1. Four out of 14 cases with late hemorrhagic disease of the newborn (HDN) had received vitamin K at birth (2 cases were having underlying hepatic disease). But all the cases developed late HDN signifying that vitamin K prophylaxis at birth has no role in preventing late HDN whereas the authors have given a key message that late HDN is prevalent because of lack of vitamin K prophylaxis. The common age of presentation of late HDN is 1-2 months(1,2). The plasma half life of vitamin K is only 72 hours and its storage in a healthy liver is linked upto one month(3,4). Vitamin K given at birth prevents classical HDN and reduces the incidence of late HDN significantly. To decrease the incidence of late HDN further, second dose of vitamin K may be given at 1 month of age and study in this context is desired.

2. Only 2 cases out of the 14 had cause for the development of late HDN indicating that late HDN is either predominantly idiopathic or primary in etiology. Whereas late onset HDN is often associated with vitamin K malabsorption as noted in neonatal hepatitis or biliary atresia, the present study has given full discredit to exclusive breast feeding.

3. Authors have attributed the cause of bleeding in cases no. 13 and 14 to vitamin K deficiency in whom aminotransferases were raised, which can be said so only if Proteins Induced in Vitamin K Absence (PIVKA) would have been elevated. PIVKA were not assessed in the present study. Levels of PIVKA-II is more specific than prothrombin time because it does not get elevated in states of decreased synthesis of coagulation factors as occurs in hepatitis(5).