Vitamin K deficiency following broad spectrum antibiotic usage has been reported in adult and pediatric studies [1], but conclusive evidence in neonatal age group is lacking. In the June recent issue of Indian Pediatrics, Sethi, et al. [2] reported 100% prevalence of vitamin K deficiency in hospitalized newborns at enrolment, which persisted despite vitamin K administration. This fact could be attributed to physiological hypoprothrombine-mic state of premature neonates or due to co-existing sepsis for which the neonates required antibiotic therapy. Multiple confounding factors might result in vitamin K deficiency – prematurity, class of antibiotics administered and sepsis [3]. Antibiotic administration might have worsened the pre-existing vitamin K deficiency, which did not respond to single intramuscular dose of vitamin K. In the presence of pre-existing PIVKA 2 levels >2 ng/mL in both the groups, the safety and efficacy of intramuscular route needs to be addressed.

It was mentioned that median postnatal age at enrolment was 10.5 days (vitamin K group) and 10 days (no vitamin K group) with IQR of 9-18 days in both the groups. As it was presented that early onset sepsis (sepsis within 72 hours of life) occurred in 58.5% of vitamin K group and 41% of no vitamin K group, which seems contradicting the age of enrolment [4]. PIVKA 2 levels can also be increased in other co-morbid conditions like cholestasis, neonatal giant cell hepatitis, whose evaluation may be necessary [5]. However, this study being the first of its kind in neonates, forms a platform for future research.

1. Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Rev. 2009;23:49-59.

2. Sethi A, Jeeva Sankar M, Thukral A, Saxena R, Chaurasia S, Agarwal A. Prophylactic vitamin K administration in neonates on prolonged antibiotic therapy: A randomized controlled trial. Indian Pediatr. 2019;56:463-7.

3. Chen L-J, Hsiao F-Y, Shen L-J, Wu F-LL, Tsay W, Hung C-C, et al. Use of hypoprothrombinemia-inducing cephalos-porins and the risk of hemorrhagic events: A nationwide nested case-control study. Plos One. 2016;11:e0158407.

4. Shah BA, Padbury JF. Neonatal sepsis: An old problem with new insights. Virulence. 2014;5:170-8.