1. Exclusively breastmilk‐fed preterm infants are at high risk of developing subclinical vitamin K deficiency despite intramuscular prophylaxis at birth
- Author
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Paul Clarke, Martin J. Shearer, David J. Card, Amy Nichols, Vennila Ponnusamy, Ajit Mahaveer, Kieran Voong, Karen Dockery, Nicky Holland, Shaveta Mulla, Lindsay J. Hall, Cecile Maassen, Petra Lux, Leon J. Schurgers, Dominic J. Harrington, RS: CARIM School for Cardiovascular Diseases, Biochemie, and RS: Carim - B02 Vascular aspects thrombosis and Haemostasis
- Subjects
Vitamin K ,Milk, Human ,Infant, Newborn ,Infant ,Humans ,Aftercare ,Vitamin K Deficiency ,Hemorrhage ,Prospective Studies ,Vitamin K 1 ,Hematology ,Infant, Premature ,Patient Discharge - Abstract
BACKGROUND: There is near-global consensus that all newborns be given parenteral vitamin K1 (VK1 ) 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 under-γ-carboxylated (Glu) species of Gla-proteins, factor II (PIVKA-II) and osteocalcin (GluOC), synthesized by liver and bone respectively.PATIENTS/METHODS: Prospective, multi-center, observational study in preterm infants born RESULTS: Post discharge, breastmilk-fed babies had significantly lower serum VK1 (0.15 vs. 1.81 μg/L), higher PIVKA-II (0.10 vs. 0.02 AU/mL) and higher %GluOC (63.6% vs. 8.1%) than those receiving a formula/mixed-feed diet. Pre-discharge (based on elevated PIVKA-II), only 1 (2%) of 45 breastmilk-fed infants was VK insufficient. Post-discharge, 8 (67%) of 12 exclusively breastmilk-fed babies were VK insufficient versus only 1 (4%) of 25 formula/mixed-fed babies.CONCLUSIONS: Preterm infants who remain exclusively or predominantly human breastmilk-fed post neonatal unit discharge are at high risk of developing subclinical VK deficiency in early infancy. Routine post-discharge VK1 supplementation of breastfed infants to provide intakes comparable to those from formula milks should prevent this deficiency.
- Published
- 2022