ABSTRACT. Our report presents data on maturation of the vitamin K-dependent carboxylation system in fetal and neonatal rat livers. This system which converts precursors of clotting factors 11, VII, IX, X, protein S, and protein C to y-carboxylated proteins exhibited low y-carboxylation activity before birth. However, around the time of birth there was a sudden increase in all enzyme activities associated with the vitamin K-dependent carboxylation system. In 2-d neonatal rats these activities dropped to levels that were measured in fetal livers whereupon the activities had risen to adult levels in 7-d neonatal rats. However, the activities of the two pathways that provide the carboxylase with reduced vitamin KH2 cofactor were never as high as that measured in maternal livers. It appeared that the pathway which is insensitive to coumarin anticoagulant drugs matures later than the coumarin drug-sensitive pathway. This conclusion is supported by the finding of a late appearance in development of the vitamin K-reducing enzyme DT-diaphorase. Warfarin, when administered to the mother, affected the fetal livers at all stages of development studied (d 16-21). This was clearly demonstrated by vitamin K-dependent 14C-labeling of a 70-kD liver protein that has been shown previously to be a marker for the effect of this drug on the liver. The data demonstrate a similar mechanism of action of warfarin in fetal and neonatal rat livers and an ongoing maturation process of the vitamin Kdependent carboxylation system in these rats. (Pediatr Res 26: 370-376,1989) Abbreviations Vitamin KIH2, the fully reduced hydroquinone form of vitamin K1 Carboxylase activity, the activity of the enzyme that carries out y-carboxylation DTT. dithiothreitol It is well documented that premature infants and infants at term are born with reduced levels of many of the essential protein factors of the hemostatic system (1, 2). Among these are the vitamin K-dependent clotting factors (2, 3). At term, blood concentrations of these factors are about 30-60% of their con-