Abstract
All newborns require phylloquinone after birth to prevent vitamin K deficiency bleeding. Babies born prematurely may be at particular risk of deficiency without adequate supplementation during infancy. The main sources of phylloquinone in preterm babies during the neonatal period are the prophylactic dose of phylloquinone given at birth, and that derived from parenteral and/or enteral feeding. This observational study formed part of a prospective, multicentre, randomised, controlled trial that examined the vitamin K status of preterm infants after random allocation to one of three phylloquinone prophylactic regimens at birth (0.5 or 0.2 mg intramuscularly or 0.2 mg intravenously). In this nutritional sub-study we quantified the proportional and total phylloquinone intakes of preterm infants within the neonatal period from all sources. Almost all infants had average daily phylloquinone intakes that were in excess of the currently recommended amounts. In infants who did not receive parenteral nutrition, the bolus dose of phylloquinone given at birth was the major source of phylloquinone intake, whereas in infants who received parenteral nutrition, the intake from the parenteral preparation exceeded that from the bolus dose by a ratio of approximately 3:1. Our study supports the concern of others that preterm infants who receive current parenteral nutrition formulations may be receiving excessive vitamin K.
Highlights
Vitamin K-dependent coagulation factors are synthesised exclusively in the liver and so the maintenance of adequate hepatic vitamin K reserves is essential for normal haemostasis
We had speculated that the initial bolus doses of phylloquinone given for prophylaxis at birth would assume less importance as a source of the vitamin contributing to the overall intake at study completion, due to the increasing respective contributions to overall phylloquinone intake derived from other nutritional sources
This study of phylloquinone intake in the first weeks of life shows that all preterm infants received at least the minimum daily recommended intake of phylloquinone, but that most received an excessive intake
Summary
Vitamin K-dependent coagulation factors are synthesised exclusively in the liver and so the maintenance of adequate hepatic vitamin K reserves is essential for normal haemostasis. The combination of low hepatic reserves and relatively low concentrations of phylloquinone in breast milk (compared to formula milks) places the breast-fed infant at increased risk of developing vitamin K deficiency. They are dependent upon adequate intakes of vitamin K postnatally and during early infancy to keep them healthy. Preterm infants may be at higher risk of developing VKDB without adequate ongoing phylloquinone intakes following birth [6], so a baseline understanding of their current typical intakes from various sources during the neonatal period is clearly important
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