European Journal of Pediatrics

, 168:127

Vitamin K, an update for the paediatrician

  • Myriam Van Winckel
  • Ruth De Bruyne
  • Saskia Van De Velde
  • Stephanie Van Biervliet
Review

DOI: 10.1007/s00431-008-0856-1

Cite this article as:
Van Winckel, M., De Bruyne, R., Van De Velde, S. et al. Eur J Pediatr (2009) 168: 127. doi:10.1007/s00431-008-0856-1

Abstract

Introduction

This review summarizes current knowledge on vitamin K for the paediatrician. Vitamin K is a fat-soluble vitamin, present in plants as phylloquinone and produced by bacteria as menaquinone. It is acting as a co-factor for γ-glutamyl carboxylase. This enzyme is responsible for post-translational modification of some glutamate side chains to γ-carboxyglutamate. The majority of γ-carboxylated proteins function in blood coagulation; others play a role in calcium homeostasis.

Data

Newborn babies are at particular risk of vitamin K deficiency, as placental transfer is limited and human milk is a poor source. Vitamin K prophylaxis at birth effectively prevents vitamin K deficiency bleeding (VKDB), formerly known as “haemorrhagic disease of the newborn”. Recent epidemiological studies provide data on the effectiveness of different administration routes and dosing schemes. Infants of mothers taking drugs that inhibit vitamin K are at risk of early VKDB and should receive 1 mg intramuscular (IM) as soon as possible after birth. Classic VKDB is prevented by intramuscular as well as by oral administration of 1 mg vitamin K. In exclusively breast-fed infants, single IM administration at birth is also effectively preventing (rare) late VKDB but single oral administration is not. If given orally, prophylaxis should be continued by either weekly administration of 1 mg till 12 weeks or repeating 2 mg at weeks 1 and 4. Daily administration of 25 μg offers insufficient protection. The only infants not fully protected in this way are those with yet unrecognised liver disease.

Conclusions

Further work is needed before firm recommendations can be made regarding dose in preterm infants and in patients with fat malabsorption/cholestasis or regarding the role of vitamin K in the prevention of osteoporosis.

Keywords

Vitamin K Phylloquinone Vitamin K deficiency bleeding Prophylaxis 

Abbreviations

IM

intramuscular

GGCX

γ-glutamyl carboxylase

VKOR

vitamin K-epoxide reductase

VKD

vitamin K deficiency

VKDB

vitamin K deficiency bleeding

VKCFD

Vitamin K dependent clotting factor deficiency

MM preparation

mixed micellar preparation

PT

prothrombin time

INR

international normalised ratio

PIVKA

protein induced by vitamin K absence

ucOC

under-γ-carboxylated osteocalcin

BMD

bone mineral density

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Myriam Van Winckel
    • 1
  • Ruth De Bruyne
    • 1
  • Saskia Van De Velde
    • 1
  • Stephanie Van Biervliet
    • 1
  1. 1.Department of PaediatricsUZ GentGhentBelgium

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