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[Evaluation of various forms of vitamin-K prophylaxis in breastfed infants]
1Academisch Ziekenhuis, afd. Kindergeneeskunde, Nijmegen.
Insights
Daily or weekly vitamin K1 prophylaxis effectively prevents vitamin K deficiency in breastfed infants. A daily dose of 25 micrograms or weekly 1 mg of vitamin K1 is recommended for infants during the first three months of life.
Area of Science:
- Neonatal Health
- Pediatric Nutrition
- Hematology
Background:
- Vitamin K deficiency bleeding (VKDB) is a serious concern in exclusively breastfed infants.
- Standard prophylaxis with a single oral or intramuscular dose of vitamin K1 may not provide complete long-term protection.
- Understanding optimal prophylaxis regimens is crucial for preventing VKDB.
Purpose of the Study:
- To evaluate the efficacy of different vitamin K1 prophylaxis schedules in healthy breastfed infants.
- To establish evidence-based recommendations for preventing vitamin K deficiency.
Main Methods:
- Prospective clinical trials comparing oral and intramuscular vitamin K1 administration.
- Monitoring vitamin K1 and PIVKA-II concentrations, and coagulation factors at various infant ages.
- Assessing regimens including single 1 mg oral/intramuscular doses, weekly 1 mg oral, and daily 25 microgram oral vitamin K1.
Main Results:
- Single 1 mg doses of vitamin K1 (oral or IM) were insufficient to prevent PIVKA-II after one month.
- Weekly 1 mg or daily 25 microgram oral vitamin K1 resulted in higher vitamin K1 levels.
- No detectable PIVKA-II was observed with weekly or daily vitamin K1 prophylaxis.
Conclusions:
- Single-dose vitamin K1 prophylaxis may not fully protect against late-onset VKDB in breastfed infants.
- Weekly 1 mg or daily 25 microgram oral vitamin K1 proved effective in preventing vitamin K deficiency.
- Daily 25 microgram oral vitamin K1 is recommended for breastfed infants during the first three months of life.
Objective:
To establish recommendations for prevention of vitamin K deficiency in healthy breastfed infants.
Design:
Prospective clinical trials of different methods of vitamin K prophylaxis.
Methods:
Study of vitamin K1 and proteins induced by vitamin K absence (PIVKA)-II concentrations, and some coagulation factors at the ages of 2, 4, 8 and 12 weeks in healthy breastfed infants with either once 1 mg vitamin K1 orally (n = 165) or intramuscularly (n = 166), or weekly 1 mg orally (n = 48), or daily 25 micrograms orally (n = 58).
Results:
Despite significantly higher vitamin K1 plasma concentrations after intramuscular administration, there was no difference in activities of coagulation factors VII and X, and PIVKA-II concentrations between oral and intramuscular administration. The two single administrations of 1 mg could not prevent the appearance of PIVKA-II after the age of 1 month. When vitamin K was administered as 1 mg per week or 0.025 mg per day, significantly higher concentrations of vitamin K1 were found and no PIVKA-II was detectable.
Conclusion:
A single administration of 1 mg vitamin K1 orally or intramuscularly may not afford complete protection against late vitamin K deficiency in healthy breastfed infants. A regimen of 1 mg per week or 25 micrograms vitamin K1 per day proved to be effective in prevention of vitamin K deficiency and the latter is recommended for breastfed infants during the first three months of life.
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