Abstract
Little is known about the metabolic turnover and excretion of vitamin K in healthy newborn infants and the metabolic consequences of prophylactic regimens designed to protect against vitamin K deficiency bleeding (VKDB). We measured the excretion of two urinary metabolites (≤24 h) of vitamin K (5C- and 7C-aglycones) in term infants before (n = 11) and after (n = 5) a 1000 μg i.m. dose of vitamin K1 (K1) and in preterm infants after 200 μg i.m. (n = 4), 500 μg i.m. (n = 4), or 200 μg i.v. (n = 5). In preterm infants, we also measured serum K1, vitamin K1 2,3-epoxide, and PIVKA-II at 5 d postpartum. Before prophylaxis, the rate of 5C- and 7C-aglycone excretion was 25 times lower than adults, reflecting low vitamin K stores at birth. After prophylaxis, the excretion rate correlated to K1 dose (r = 0.6) but was two orders of magnitude lower than that in adults, probably reflecting the immaturity of neonatal catabolism. All term and 10 of 13 preterm infants mainly excreted 5C-aglycone. We present evidence that increased excretion of the 7C-aglycone was associated with metabolic overload because of the exposure to high-tissue K1 concentrations. Measurement of the 5C- and 7C-aglycones may facilitate longitudinal studies of vitamin K status in neonates and aid the development of improved prophylactic regimens.
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Abbreviations
- 5C-aglycone:
-
2-methyl-3-(3′-3′-carboxymethylpropyl)-1,4-naphthoquinone
- 7C-aglycone:
-
2-methyl-3-(5′-carboxy-3′-methyl-2′-pentenyl)-1,4-naphthoquinone metabolite
- Gla:
-
γ-carboxyglutamate residues
- K1:
-
vitamin K1 or phytomenadione
- K1O:
-
vitamin K1 2,3-epoxide
- K2:
-
menaquinones
- PIVKA-II:
-
undercarboxylated factor II
- VKOR:
-
vitamin K1 2,3-epoxide reductase
- VKDB:
-
vitamin K deficiency bleeding
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Acknowledgements
We thank all parents and infants who participated in this study. We are indebted to the neonatal nurses and midwives at Hope Hospital for their help with this study, in particular for perseverance and diligence in urine collection. We also thank Mark Guy and the staff of the Department of Biochemistry at Hope Hospital, and Donna Roeves, Kieran Voong, and Julia Harvey for their support.
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Harrington, D., Clarke, P., Card, D. et al. Urinary Excretion of Vitamin K Metabolites in Term and Preterm Infants: Relationship to Vitamin K Status and Prophylaxis. Pediatr Res 68, 508–512 (2010). https://doi.org/10.1203/PDR.0b013e3181f981c7
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DOI: https://doi.org/10.1203/PDR.0b013e3181f981c7
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