Santorino Data, Siedner Mark J, Mwanga-Amumpaire Juliet, Shearer Martin J, Harrington Dominic J, Wariyar Unni
Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Plot 8-18 Mbarara-Kabale road, P.O. Box 1410, Mbarara, Uganda.
Department of Medicine and Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 125 Nashua Street, Boston, MA 02114, USA.
Nutrients. 2015 Oct 16;7(10):8545-52. doi: 10.3390/nu7105408.
Vitamin K deficiency bleeding (VKDB) in infancy is a serious but preventable cause of mortality or permanent disability. Lack of epidemiologic data for VKDB in sub-Saharan Africa hinders development and implementation of effective prevention strategies. We used convenience sampling to consecutively enroll mothers delivering in a southwestern Uganda Hospital. We collected socio-demographic and dietary information, and paired samples of maternal venous and neonatal cord blood for the immunoassay of undercarboxylated prothrombin (PIVKA-II), a sensitive marker of functional vitamin K (VK) insufficiency. We used univariable and multivariable logistic regression models to identify predictors of VK insufficiency. We detected PIVKA-II of ≥0.2 AU (Arbitrary Units per mL)/mL (indicative of VK insufficiency) in 33.3% (47/141) of mothers and 66% (93/141) of newborns. Importantly, 22% of babies had PIVKA-II concentrations ≥5.0 AU/mL, likely to be associated with abnormal coagulation indices. We found no significant predictors of newborn VK insufficiency, including infant weight (AOR (adjusted odds ratio) 1.85, 95% CI (confidence interval) 0.15-22.49), gender (AOR 0.54, 95% CI 0.26-1.11), term birth (AOR 0.72, 95% CI 0.20-2.62), maternal VK-rich diet (AOR 1.13, 95% CI 0.55-2.35) or maternal VK insufficiency (AOR 0.99, 95% CI 0.47-2.10). VK insufficiency is common among mothers and newborn babies in southwestern Uganda, which in one fifth of babies nears overt deficiency. Lack of identifiable predictors of newborn VK insufficiency support strategies for universal VK prophylaxis to newborns to prevent VKDB.
婴儿维生素K缺乏性出血（VKDB）是导致死亡或永久性残疾的一个严重但可预防的原因。撒哈拉以南非洲地区缺乏VKDB的流行病学数据，这阻碍了有效预防策略的制定和实施。我们采用便利抽样法，连续纳入在乌干达西南部一家医院分娩的母亲。我们收集了社会人口学和饮食信息，并采集了配对的母亲静脉血和新生儿脐带血样本，用于检测脱羧基凝血酶原（PIVKA-II），这是功能性维生素K（VK）不足的一个敏感标志物。我们使用单变量和多变量逻辑回归模型来确定VK不足的预测因素。我们在33.3%（47/141）的母亲和66%（93/141）的新生儿中检测到PIVKA-II≥0.2 AU（每毫升任意单位）/毫升（表明VK不足）。重要的是，22%的婴儿PIVKA-II浓度≥5.0 AU/毫升，这可能与凝血指标异常有关。我们没有发现新生儿VK不足的显著预测因素，包括婴儿体重（调整优势比[AOR]1.85，95%置信区间[CI]0.15 - 22.49）、性别（AOR 0.54，95% CI 0.26 - 1.11）、足月出生（AOR 0.72，95% CI 0.20 - 2.62）、母亲富含VK的饮食（AOR 1.13，95% CI 0.55 - 2.35）或母亲VK不足（AOR 0.99，95% CI 0.47 - 2.10）。在乌干达西南部，母亲和新生儿中VK不足很常见，其中五分之一的婴儿接近明显缺乏。缺乏可识别的新生儿VK不足预测因素，支持对新生儿进行普遍VK预防以预防VKDB的策略。
