Severe liver haemorrhage in extremely low birthweight infants Reply

Sir, My co-authors and I are grateful to P Clarke and M Shearer for their interest in and contribution concerning our work on severe liver haemorrhage in extremely low birthweight infants. It is correct that we did not report on the vitamin K status of the infants, and we agree that the possibility of vitamin K deficiency bleeding merits consideration in unexpected bleeding in high-risk infants. A review of the records of our patients revealed that all infants received vitamin K by either the intramuscular or slow intravenous route, as suggested by the literature on neonates at high risk for haemorrhage (1). In three infants doses were repeated owing to their increased risk, to prevent late-onset vitamin K deficiency. If severe liver haemorrhage resulted from low fibrinogen and decreased concentrations of vitamin Kdependent factors, this would be more likely to be due to the inability of a damaged liver to utilize vitamin K. According to our proposed concept of pathogenesis, none of our infants showed additional bleeding sites such as intracranial, nasal or cutaneous, which would strengthen the suggestion of vitamin K deficiency. Nevertheless, further studies on the vitamin K status in very low birthweight infants with necrotizing enterocolitis, disseminated intravascular coagulation or sepsis will be of interest in revealing the precise need for supplementary vitamin K in high-risk neonates.