A study on the subclinical hepatic dysfunction as a causative factor of infantile vitamin K deficiency hemorrhage

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Infantile vitamin K deficiency hemmorrhage is a serious disease, mainly seen in breast-fed infants during early infancy, usually without any apparent causes. We suspected the liver function somehow related to the development of this desease, and studied to elucidate its role as a causative factor of this disease.1. Eight out of nine infants, who showed low normotest at the age of three weeks, developed hepatic dysfunction later.2. Serum levels of rapid turnover proteins, such as ceruloplasmin, were elevated in the patients, as well as in the infants who showed low normotest. These results suggested that there was no impairment in the production of the proteins, but there existed bile stasis in the infants with vitamin K deficiency.3. Serum bile acids were determined in eight infants with vitamin K deficiency with gas-chromatography. All the infants showed markedly elevated serum total bile acid and high C/CDC ratio, which strongly suggested the existense of bile stasis.4. Vitamin K was administered p.o. to 194 normal newborn infants at the age of 5 days, and serum level of vitamin K and serum PIVKA-II were determined. Among them, seven infants showed no elevation of serum vitamin K after 3 hours post vitamin K adminstration, of whom six became positive for PIVKA- II at the age of 3 weeks, suggesting the presence of vitamin K deficiency.The results of the present study clearly indicate that malabsorption of vitamin K due to "physiologic" cholestasis in early infancy plays an important role in the development of idiopathic infantile vitamin K deficiency hemorrhage.