthy infants: A multicentre study
Serafina Perrone1, Giuseppe De Bernardo2, Chiara Lembo3
1Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy.
Insights
Late vitamin K deficiency bleeding (VKDB) is a risk for breastfed newborns. Oral vitamin K1 supplementation after birth significantly reduced early indicators of VK deficiency in infants, preventing potential VK insufficiency.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Biochemistry
Background:
- Late vitamin K deficiency bleeding (VKDB) poses a global health concern in early infancy.
- Exclusively breastfed newborns are particularly susceptible to vitamin K (VK) deficiency.
- Protein Induced by VK Absence (PIVKA-II) is a sensitive marker for subclinical VK deficiency in neonates.
Purpose of the Study:
- To evaluate PIVKA-II levels in exclusively breastfed term newborns.
- To compare PIVKA-II levels across different VKDB prophylaxis regimens.
- To assess PIVKA-II at 48 hours, 1 month, and 3 months of age.
Main Methods:
- Prospective observational study in four hospitals with 105 newborns.
- Measurement of PIVKA-II levels using enzyme-linked immunosorbent assay.
- Administration of varying VKDB prophylaxis regimens at birth and during early weeks.
Main Results:
- No significant difference in PIVKA-II at 48 hours between intramuscular and oral VK1 at birth.
- Significantly lower PIVKA-II at 1 and 3 months with supplementation regimens beyond initial prophylaxis.
- Lowest PIVKA-II concentrations observed with 1mg IM VK1 at birth plus daily oral VK1 (150 μg) from week 2 to 14.
Conclusions:
- Oral VK1 supplementation post-discharge effectively reduces PIVKA-II in exclusively breastfed term infants.
- Findings underscore the importance of oral VK1 in the first three months for exclusively breastfed infants.
- Oral VK1 supplementation is crucial for preventing VK insufficiency and associated bleeding risks.
Background/Aim:
Late vitamin K deficiency bleeding (VKDB) during early infancy is a serious problem worldwide. Vitamin K (VK) deficiency commonly occurs in newborns who are exclusively breastfed. Protein Induced by VK Absence (PIVKA-II) has been identified as an early indicator of subclinical VK deficiency in neonates, surpassing prothrombin time. To assess PIVKA-II levels at 48 h, 1 and 3 months of age in full-term newborns who were exclusively breastfed and received varying VKDB prophylaxis regimens.
Methods:
A prospective observational study was conducted in four hospitals, enrolling 105 newborns. PIVKA-II levels were measured using a sandwich-type enzyme-linked immunosorbent assay.
Results:
At 48 h of age, there was no significant difference in PIVKA-II concentrations between newborns who received intramuscular administration of 1 mg of phylloquinone (VK1) and those who received oral administration of 2 mg of VK1 at birth. At 1 and 3 months of life, infants who received any supplementation regimen between 2 and 14 weeks exhibited significantly lower PIVKA-II concentrations compared to infants who received only 1 mg of intramuscular VK1 at birth. The prophylaxis involving a dose of 1 mg of intramuscular VK1 at birth followed by oral administration of 150 μg/day of VK1 from the 2nd to the 14th week of life showed the lowest PIVKA-II blood concentrations.
Conclusions:
Oral supplementation of VK1 after discharge significantly reduced PIVKA-II concentrations in exclusively breastfed term infants. These findings suggest the importance of oral VK1 supplementation in exclusively breastfed infants during their first 3 months of life to avoid the risk of VK insufficiency.
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