title: Total and Differential Phylloquinone (Vitamin K1) Intakes of Preterm Infants from All Sources during the Neonatal Period.
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.
authors.affiliation: Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK. paul.clarke@nnuh.nhs.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Clarke
authors.affiliation: Newborn Intensive Care, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK. simon.mitchell@cmft.nhs.uk.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Mitchell
authors.affiliation: The Centre for Haemostasis and Thrombosis, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK. martin.shearer@gstt.nhs.uk.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shearer
mesh_terms: D004750:Enteral Nutrition; D005865:Gestational Age; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D010288:Parenteral Nutrition; D064167:Recommended Dietary Allowances; D010837:Vitamin K 1 / Q000008:administration & dosage*; D014813:Vitamin K Deficiency / Q000150:complications / Q000517:prevention & control
chemical_list: D010837:Vitamin K 1
keywords: bleeding; deficiency; dietary; micronutrients; nutrition; phylloquinone; prematurity; prophylaxis; supplement