Late onset vitamin K deficiency bleeding, extreme prematurity and a human milk based diet

An extremely preterm female infant (born at 23+5 weeks; weight 555g) received 0.4mg/kg IM Vitamin K1 (VK). She received an exclusively human milk-based diet and was commenced on a commercially available human-milk fortifier

Review Article Diabetes mellitus and burns. Part II-outcomes from burn injuries and future directions

Abstract: Diabetes mellitus is an increasingly prevalent comorbidity in patients presenting to burn facilities. Diabetic patients tend to be older and present in a delayed manner with deeper injuries predominantly affecting the lower limb. Morbidity from burns is higher in this cohort including a longer length of hospital stay, greater need for surgical interventions and increased rate of infective complications. Nevertheless, there seems to be little effect of diabetes on associated mortality. The second part of this review article concentrates on the epidemiological profile of diabetic burn patients and the effect of the disease on morbidity and mortality. In addition, we present a review of therapeutic adjuncts, which may hold promise for the future management of this cohort of burn patients

Late-onset vitamin K deficiency bleeding in an extremely preterm infant fed an exclusively human milk–based diet

All newborns need extra phylloquinone (vitamin K1; K1) to prevent vitamin K deficiency bleeding (VKDB). In preterm babies, the main sources are prophylactic K1 given at birth and parenteral and/or enteral feeding thereafter. Preterm babies are at risk of late-onset VKDB if ongoing K1 supplementation is inadequate. For extremely preterm infants fed an exclusive human milk diet, the low K1 content of human milk may predispose them to vitamin K deficiency. Human milk fortification with either bovine milk–derived fortifier or human milk–based fortifier (HMF) made from pooled donor milk is a widely used strategy to improve the micronutrient and growth status of preterm infants. However, the K1 content of HMF is markedly lower than that of bovine-based preparations. We present an unusual case of late-onset VKDB in an extremely preterm infant who received an exclusive human milk diet and HMF and quantify total K1 intake prior to the bleeding