Vitamin K Deficiency Bleeding in Infancy
Abstract
:1. Introduction
2. Epidemiology and Classification of VKDB
3. Diagnosis of VKDB in Infancy
4. Treatment of VKDB in Infancy
5. Prevention of VKDB in Infancy and Prophylaxis Guidelines
Author Contributions
Acknowledgments
Conflicts of Interest
References
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n | Phylloquinone | Menaquinone-4 | |
---|---|---|---|
Human milk | |||
2–14 days | 29 | 7.7 ± 4.1 (1.6–17.1) | 2.7 ± 2.8 (<0.4–13.2) |
15–60 days | 76 | 9.2 ± 6.1 (1.6–33.9) | 2.5 ± 3.0 (<0.4–16.2) |
Cow’s milk | 8 | 17.4 ± 3.0 (11.3–20.2) | 4.5 ± 4.7 (<0.4–15.2) |
Formula milk | 12 | 19.9 ± 6.5 (12.6–32.0) | 5.4 ± 4.6 (1.2–13.2) |
K1 | MK-4 | MK-5 | MK-6 | MK-7 | MK-8 | MK-9 | MK-10 | ||
---|---|---|---|---|---|---|---|---|---|
Adult | A | 648 | 116 | 109 | 422 | 387 | 910 | 2054 | 11,854 |
B | 1898 | 289 | 281 | 2140 | 1988 | 511 | 3080 | 15,662 | |
C | 5345 | - | - | 507 | 1826 | 2476 | 2702 | 7085 | |
D | 1634 | - | 273 | 407 | 1071 | 525 | - | 5167 | |
E | 2477 | 73 | 1570 | 189 | 753 | 389 | 1411 | 5745 | |
F | 2220 | 537 | 1138 | 2071 | 2562 | 1273 | 2548 | 9585 | |
Newborn | A | 4 | - | - | - | - | - | - | - |
B | 18 | - | - | - | 1 | - | - | - | |
C | 3 | - | - | - | - | - | - | - | |
D | 10 | - | - | - | - | - | - | - | |
E | 3 | - | - | - | - | - | - | - | |
F | 2 | - | - | - | 1 | - | - | - |
1. Poor placental transfer of vitamin K |
2. Immature gut flora |
3. Low vitamin K content in breast milk and substantial differences among individuals |
4. Poor intestinal absorption of vitamin K |
5. Low activity level of vitamin K epoxide reductase |
Classification | Time of Presentation | Etiology | Common Bleeding Sites |
---|---|---|---|
Early-onset VKDB | 0–24 h | Maternal medications (e.g., warfarin and anticonvulsants) | Subperiosteal layer of the skull and intracranial, cranial, intrathoracic, and intra-abdominal regions |
Classic VKDB | 2–7 days | Mainly idiopathic, maternal medications, and breastfeeding | Gastrointestinal tract, nose, umbilical stump, and skin as well as at the wound after circumcision |
Late-onset VKDB | 2–12 weeks | Mainly secondary, underlying diseases (e.g., biliary atresia, cystic fibrosis, and other liver diseases with cholestasis), chronic diarrhea, occasionally idiopathic, and antibiotic therapy | Intracranial regions, skin, and the gastrointestinal tract |
Country | Reference | Observation Period | Incidence Per 100,000 Infants (95% CI) |
---|---|---|---|
United Kingdom | 34 | 1988–1990 | 4.4 (2.0–8.4) |
Germany | 35 | 1988–1998 | 7.2 (3.5–13.3) |
Japan | 36 | 1981–1983 | 10.5 (7.0–15.0) |
Thailand | 21 | 1981–1984 | 72.0 |
Route | Country | Observation Period | Strategy of Vitamin K Prophylaxis | Incidence per 100,000 Infants Receiving the Regimen (95% CI) |
---|---|---|---|---|
IM | United Kingdom | 1 mg at birth, 3 × 1 mg PO (day 1, week 1, and week 4) | 0.1 | |
The United States | 1 mg at birth | No data available | ||
Canada | 1 mg at birth | 0.37 | ||
Denmark | 2000– | 2 mg at birth | No data available | |
New Zealand | 1 mg at birth | 0.16 (0–0.46) | ||
PO | The Netherlands | 1992–1994 | 1 mg at birth, 25 μg/day for 13 weeks | 0 (0–0.7) |
2005–2005 | 1 mg at birth, 25 μg/day for 13 weeks | 3.2 (1.2–6.9) | ||
2014–2016 | 1 mg at birth, 150 μg/day for 13 weeks | 1.2 (0.6–2.3) | ||
Germany | 1993–1994 | 3 × 1 mg (days 1, 4–10, and 28–42) | 1.3 (0.8–2.0) | |
1995–1998 | 3 × 2 mg (days 1, 4–10, and 28–42) | 0.4 (0.2–0.7) | ||
1997–2001 | 3 × 2 mg (days 1, 4–10, and 28–42) | 0.8 (0.4–1.4) | ||
1997–2001 | 3 × 2 mg (days 1, 4–10, and 28–42) | 0.44 (0.2–0.9) | ||
France | 2 mg weekly for 6 months | No data available | ||
Australia | 1993–1994 | 3 × 1 mg (days 1, 3–5, and 21–28) | 1.5 (0.5–3.6) | |
Denmark | 1990–1992 | 1 mg at birth | 4.5 (1.6–10.3) | |
1992–2000 | 2 mg at birth, 1 mg weekly for 3 months | 0 (0–0.9) | ||
Switzerland | 1986–1988 | 1–3 mg at birth | 6.4 (2.5–13.1) | |
1995–2002 | 2 × 2 mg (days 1, 4) | 1.2 (0–6.5) | ||
2003–present | 3 × 2 mg (days 1, 4, week 4) | 0.87 (0.24–2.24) | ||
Sweden | 1987–1989 | 1–2 mg at birth | 6.0 (3.7–9.8) | |
United Kingdom | 3 × 2 mg (days 1, 3–7, and week 4) | 0.43 | ||
Thailand | 1988–1995 | 2 mg at birth | 4.2–7.8 | |
Japan | 1988–1990 | 3 × 2 mg MK-4 (days 1, 7, and 28) | 2.8 (2.0–3.78) | |
1994–2004 | 3 × 2 mg MK-4 (days 1, 7, and 28) | 1.9 (1.2–3.0) |
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Araki, S.; Shirahata, A. Vitamin K Deficiency Bleeding in Infancy. Nutrients 2020, 12, 780. https://doi.org/10.3390/nu12030780
Araki S, Shirahata A. Vitamin K Deficiency Bleeding in Infancy. Nutrients. 2020; 12(3):780. https://doi.org/10.3390/nu12030780
Chicago/Turabian StyleAraki, Shunsuke, and Akira Shirahata. 2020. "Vitamin K Deficiency Bleeding in Infancy" Nutrients 12, no. 3: 780. https://doi.org/10.3390/nu12030780
APA StyleAraki, S., & Shirahata, A. (2020). Vitamin K Deficiency Bleeding in Infancy. Nutrients, 12(3), 780. https://doi.org/10.3390/nu12030780