Effects of oral and intramuscular vitamin K prophylaxis on vitamin K1, PIVKA-II, and clotting factors in breast fed infants.

Abstract

A randomised clinical trial was conducted to establish the effects of oral and intramuscular administration of vitamin K at birth on plasma concentrations ofvitamin K1, proteins induced by vitamin K absence (PIVKA-II), and clotting factors. Two groups of about 165 healthy breast fed infants who received at random 1 mg vitamin K1 orally or intramuscularly after birth were studied at 2 weeks and 1 and 3 months of age. Although vitamin K1 concentrations were statistically significantly higher in the intramuscular group, blood coagulability, activities of factors VII and X and PIVKA-II concentrations did not reveal any difference between the two groups. At 2 weeks of age vitamin K, concentrations were raised compared with reported unsupplemented concentrations and no PIVKA-II was detectable. At 3 months vitamin K1 concentrations were back at unsupplemented values and PIVKA-II was detectable in 11.5% of infants. Therefore, a repeated oral prophylaxis will be necessary to completely prevent (biochemical) vitamin K deficiency beyond the age of 1 month.

Neonatal plasma vitamin K1 levels following oral and intramuscular administration of vitamin K1

“…Most authors (3, 5) have reported undetectable levels in cord blood which is in agreement with our observations. Follow-up studies (7,9) have shown that in completely breast-fed infants, vitamin K1 plasma levels continue to decrease with increasing age. At one month of age, values reached 0.4-0.6 pg/l, irrespective of the route of administration of vitamin K at birth and approached those of infants without vitamin K prophylaxis (6,8).…”

“…There are a number of studies reporting plasma vitamin K levels (3)(4)(5)(6)(7)(8)(9) in newborn infants. Results are difficult to compare because the time of sampling, dosage, time o f administration and route of administration of vitamin K vary from report to report.…”

Impact of Supplemental Vitamin K1 Administration on Postoperative Blood Component Requirements After Craniosynostosis Repair

“…Currently used as a tumor marker for surveillance of hepatocellular carcinoma in adults, 11 PIVKA-II has been suggested as a sensitive biomarker for vitamin K deficiency. 5,10,24 Protein induced in vitamin K absence-prothrombin is a nonfunctional precursor of prothrombin made when glutamic acid residues cannot be fully carboxylated by vitamin K in the liver. 1 Reliability of this marker in infants has been debated, as PIVKA-II has been detected in neonates only days after vitamin K 1 prophylaxis.…”

Vitamin K Prophylaxis in Infants

“…Formula-fed infants 1 mg orally shortly after birth + 150 μg daily from day 8 1 mg orally shortly after birth to 3 months  If an infant consumes at least 500 mL of formula, this dose may be skipped.…”