Vitamin K in the newborn: influence of nutritional factors on acarboxy-prothrombin detectability and factor II and VII clotting activity

Abstract

The incidence of acarboxy-prothrombin and the clotting activity of factors II and VII were evaluated on the fifth day of life in 183 healthy newborns, who had received no vitamin K prophylaxis. Acarboxy-prothrombin was detected in 93/183 newborns. All acarboxy-prothrombin-negative babies had factors II and VII clotting activities above 25% whereas a great variability was observed in acarboxy-prothrombin-positive babies: 21/93 had factor II and 14/93 had factor VII activities below 25%. Seventy-two of the acarboxy-prothrombin-positive babies had normal factor II and VII clotting times on the fifth day of life. These babies must be suspected to have had vitamin K deficiency on one of the first 4 days, as acarboxy-prothrombin has a 50% disappearance rate of 50 h. Acarboxy-prothrombin was mainly observed in breast-fed infants (84/122) and only rarely detectable in infants receiving supplementary (7/44) or exclusive formula feeding (2/17). The type of milk feeding however might be less important for the babies' vitamin K supply than the actual milk intake. All acarboxy-prothrombin-positive babies had received small amounts of milk on the first 4 days of life. In those with low factor II and VII clotting activities the milk intake was low throughout the first 4 days of life, whereas babies with acarboxy-prothrombin and and normal clotting activities had increased their milk intake to more than 100 ml on the third and fourth day of life. Recommendations for vitamin K prophylaxis in newborns should be given with regard to the feeding on the first days of life.

Relationship between vitamin K dependent coagulation factors and anticoagulants (protein C and protein S) in neonatal vitamin K deficiency.

“…These findings seem to represent the typical features of classic haemorrhagic disease of the newborn and confirm the previous observations that vitamin K storage in newborn infants is inadequate to maintain their requirement after birth and that the diet is the main source of vitamin K in this period. [23][24][25][26][27] The values for protein C antigen and protein C activity in the control group were notably lower than those found in adults, as previous investigators reported. [28][29][30] Furthermore, in vitamin K deficiency, protein C activity and gammacarboxyl protein C decreased to near the values observed in patients with homozygous protein C deficiency,'2-14 while the decrease in total protein C antigen was less.…”

The efficacy of oral Vitamin K1: Implications for future prophylaxis to prevent haemorrhagic disease of the newborn

“…4~ This method also shows a consistent and marked elevation in PIVKA II levels in exclusively breast-fed infants on day 5-7 of life, who received no Vitamin K, , which corresponds with the age of peak frequency of classical HD. 22,46,47 On the other hand, PIVKA II levels are zero in infants given oral Vitamin K,, 1.0 mg, after birth.28 As well, all cases of late onset HD tested for PIVKA II by Motohara showed strongly positive results at the time of presentation, by both CIE and immunological methods.48…”

Vitamin K for Neonates Receiving Antibiotics

“…week [5]. The study [3] population had several of these risk factors predisposing to vitamin K deficiency.…”