Card, David

Clarke, Paul

Dockery, Karen

Hall, Lindsay

Harrington, Dominic

Holland, Nicky

Mahaveer, Ajit

Nichols, Amy

Ponnusamy, Vennila

Schurgers, Leon

Shearer, Martin J

Voong, Kieran

English

University of East Anglia digital repository

BACKGROUND• Vitamin K (VK) status of preterm infants post-NICU discharge and in early infancy is unknown• Exclusive breast milk feeding is oCen the only factor idenDfiable in cases of idiopathic VKdeficiency bleeding• Despite the low VK content of human milk, VKsupplements are not rouDnely given to human milk-fed preterm infants aCer NICU discharge; in contrast, vitamins A, B, C, D, and E are widely givenAIMTo examine the VK status of breast milk fed preterm infants nearing discharge and in early infancy. HYPOTHESISIn the absence of extra VK supplementaDon at/aCer discharge home, preterm babies who remain exclusively or predominantly human milk fed will have a high prevalence of subclinical VK deficiency in early infancy. Title:SubtitleLeeroy Jenkins, author2, author3, author4Preterm infants who remain exclusively human milk fed post NICU discharge are at high risk of developing vitamin K deficiency in early infancyMAIN RESULTS:VK status approaching NICU discharge Of n=45 infants assessed prior to discharge (at median PMA 35+1): only 1/45 (2%) was VK deficient, an exclusively breast fed 23+6-week gestation baby.HIGH PREVALENCE OF SUBCLINICAL VITAMIN K1 DEFICIENCY AMONG HUMAN MILK-FED PRETERM INFANTS IN EARLY INFANCYPaul Clarke1,2 David Card3 Amy Nichols1 Kieran Voong3 Vennila Ponnusamy4 Ajit Mahaveer5 Karen Dockery5 Nicky Holland4Lindsay Hall6 Leon Schurgers7 Dominic Harrington3 MarDn J Shearer3 Phylloquinone vitamin K11. Neonatal Unit, Norfolk and Norwich University Hospital, Norwich, UK.2. Norwich Medical School, University of East Anglia, Norwich, UK.3. Haemostasis & Thrombosis and The Human Nutristasis Unit, Guy’s and St Thomas’s Hospital, London, UK.4. Neonatal Unit, St Peters Hospital, Chertsey, UK.5. Neonatal Unit, St Mary’s Hospital, Manchester, UK.6. Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.7. Department of Biochemistry, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands.METHODSDesign: ProspecDve, mulDcentre, observaDonal cohort study with ethics approvalIncluded: preterm infants born <33 weeks’ gestaDon and exclusively or predominantly human milk fed, approaching NICU discharge. Excluded: infants with cholestasis. Measures of VK status: serum concentraDons of vitamin K1 (VK1) and PIVKA-II (Protein Induced by Vitamin K Absence/antagonism of blood clodng factor II; undercarboxylated prothrombin) Timing of assessment: Samples taken at two Dme-points: ~35 weeks postmenstrual age (PMA) for baseline VK status, and at ~2 months corrected age (CA) (primary outcome). Definitions used for ‘Satisfactory’ and ‘Deficiency’ of vitamin K statusSatisfactory VK status: normal PIVKA-II(<50.9 mAU/mL)VK deficiency: raised PIVKA-II (≥51.0 mAU/mL)CONCLUSIONS:• The majority of exclusively breast milk fed babies had evidence of mild vitamin K deficiency by 2-3 months CA• Preterm infants who remain exclusively human milk fed post NICU discharge are at a high risk of developing mild vitamin K1 deficiency in early infancy without additional K1 supplements• Routine post-discharge K1 supplementation may prevent subclinical K1 deficiency in breast-fed babies in early infancyAcknowledgements: We thank Dr Shaveta Mulla and Dr Priyadarshan Ambadkar for supporting the study.Funding: Nutricia Ltd provided a small study grant which supported the travel expenses of parents and the courier costs of specimen transportationVK status in early infancy: N=37 completed the study, at median CA 8 weeks. By this time only 12/37 (32%) remained exclusively breast milk (BM) fed. Overall by 8 weeks CA, 9/37 (24%) infants had developed VK deficiency (as shown by ↑PIVKA-II). But of BM-fed infants 8/12 (67%) were VK deficient vs. only 1/25 (4%) FM/mixed feeding babies, p=0.0001 (Figure). VK1 concentrations were significantly lower and PIVKA-II concentrations higher in exclusive BM vs FM/mixed fed babies, Table. Figure PIVKA-II concentra4ons at ~8 weeks corrected age according to mode of milk feeding since discharge

High prevalence of subclinical vitamin K1 deficiency among human milk-fed preterm infants in early infancy

https://ueaeprints.uea.ac.uk/id/eprint/73037/2/JENS_vitK_poster_FINAL21SEP19.pdf

High prevalence of subclinical vitamin K1 deficiency among human milk-fed preterm infants in early infancy

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