Vitamin K insufficiency and the prophylaxis strategy in term healthy infants: A multicentre study.

BACKGROUND/AIM: Late vitamin K deficiency bleeding (VKDB) during early infancy is a serious problem worldwide. Vitamin K (VK) deficiency commonly occurs in newborns who are exclusively breastfed. Protein Induced by VK Absence (PIVKA-II) has been identified as an early indicator of subclinical VK deficiency in neonates, surpassing prothrombin time. To assess PIVKA-II levels at 48 h, 1 and 3 months of age in full-term newborns who were exclusively breastfed and received varying VKDB prophylaxis regimens. METHODS: A prospective observational study was conducted in four hospitals, enrolling 105 newborns. PIVKA-II levels were measured using a sandwich-type enzyme-linked immunosorbent assay. RESULTS: At 48 h of age, there was no significant difference in PIVKA-II concentrations between newborns who received intramuscular administration of 1 mg of phylloquinone (VK1) and those who received oral administration of 2 mg of VK1 at birth. At 1 and 3 months of life, infants who received any supplementation regimen between 2 and 14 weeks exhibited significantly lower PIVKA-II concentrations compared to infants who received only 1 mg of intramuscular VK1 at birth. The prophylaxis involving a dose of 1 mg of intramuscular VK1 at birth followed by oral administration of 150 µg/day of VK1 from the 2nd to the 14th week of life showed the lowest PIVKA-II blood concentrations. CONCLUSIONS: Oral supplementation of VK1 after discharge significantly reduced PIVKA-II concentrations in exclusively breastfed term infants. These findings suggest the importance of oral VK1 supplementation in exclusively breastfed infants during their first 3 months of life to avoid the risk of VK insufficiency.

Hypoxic ischemic brain injury: animal models reveal new mechanisms of melatonin-mediated neuroprotection.

Oxidative stress (OS) and inflammation play a key role in the development of hypoxic-ischemic (H-I) induced brain damage. Following H-I, rapid neuronal death occurs during the acute phase of inflammation, and activation of the oxidant-antioxidant system contributes to the brain damage by activated microglia. So far, in an animal model of perinatal H-I, it was showed that neuroprostanes are present in all brain damaged areas, including the cerebral cortex, hippocampus and striatum. Based on the interplay between inflammation and OS, it was demonstrated in the same model that inflammation reduced brain sirtuin-1 expression and affected the expression of specific miRNAs. Moreover, through proteomic approach, an increased expression of genes and proteins in cerebral cortex synaptosomes has been revealed after induction of neonatal H-I. Administration of melatonin in the experimental treatment of brain damage and neurodegenerative diseases has produced promising therapeutic results. Melatonin protects against OS, contributes to reduce the generation of pro-inflammatory factors and promotes tissue regeneration and repair. Starting from the above cited aspects, this educational review aims to discuss the inflammatory and OS main pathways in H-I brain injury, focusing on the role of melatonin as neuroprotectant and providing current and emerging evidence.

Prenatal and Neonatal Bone Health: Updated Review on Early Identification of Newborns at High Risk for Osteopenia.

Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the 'foetal programming' of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today's management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.

Supplement feed efficiency of growing beef cattle grazing native Campos grasslands during winter: a collated analysis.

Supplementing growing cattle grazing native subtropical Campos grasslands during winter improves the low, even negative, average daily weight gain (ADG) typical of extensive animal production systems in Uruguay. Nonetheless, to render the practice profitable, it is crucial to control supplement feed efficiency (SFE), that is, the difference in ADG between supplemented and control animals (ADGchng) per unit of supplement dry matter (DM) intake. Little has been studied specifically on how SFE varies in these systems. The objective of this study was to quantify the magnitude and variation in SFE of growing beef cattle grazing stockpiled native Campos grasslands during winter and assess putative associations with herbage, animals, supplements, and climatic variables. We compiled data from supplementation trials carried out in Uruguay between 1993 and 2018, each evaluating between one and six supplementation treatments. The average ADG of unsupplemented and supplemented animals were 0.13 ±â€…0.174 and 0.49 ±â€…0.220 kg/animal/day, respectively. In both cases, ADG decreased linearly as the proportion of green herbage in the grazed grassland was lower, but the ADG of unsupplemented animals was further reduced when winter frosts were numerous. Estimated SFE were moderately high, with an average of 0.21 ±â€…0.076 ADGchng/kg DM, resulting from average ADGchng of 0.38 ±â€…0.180 kg/animal/day in response to an average supplementation rate of 1.84 ±â€…0.68 kg supplement DM intake/animal/day (0.86%  ±â€…0.27% body weight). No association was found between SFE and supplementation rate or type (protein vs. energy-based; P > 0.05), but forage allowance negatively affected it, and herbage mass positively affected it, yet in a smaller magnitude, suggesting that a balance is needed between the two to maximize SFE. Weather conditions during trials affected SFE (P < 0.05), with greater SFE in winters with lower temperatures and more frosts. Daytime grazing time was consistently lower in supplemented animals compared to their unsupplemented counterparts, whereas ruminating time during the day was similar, increasing as the proportion of green herbage decreased. Herbage intake estimated from energy balance suggested the existence of some substitution effect. This agrees with the moderately high SFE and with the total digestible nutrients-to-protein ratio of these subtropical humid grasslands being higher than in semi-arid rangelands and dry-season tropical pastures but lower than in sown pastures.