Negative Impact of Prolonged Antibiotics or Persistent Diarrhea on Vitamin K1 Levels in 2-24 Weeks aged Egyptian Infants.

BACKGROUND: To evaluate the hazard of prolonged antibiotic therapy and/or persistent diarrhea on vitamin K1 (VK1) level and bleeding profile in infants (2-24 weeks). METHODS: A one-year case-control study, conducted at Ain Shams University, Egypt. 338 infants (2-24 weeks) were recruited and divided into 3 groups (1:1:3 ratios); group A (n=67) patients who received antibiotics for ≥10 days, group B (n=67) who had persistent diarrhea ≥ 14 days and group C (n=204) age- and gender- matched infants who had not either received antibiotics nor had diarrhea. All subjected to clinical assessment, bleeding history and had their complete blood count (CBC), PT and PTT, liver transaminases and VK1 level assayed. RESULTS: There was a significant increase in frequency of VKDB (vitamin K deficiency bleeding) and abnormal bleeding profile in cases than control group. There was significant negative correlation between VK1 level and duration of diarrhea, length of antibiotics used and bleeding profile. Antibiotic usage has hazardous effect on VK1 level in those with diarrhea; more patients were receiving antibiotic in those with persistent diarrhea and VKDB (N=55) than those with persistent diarrhea and normal VK1 (N=12). The longer duration of antibiotic therapy the lower level of VK1. Combining cephalosporin/penicillin therapy and/or diarrhea, in particular, had an impact on VK1 level. CONCLUSION: VKDB, a preventable cause of life-threatening hemorrhage, is still a major health problem in Egyptian infants, where persistent diarrhea and misuse of antibiotics are prevalent, necessitate a booster dose of VK in those high risk infants.

A Case of Combined Congenital Deficiency of Factor V and Factor VIII

Hemorrhagic disease of newborn by combined blood clotting factor deficiencies is very rare. Combined deficiency of factor V and factor VIII is the most common form among these cases, and inherited by autosomal recessive trait. Clinical findings are easy bruising, post-traumatic bleeding and bleeding after tooth extractions, and the main laboratory findings are prolonged partial thromboplastin time (PTT) and prothrombin time (PT) that are different from hemophilia A only with prolonged PTT. We experienced a case of combined congenital deficiency of factor V and factor VIII in a 1-day-old boy. We report the case with brief review of literature.