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

Bryson, Sean

Card, David

Clarke, Paul

Mulla, Shaveta

Pandya, Atisha

Shearer, Martin J.

Vasu, Vimal

University of East Anglia digital repository

• The current recommendation for VK is 8-10 µg/day in VLBW infants & 5µg/day in healthy breastfed infants (0-6 months) (ESPGHAN 2016). • Exclusive human milk diets have lower VK content compared to preterm formula diets. Further, human milk fortifiers (HMF) are known to have lower VK content compared to Cow’s Milk fortifiers.  • Our baby received exclusive HMF which contained 0.3µg/100ml VK (approximately 20 times lower than compared to a cow’s milk fortifier). (1)191. Prevention of Vitamin K Deficiency Bleeding in Newborn Infants, Mihatsch, Walter A. (2016), J Pediatric Gastroenterology and Nutrition, Jul;63(1):123-9 2. PIVKA-II plasma levels as markers of subclinical vitamin K deficiency in term infants. Dituri F, (2012). J Maternal Fetal Neonatal Med. Sep;25(9):1660-3 LATE ONSET VITAMIN K DEFICIENCY BLEEDING,  EXTREME PREMATURITY AND A HUMAN MILK BASED DIET Sean Bryson1, Atisha Pandya1, Shaveta Mulla1, David Card2, Martin J Shearer3, Paul Clarke4, Vimal Vasu1 Affliations 1. Department of Neonatal Medicine, East Kent University NHS Foundation Trust, Ashford, Kent 2. Human Nutristasis Unit, Vitapath, Guys and St Thomas’s NHS Trust, London 3. Centre for Haemostasis and Thrombosis, Guys and St Thomas’s NHS Foundation Trust, London 4. Neonatal Unit, Norfolk and Norwich University Hospital, Norwich UK• Protein induced by Vitamin K absence, under carboxylation = PIVKA-2 is a functional marker of overall hepatic VK status.  • An elevated PIVKA-2 (>50.9mAU/ml) indicates a VK deficiency.  • Serum VK is a marker for overall body tissue stores of VK but unreliable for diagnosis of VKDB.  • Normal Serum VK is 0.15 - 1.55 µg/L. (2)CONCLUSIONSPreterm babies fed an exclusively human milk-derived diet (including HMF) receive inadequate VK intake and therefore maybe at risk of VKDB without additional VK supplementation. • 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.  • On D73 (CGA: 33+6 weeks; weight 1521g) she had significant ‘oozing’ from a heel-prick site. Investigations demonstrated deranged coagulation. She was treated  with IM VK followed by oral VK thereafter.  • After 3 days, her coagulation normalized. PIVKA-2 analysis confirmed the diagnosis of late-onset VKDB. The results are illustrated in Figure 1 (abnormal values in red). Test D73 (Day of diagnosis)D76 D77 D93 (Post  treatment)Ref rangePT 149.8 12.9 12-16sAPTT 84.4 39.5 22-25sFactor VIII 13750-100 IU/dlFactor IX 760-150 IU/dlFactor XI 4870-160 IU/dlPIVKA- 2 13437.2 28.02 17.36-50.0 mAU/mLVK 40.12 3.44 0.15-1.55 ug/lRECOMMENDED DAILY VITAMIN K REQUIREMENT?WHAT IS PIVKA-2? BLOOD RESULTS (Figure 1)

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

https://ueaeprints.uea.ac.uk/88627/1/P272_JENS_Bryson_et_al_NUTRITION3_19SEP2019.pdf

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

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