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Kumar C, Marda S, Pothala R, Deshmukh N. Late Onset Vitamin K Deficiency Bleeding in a Neonate and Role of Elevated PIVKA-II Levels. Indian J Pediatr 2024; 91:645. [PMID: 38622448 DOI: 10.1007/s12098-024-05126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Chanchal Kumar
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Hyderabad, India.
| | - Srikanth Marda
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Hyderabad, India
| | - Rajeev Pothala
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Hyderabad, India
| | - Namita Deshmukh
- Neonatology Unit, Department of Pediatrics, Ankura Hospital for Women and Children, Hyderabad, India
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Perrone S, De Bernardo G, Lembo C, Dell'Orto V, Giordano M, Beretta V, Petrolini C, Gambini L, Toni AL, Parigi G, Fontanarosa I, Natale MP, D'Amato G, Sordino D, Buonocore G. Vitamin K insufficiency and the prophylaxis strategy in term healthy infants: A multicentre study. Eur J Clin Invest 2024; 54:e14141. [PMID: 38071415 DOI: 10.1111/eci.14141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND/AIM Late vitamin K deficiency bleeding (VKDB) during early infancy is a serious problem worldwide. Vitamin K (VK) deficiency commonly occurs in newborns who are exclusively breastfed. Protein Induced by VK Absence (PIVKA-II) has been identified as an early indicator of subclinical VK deficiency in neonates, surpassing prothrombin time. To assess PIVKA-II levels at 48 h, 1 and 3 months of age in full-term newborns who were exclusively breastfed and received varying VKDB prophylaxis regimens. METHODS A prospective observational study was conducted in four hospitals, enrolling 105 newborns. PIVKA-II levels were measured using a sandwich-type enzyme-linked immunosorbent assay. RESULTS At 48 h of age, there was no significant difference in PIVKA-II concentrations between newborns who received intramuscular administration of 1 mg of phylloquinone (VK1) and those who received oral administration of 2 mg of VK1 at birth. At 1 and 3 months of life, infants who received any supplementation regimen between 2 and 14 weeks exhibited significantly lower PIVKA-II concentrations compared to infants who received only 1 mg of intramuscular VK1 at birth. The prophylaxis involving a dose of 1 mg of intramuscular VK1 at birth followed by oral administration of 150 μg/day of VK1 from the 2nd to the 14th week of life showed the lowest PIVKA-II blood concentrations. CONCLUSIONS Oral supplementation of VK1 after discharge significantly reduced PIVKA-II concentrations in exclusively breastfed term infants. These findings suggest the importance of oral VK1 supplementation in exclusively breastfed infants during their first 3 months of life to avoid the risk of VK insufficiency.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Giuseppe De Bernardo
- Division of Pediatrics Neonatology and NICU, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Chiara Lembo
- Department of Neonatology, APHP, Necker-Enfants Malades Hospital, Paris, France
| | - Valentina Dell'Orto
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Virginia Beretta
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Chiara Petrolini
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | - Lucia Gambini
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, Pietro Barilla Children's Hospital, Parma, Italy
| | | | | | | | | | | | - Desiree Sordino
- Department of Emergency, NICU, A.O.R.N. Santobono-Pausillipon, Naples, Italy
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Clarke P, Embleton ND, Fewtrell M, Harrington DJ, Kelly AM, Moris N, Patto A, Ponnusamy V, Vasu V, Shearer MJ. Vitamin K: missed at peril-the case for extra supplementation to prevent deficiency in breastfed preterm infants. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326737. [PMID: 38429074 DOI: 10.1136/archdischild-2023-326737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care Unit, Norfolk Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mary Fewtrell
- Department of Population, Policy and Practice Research and Teaching, UCL Institute of Child Health, London, UK
- Department of Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dominic J Harrington
- The Nutristasis Unit, Synnovis, St Thomas' Hospital, London, UK
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Anne M Kelly
- Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Alexander Patto
- NanoPhotonics Centre, University of Cambridge, Cambridge, UK
| | - Vennila Ponnusamy
- Neonatal Intensive Care Unit, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Vimal Vasu
- Department of Neonatal Medicine, William Harvey Hospital, Ashford, UK
- School of Biosciences, University of Kent, Canterbury, UK
| | - Martin J Shearer
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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Vasu V, Mulla S, Pandya A, Card D, Shearer MJ, Clarke P. Late-onset vitamin K deficiency bleeding in an extremely preterm infant fed an exclusively human milk-based diet. J Thromb Haemost 2024; 22:466-469. [PMID: 37981048 DOI: 10.1016/j.jtha.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/21/2023]
Abstract
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.
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Affiliation(s)
- Vimal Vasu
- Department of Neonatal Medicine, William Harvey Hospital, Ashford, Kent, UK; School of Biosciences, University of Kent, Canterbury, UK.
| | - Shaveta Mulla
- Department of Neonatal Medicine, William Harvey Hospital, Ashford, Kent, UK
| | - Atisha Pandya
- Department of Neonatal Medicine, William Harvey Hospital, Ashford, Kent, UK
| | - David Card
- Human Nutristasis Unit, Synnovis, Guy's and St. Thomas's NHS Trust, London, UK
| | - Martin J Shearer
- Centre for Haemostasis and Thrombosis, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK
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Zhu M, Song Y, Xu Y, Xu H. Manipulating Microbiota in Inflammatory Bowel Disease Treatment: Clinical and Natural Product Interventions Explored. Int J Mol Sci 2023; 24:11004. [PMID: 37446182 DOI: 10.3390/ijms241311004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a complex multifactorial chronic inflammatory disease, that includes Crohn's disease (CD) and ulcerative colitis (UC), having progressively increasing global incidence. Disturbed intestinal flora has been highlighted as an important feature of IBD and offers promising strategies for IBD remedies. A brief overview of the variations occurring in intestinal flora during IBD is presented, and the role of the gut microbiota in intestinal barrier maintenance, immune and metabolic regulation, and the absorption and supply of nutrients is reviewed. More importantly, we review drug research on gut microbiota in the past ten years, including research on clinical and natural drugs, as well as adjuvant therapies, such as Fecal Microbiota Transplantation and probiotic supplements. We also summarize the interventions and mechanisms of these drugs on gut microbiota.
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Affiliation(s)
- Mengjie Zhu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yijie Song
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yu Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Hongxi Xu
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Mong MA. Vitamin K and the Visual System-A Narrative Review. Nutrients 2023; 15:nu15081948. [PMID: 37111170 PMCID: PMC10143727 DOI: 10.3390/nu15081948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Vitamin K occupies a unique and often obscured place among its fellow fat-soluble vitamins. Evidence is mounting, however, that vitamin K (VK) may play an important role in the visual system apart from the hepatic carboxylation of hemostatic-related proteins. However, to our knowledge, no review covering the topic has appeared in the medical literature. Recent studies have confirmed that matrix Gla protein (MGP), a vitamin K-dependent protein (VKDP), is essential for the regulation of intraocular pressure in mice. The PREDIMED (Prevención con Dieta Mediterránea) study, a randomized trial involving 5860 adults at risk for cardiovascular disease, demonstrated a 29% reduction in the risk of cataract surgery in participants with the highest tertile of dietary vitamin K1 (PK) intake compared with those with the lowest tertile. However, the specific requirements of the eye and visual system (EVS) for VK, and what might constitute an optimized VK status, is currently unknown and largely unexplored. It is, therefore, the intention of this narrative review to provide an introduction concerning VK and the visual system, review ocular VK biology, and provide some historical context for recent discoveries. Potential opportunities and gaps in current research efforts will be touched upon in the hope of raising awareness and encouraging continued VK-related investigations in this important and highly specialized sensory system.
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Affiliation(s)
- Michael A Mong
- Department of Ophthalmology, Veteran Affairs North Texas Health Care Medical Center, Dallas, TX 75216, USA
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Clarke P, Shearer MJ, Card DJ, Nichols A, Ponnusamy V, Mahaveer A, Voong K, Dockery K, Holland N, Mulla S, Hall LJ, Maassen C, Lux P, Schurgers LJ, Harrington DJ. Exclusively breastmilk-fed preterm infants are at high risk of developing subclinical vitamin K deficiency despite intramuscular prophylaxis at birth. J Thromb Haemost 2022; 20:2773-2785. [PMID: 36087073 PMCID: PMC9828794 DOI: 10.1111/jth.15874] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is near-global consensus that all newborns be given parenteral vitamin K1 (VK1 ) at birth as prophylaxis against VK deficiency bleeding (VKDB). Breastmilk has a low VK content and cases of late VKDB are reported in exclusively breastmilk-fed preterm infants despite VK prophylaxis at birth. OBJECTIVES To assess the prevalence of functional VK insufficiency in preterm infants based on elevated under-γ-carboxylated (Glu) species of Gla proteins, factor II (PIVKA-II), and osteocalcin (GluOC), synthesized by liver and bone, respectively. PATIENTS/METHODS Prospective, multicenter, observational study in preterm infants born <33 weeks' gestation. Blood samples and dietary history were collected before hospital discharge, and after discharge at 2-3 months' corrected age. Outcome measures were serum VK1 , PIVKA-II, and %GluOC (GluOC as a percentage of the sum of GluOC plus GlaOC) compared between exclusively breastmilk-fed and formula/mixed-fed infants after discharge. RESULTS After discharge, breastmilk-fed babies had significantly lower serum VK1 (0.15 vs. 1.81 μg/L), higher PIVKA-II (0.10 vs. 0.02 AU/ml) and higher %GluOC (63.6% vs. 8.1%) than those receiving a formula/mixed-feed diet. Pre-discharge (based on elevated PIVKA-II), only one (2%) of 45 breastmilk-fed infants was VK insufficient. After discharge, eight (67%) of 12 exclusively breastmilk-fed babies were VK insufficient versus only one (4%) of 25 formula/mixed-fed babies. CONCLUSIONS Preterm infants who remain exclusively or predominantly human breastmilk-fed after neonatal unit discharge are at high risk of developing subclinical VK deficiency in early infancy. Routine postdischarge VK1 supplementation of breastfed infants to provide intakes comparable to those from formula milks should prevent this deficiency.
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Affiliation(s)
- Paul Clarke
- Neonatal Intensive Care UnitNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Martin J. Shearer
- Centre for Haemostasis and ThrombosisGuy's and St Thomas's NHS Foundation TrustLondonUK
| | - David J. Card
- Nutristasis Unit, Viapath, Guy's and St Thomas's NHS Foundation TrustLondonUK
| | - Amy Nichols
- Neonatal Intensive Care UnitNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
| | - Vennila Ponnusamy
- Neonatal Intensive Care UnitAshford and St Peter's Hospitals NHS Foundation TrustChertseyUK
| | - Ajit Mahaveer
- Neonatal Intensive Care Unit, St Mary's HospitalManchester University NHS Foundation TrustManchesterUK
| | - Kieran Voong
- Centre for Haemostasis and ThrombosisGuy's and St Thomas's NHS Foundation TrustLondonUK
| | - Karen Dockery
- Neonatal Intensive Care Unit, St Mary's HospitalManchester University NHS Foundation TrustManchesterUK
| | - Nicky Holland
- Neonatal Intensive Care UnitAshford and St Peter's Hospitals NHS Foundation TrustChertseyUK
| | - Shaveta Mulla
- Neonatal Intensive Care UnitNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
| | - Lindsay J. Hall
- Gut Microbes & HealthQuadram Institute BioscienceNorwichUK
- ZIEL – Institute for Food & HealthTechnical University of MunichFreisingGermany
| | - Cecile Maassen
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Petra Lux
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Leon J. Schurgers
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
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