Plasma concentrations of vitamin K1 and PIVKA-II in bottle-fed and breast-fed infants with and without vitamin K prophylaxis at birth

Abstract

Plasma vitamin K1 and proteins induced by vitamin K absence (PIVKA) were assayed simultaneously 1-4 days and 29-35 days after delivery in three groups of infants: breast-fed not receiving vitamin K at birth (n = 12), bottle-fed without vitamin K administration at birth (n = 7) and breast-fed receiving 1 mg vitamin K1 administered by intramuscular injection at birth (n = 13). The bottle-fed infants had a significantly higher vitamin K1 plasma level than breast-fed infants who did not receive vitamin K1 at birth. Extremely high levels of vitamin K were obtained 1-4 days after intramuscular administration. At the age of 1 month, breast-fed infants had the same plasma vitamin K1 concentration whether or not they had received vitamin K1 supplements. Decarboxy prothrombin (PIVKA-II) a reliable indicator of biochemical vitamin K deficiency, was found in 5 out of 12 breast-fed and in 2 out of 6 bottle-fed infants who had not received supplemental vitamin K1 after birth. In a separate study, we followed up to 90 days after birth a larger group if infants. PIVKA-II was found with significantly greater frequency in breast-fed infants receiving no vitamin K than in breast-fed infants receiving 1 mg vitamin K intramuscularly at birth, or in bottle-fed infants without extra vitamin K1. These data form a strong argument for routine vitamin K prophylaxis after birth for all breast-fed infants. The optimum dose and manner of administration require further study.

Prothrombin and PIVKA‐II Levels in Cord Blood from Newborn Exposed to Anticonvulsants During Pregnancy

“…In one study of 51 newborn blood samples from Japan, using the same assay as in our study, 21.5% exhibited PIVKA-I1 ranging from 0.13 to 1 AU/ml (13). In another study from the Netherlands, again using the same assay, PIVKA-I1 was detected in 31% five of 16 cordblood samples); the range was 0.22-3.86 AU/ml (23). In our study, PIVKA-I1 was detected in 54% of control newborn (six of 11 samples); range, 0.18-4.43.…”

Analysis of Chromosome Aberrations and Sister Chromatid Exchanges in Peripheral Blood Lymphocytes of Newborns after Vitamin K Prophylaxis at Birth

“…McNinch et al (10) detected a peak level of 1781 ng/mL after 12 h. This shows that the blood lymphocytes in the vitamin K group certainly have been exposed to extremely high levels of vitamin K before sampling. Previous studies have shown that the plasma level declines rapidly ( 12).…”

Pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K1) in severe acute liver disease

“…The hepatic synthesis of these vitamin K-dependent factors differs from other coagulation factors in that their functional activity is also dependent on the integrity of the microsomal g-glutamyl carboxylation system, which converts the inactive protein precursors to their active zymogens, with a reduced ratio of functional to antigenic levels of prothrombin being a hallmark of an impaired carboxylation resulting in the hepatic secretion of non-functional PIVKA-II [22,23]. In ALF, it has been commonly assumed that the reduced levels of prothrombin (and other vitamin K-dependent proteins) are due to impaired hepatic protein synthesis [22].…”