Vitamin K Dosing

Vitamin K Dosing

Vitamin K Prophylaxis for Premature Infants: 1 mg versus 0.5 mg. Costakos DT, Greer FR, Love LA, et al. Am J Perinatol 2003; 485-490.

We studied babies (22 to 32 weeks gestational age) of mothers wishing to breast-feed. Group 1 received 1 mg of vitamin K and Group 2 received 0.5 mg of vitamin K. The Day 2 plasma levels of vitamin K were 1900 to 2600 times higher on average, and the Day 10 vitamin K levels 550 to 600 times higher on average, relative to normal adult plasma values, whether an initial prophylaxis dose of 0.5 mg or 1 mg was used. We conclude that 0.5 mg as the initial dose of vitamin K intramuscularly or intravenously would likely be more than adequate to prevent hemorrhagic disease of the newborn, and that 0.3 mg/per kg may be used for babies with birth weights below 1000 g. To decrease vitamin K intakes in this population, new preparations of total parenteral nutrition multivitamins are needed.

Comments: It makes sense that ELBW premature infants should not require a full dose (or even a half dose) of vitamin K. However, based on the plasma levels seen in this study, we can compute a half-life of vitamin K in study infants of approximately 4-5 days. This means that levels will fall to below adult normal levels within 6-8 weeks. Is current nutritional supplementation of vitamin K adequate to support the infant’s needs beyond that point in time, or do we need to consider repeating the vitamin K injection monthly? ABK.

Date: 22 Jan 2004
Time: 14:02:21

The Costakos and Kumar studies share some of the same authors, and the lab in which the plasma Vitamin K levels were done is the same lab. In the Kumar study, by 40 weeks' postconception, the Vitamin K values in the prematures started with 1 mg IM, then are similar to those in term formula-fed infants. In the Costakos et al study, the plasma Vitamin K values for preterm infants (22 to 32 weeks) plasma levels of phylloquinone that are in agreement with the levels reported by Kumar, even after a lower initial dose (0.5 mg) of Vitamin K is used in a subset of the patients and in this study, babies received a lower amount of Vitamin K via TPN vitamins, intralipid (fat), and enteral routes, compared to the patients in the Kumar study. Furthermore-the Costakos et al study reviews the literature, with a discussion about how much is too little. Loughnan et al report that 0.1 mg/kg Vitamin K, prophylaxis intravenously or orally may not be enough to prevent late onset hemorrhagic disease in premature infants. In the Loughnan case series of two exclusively breast fed prematures, 1.63 kg (29 weeks) and 0.73 kg (25 weeks) these babies had clinical Vitamin K deficiency at Day 74 and Day 84 of life, respectively, though plasma Vitamin K levels were not measured. The larger of the two babies reportedly had liver disease. Both babies received 1 mg Vitamin K orally before Day 30, in addition to the initial low dose IV Vitamin K (0.1 mg/kg).
The fact remains fact that Vitamin K has a role in the brain growth factor receptor system, and that Vitamin K menaquinone is present in the brain, and that conversion of dietary phylloquinone to tissue menaquinone is not dependent on gut bacteria, so the future dosing recommendations will have to consider than just the best dose for an immature coagulation system.In fact, Dr Volpe , of Harvard, has recently published that Vitamin K is an in vivo antioxidant, and that nano amounts of Vitamin K prevent periventriclar leukomalacia.

Costakos DT, Freer FR, Love LA, Dahlen LR, Suttie JW. Vitamin K Prophylaxis for Premature Infants: 1mg vs 0.5mg. American Journal of Perinatology 2003 Nov;Vol 20, No. 8;485-490.

Kumar D, Greer FR, Super DM, Suttie JW, Moore JJ. Vitamin K status of premature infants: Implications for current recommendations. Pediatrics 2001 November Vol. 108;No. 5:1117-112.

Loughnan PM, McDougall PN, Balvin H, Doyle LW, Smith AL. Late onset haemorrhagic disease in premature infants who received intravenous vitamin K1. J Paediatr. Child Health (1996) 32,268-269.

Ferland G. The vitamin K-dependent proteins: An Update. Nutrition Reviews. Washington; August 1999;1-9.

Davidson RT, Foley AL, Engelke JA, Suttie JW. Conversion of dietary phylloquinone to tissue menaquinone-4 in rats is not dependent on gut bacteria. Nutrient Metabolism-Research Communication. Manuscript October 27, 1997:220-223.

Li J, Lin JC, Wang H, Peterson JW, Furie BC, Furie B, Booth SL, Volpe JJ, Rosenberg PA. Novel role of vitamin k in preventing oxidative injury to developing oligodendrocytes and neurons J Neurosci. 2003 Jul 2;23(13):5816-26.

UserName: Dennis T Costakos, MD
Institution: FSH-Mayo Health
telephone: 608 785-0940
email: costakos.dennis@mayo.edu

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