Exclusively breastmilk‐fed preterm infants are at high risk of developing subclinical vitamin K deficiency despite intramuscular prophylaxis at birth

Abstract

Background: There is near-global consensus that all newborns be given parenteral vitamin K 1 (VK 1 ) at birth as prophylaxis against VK deficiency bleeding (VKDB).Breastmilk has a low VK content and cases of late VKDB are reported in exclusively breastmilk-fed preterm infants despite VK prophylaxis at birth. Objectives:To assess the prevalence of functional VK insufficiency in preterm infants based on elevated underγ-carboxylated (Glu) species of Gla proteins, factor II (PIVKA-II), and osteocalcin (GluOC), synthesized by liver and bone, respectively.Patients/Methods: Prospective, multicenter, observational study in preterm infants born <33 weeks' gestation. Blood samples and dietary history were collected before hospital discharge, and after discharge at 2-3 months' corrected age. Outcome measures were serum VK 1 , PIVKA-II, and %GluOC (GluOC as a percentage of the sum of GluOC plus GlaOC) compared between exclusively breastmilk-fed and formula/ mixed-fed infants after discharge.

Vitamin K and the Visual System: A Narrative Review

“…These small concentrations and rapid tissue loss, lead directly to the discovery of VK in chicks, who are uniquely sensitive to the withdrawal of VK from the diet, showing clinical evidence of deficiency within hours. Similar vulnerabilities are seen in human infants, resulting in nearly universal worldwide parenteral administration of VK shortly after birth to prevent vitamin K deficiency bleeding (VKDB) of early infancy [231], which is sometimes associated with vision loss. Unique also to VK is the fact no known toxicity to naturally occurring VK isoforms have been shown, and natural forms of VK "appear to be essentially innocuous" [232].…”

Vitamin K insufficiency and the prophylaxis strategy in term healthy infants: A multicentre study

“…12 Studies have shown evidence of subclinical VK deficiency in a considerable number of exclusively breastfed preterm infants at 2-5 months of age, which is related to the duration of breastfeeding. 13 There is a near-global consensus that VK prophylaxis should be provided to all newborn infants to prevent VKDB and its life-threatening consequences. 13 Various regimens of parenteral and oral prophylaxis have been implemented over the years.…”

“…13 There is a near-global consensus that VK prophylaxis should be provided to all newborn infants to prevent VKDB and its life-threatening consequences. 13 Various regimens of parenteral and oral prophylaxis have been implemented over the years. [14][15][16][17][18] Phylloquinone, the vitamin K1 (VK1), is the only form used therapeutically in humans, synthesized by plants and algae.…”

“…In cases of overt VK deficiency where PT is significantly prolonged, PIVKA-II levels are invariably very high. 13 Limited data are available regarding the effects of VK supplementation in breastfed newborns on PIVKA-II levels. Studies have shown that exclusively breastfed infants and infants who did not receive VK prophylaxis have suboptimal VK status, as indicated by PIVKA-II measurements, even at 1-2 months of age.…”

“…Studies have shown that exclusively breastfed infants and infants who did not receive VK prophylaxis have suboptimal VK status, as indicated by PIVKA-II measurements, even at 1-2 months of age. 13,24,27,28 Dituri et al 29 investigated PIVKA-II concentrations in newborns receiving prolonged oral VK1 supplementation, after IM VK1 administration at birth.…”