Prevalence of vitamin D deficiency in exclusively breastfed infants at Charoenkrung Pracharak Hospital

BACKGROUND Vitamin D deficiency is a common problem in exclusively breastfed infants,with supplementation recommended by various international medical organizations.However,in Thailand,no advice for routine vitamin D supplementation is available.Thus,this study investigated the prevalence of vitamin D deficiency and its associated factors in exclusively breastfed infants in Bangkok,Thailand.AIM To investigated the prevalence of vitamin D deficiency and its associated factors in exclusively breastfed infants in Bangkok,Thailand.METHODS This descriptive observational cross-sectional study assessed 1094-month-old infants at Charoenkrung Pracharak Hospital from May 2020 to April 2021.The 25-OH vitamin D level of the infants was measured using an electrochemiluminescence binding assay.Vitamin D deficiency was defined as 25-OH level<20 ng/mL,with vitamin D insufficiency 20-30 ng/mL.The sun index and maternal vitamin D supplementation data were collected and analyzed using the independent t-test,univariate logistic regression,and multivariate logistic regression to identify the associated factors.RESULTS The prevalences of vitamin D deficiency and vitamin D insufficiency were 35.78%and 33.03%,respectively with mean serum 25-OH vitamin D levels in these two groups 14.37±3.36 and 24.44±3.29 ng/mL.Multivariate logistic regression showed that the main factors associated with vitamin D status were maternal vitamin D supplementation and birth weight,with crude odds ratios 0.26(0.08–0.82)and 0.08(0.01–0.45),respectively.The sun index showed no correlation with the 25-OH vitamin D level in exclusively breastfed infants(r=−0.002,P=0.984).CONCLUSION Two-thirds of healthy exclusively breastfed infants had hypovitaminosis D.Vitamin D supplementation prevented this condition and was recommended for both lactating women and their babies.

Vitamin B12 deficiency in dialysis patients:risk factors,diagnosis,complications,and treatment:A comprehensive review

Vitamin B12 deficiency is a significant concern among patients with end-stage renal disease undergoing dialysis.However,there hasn’t been extensive research conducted on this particular patient group.The reported incidence rates vary widely,ranging from 20%to 90%,reflecting the complexity of its diagnosis.Dialysis patients often face multiple nutritional deficiencies,including a lack of essential vitamins,due to factors such as dietary restrictions,impaired absorption,and nutrient loss during dialysis.Diagnosing vitamin B12 deficiency in these patients is challenging,and addressing it is crucial to prevent complications and improve their overall quality of life.This review paper delves into the available body of evidence on vitamin B12 deficiency in dialysis patients,examining the contributing risk factors,diagnostic challenges,potential complications,and available treatment options.It provides a well-rounded perspective on the topic,making it a valuable resource for researchers,healthcare practitioners,and policymakers interested in addressing the nutritional needs of dialysis patients.

Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes

Diabetes mellitus(DM)is still one of the most common diseases worldwide,and its prevalence is still increasing globally.According to the American and European recommendations,metformin is considered a first-line oral hypoglycemic drug for controlling type 2 DM(T2DM)patients.Metformin is the ninth most often prescribed drug in the world,and at least 120 million diabetic people are estimated to receive the drug.In the last 20 years,there has been increasing evidence of vitamin B12 deficiency among metformin-treated diabetic patients.Many studies have reported that vitamin B12 deficiency is related to the malabsorption of vitamin B12 among metformin-treated T2DM patients.Vitamin B12 deficiency may have a very bad complication for the T2DM patient.In this review,we will focus on the effect of metformin on the absorption of vitamin B12 and on its proposed mechanisms in hindering vitamin B12 absorption.In addition,the review will describe the clinical outcomes of vitamin B12 deficiency in metformintreated T2DM.

Maternal Vitamin D Deficiency and Risk of Development of Gestational Diabetes Mellitus: A Scoping Review

Background: Maternal vitamin D status is a critical determinant during pregnancy, because it plays an important role in the body not only in calcium homeostasis and bone remodeling, but also in the glucose metabolism. Vitamin D deficiency is associated with adverse pregnancy outcomes including gestational diabetes mellitus. Objective: To review evidence on the association between maternal vitamin D deficiency and incidence of gestational diabetes mellitus (GDM). Methods: PRISMA for scoping review guideline and scoping review guidelines of Arksey & O’Malley (2005) was followed in methodological process. A comprehensive search strategy was carried out across the Google Scholar and PubMed from January 2012 to December 2022, using the search terms of “gestational diabetes mellitus/pregnancy outcomes” combined with “vitamin D”, “cholecalciferol” or “25-hydroxyvitamin D” and/or “deficiency”. Articles were screened at the title and the abstract level and at full text by three co-investigators of the study independently with a fourth reviewer resolving discrepancies. Research studies published only in English language were selected. Research using pregnant mothers with multiple pregnancy and chronic diseases was excluded. Results: After screening 134 titles and abstracts, finally 55 original research articles were selected. It involved 48 observational studies and 7 Randomized Control Trials (RCT). Only 30 research articles had found an association between maternal vitamin D deficiency and GDM. Conclusion: As results of previous studies are mixed and inconclusive, further research including more RCTs is needed to clarify the exact mechanism of vitamin D on glucose metabolism during pregnancy.

The Association between Vitamin D Deficiency and Developing COVID-19 Related Serious Illnesses—A Systematic Review and Meta-Analysis

Background: Coronavirus is rapidly transmitted and highly infectious, and it is also associated with high morbidity and mortality but no drugs have been recognised as being effective;therefore, it is necessary to protect against serious illnesses with an intrinsic protection mechanism. In addition, Vitamin D enhances the intrinsic protection mechanism. Purpose: This study aims to systematically review and conduct a meta-analysis to determine if vitamin D deficiency is associated with the development of severe COVID-19 illness, providing crucial insights into the potential impact of vitamin D on disease outcomes. Methods: This study is conducted through systematic reviews and meta-analysis while following well-designed research questions. Literature searches are performed according to PRISMA guidelines with inclusion and exclusion criteria through the electronic database PubMed, CINAHL and Google Scholar. All data for meta-analysis were performed using RevMan 5.4. The software program was used for blending the statistical data and deriving the cumulative result of the intervention on concluding outcomes of interest. To analyze dichotomous data, the Mantel-Haenszel method was performed, and an odds ratio was conducted for outcome evaluation with 95% confidence interval. Results: The meta-analysis showed that there is statistically significant (P Conclusion: This study indicated that Vitamin D deficiency is associated with the development of COVID-19 related serious illnesses. Also, it is highly recommended to do more randomised control trials for the establishment of this topic strongly.

Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers:A systematic review and meta-analysis

BACKGROUND The definition of diabetic foot syndrome(DFS)varies depending on the location and resources.Few classifications are available according to the indication.DF ulcers and vitamin D deficiency are common diseases among patients with diabetes.Previous literature has shown an association between DF ulcer(DFU)and vitamin D deficiency.However,the available meta-0analysis was limited by substantial bias.AIM To investigate the association between DFUs and vitamin D levels.METHODS We searched PubMed,MEDLINE,and Cochrane Library,EBSCO,and Google Scholar for studies comparing vitamin D levels and DF.The keywords DFU,DFS,diabetic septic foot,vitamin D level,25-hydroxy vitamin D,vitamin D status,and vitamin D deficiency were used.The search engine was set for articles published during the period from inception to October 2022.A predetermined table was used to collect the study information.RESULTS Vitamin D level was lower among patients with DFU compared to their counterparts[odds ratio(OR):-5.77;95%confidence interval(CI):-7.87 to-3.66;χ2 was 84.62,mean difference,9;I2 for heterogeneity,89%;P<0.001 and P for overall effect<0.001].The results remained robust for hospitalized patients(OR:-6.3295%CI:-11.66 to-0.97;χ2 was 19.39;mean difference,2;I2 for heterogeneity,90%;P=0.02).CONCLUSION Vitamin D was lower among outpatients and hospitalized patients with DFUs.Further larger randomized controlled trials are needed.

Association of Vitamin D Deficiency with Diabetic Retinopathy in Young People with Type 1 Diabetes Mellitus

Background: Diabetic retinopathy is among the most common diabetic complications, and is one of the leading causes of blindness in the world. Recent studies have linked vitamin D to the pathogenesis of diabetes and there is growing evidence that vitamin D can interfere with the mechanisms involved in diabetes and its complications. Despite improvements in treatment, diabetic retinopathy remains a significant complication of type 1 diabetes mellitus. Identification of early treatable predictors of diabetic retinopathy such as vitamin D deficiency, may allow more aggressive management of those at high risk. Purpose: To assess the association of vitamin D deficiency with diabetic retinopathy in young people with type 1 diabetes mellitus. Design: Observational study with case control design. Method: 60 young people with type 1 diabetes aged between 11 to 24 years were included in this study. Among them, 30-young people have diabetic retinopathy and 30-young people do not have diabetic retinopathy. Purposive sampling technique was applied as per inclusion criteria. Statistical analysis of the results was done by using computer-based software, SPSS version 26. P value of less than 0.05 was considered as statistically significant. Results: Vitamin D deficiency was present in 83% of the young people with diabetic retinopathy and in 53% without diabetic retinopathy. The mean vitamin D level in young people with and without diabetic retinopathy was 17.38 ± 3.77 ng/ml and 20.15 ± 5.06 ng/ml respectively and the difference was statistically significant (p = 0.019). Vitamin D deficiency was increased with the severity of diabetic retinopathy. Univariate and multivariate logistic regression showed vitamin D deficiency was independently associated with diabetic retinopathy with a crude odds ratio of 5.69 with a p value of 0.008 and adjusted odds ratio of 16.08 with a p value of 0.002 respectively. Conclusion: Result of the study revealed that vitamin D deficiency was strongly associated with diabetic retinopathy in young people with type 1 diabetes mellitus.

Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiology

AIM: To examine the vitamin D status in patients with alcoholic cirrhosis compared to those with primary biliary cirrhosis. METHODS: Our retrospective case series comprised 89 patients with alcoholic cirrhosis and 34 patients with primary biliary cirrhosis who visited our outpatient clinic in 2005 and underwent a serum vitamin D status assessment. RESULTS: Among the patients with alcoholic cirrhosis, 85% had serum vitamin D levels below 50 nmol/L and 55% had levels below 25 nmol/L, as compared to 60% and 16% of the patients with primary biliary cirrhosis, respectively (P < 0.001). In both groups, serum vitamin D levels decreased with increasing liver disease severity, as determined by the Child-Pugh score. CONCLUSION: Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiology, with lower levels of vitamin D in alcoholic cirrhosis than in primary biliary cirrhosis.

Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind

To date,metformin remains the first-line oral glucose-lowering drug used for the treatment of type 2 diabetes thanks to its well-established long-term safety and efficacy profile.Indeed,metformin is the most widely used oral insulinsensitizing agent,being prescribed to more than 100 million people worldwide,including patients with prediabetes,insulin resistance,and polycystic ovary syndrome.However,over the last decades several observational studies and meta-analyses have reported a significant association between long-term metformin therapy and an increased prevalence of vitamin B12 deficiency.Of note,evidence suggests that long-term and high-dose metformin therapy impairs vitamin B12 status.Vitamin B12(also referred to as cobalamin)is a water-soluble vitamin that is mainly obtained from animal-sourced foods.At the cellular level,vitamin B12 acts as a cofactor for enzymes that play a critical role in DNA synthesis and neuroprotection.Thus,vitamin B12 deficiency can lead to a number of clinical consequences that include hematologic abnormalities(e.g.,megaloblastic anemia and formation of hypersegmented neutrophils),progressive axonal demyelination and peripheral neuropathy.Nevertheless,no definite guidelines are currently available for vitamin B12 deficiency screening in patients on metformin therapy,and vitamin B12 deficiency remains frequently unrecognized in such individuals.Therefore,in this“field of vision”article we propose a list of criteria for a cost-effective vitamin B12 deficiency screening in metformin-treated patients,which could serve as a practical guide for identifying individuals at high risk for this condition.Moreover,we discuss additional relevant topics related to this field,including:(1)The lack of consensus about the exact definition of vitamin B12 deficiency;(2)The definition of reliable biomarkers of vitamin B12 status;(3)Causes of vitamin B12 deficiency other than metformin therapy that should be identified promptly in metformin-treated patients for a proper differential diagnosis;and(4)Potential pathophysiological mechanisms underlying metformin-induced vitamin B12 deficiency.Finally,we briefly review basic concepts related to vitamin B12 supplementation for the treatment of vitamin B12 deficiency,particularly when this condition is induced by metformin.

The impact of vitamin D deficiency on neurogenesis in the adult brain

There is increasing evidence from epidemiological studies indicating that vitamin D deficiency during adulthood is associated with adverse brain outcomes in humans（Ginde et al.,2009）and rodents（Groves et al.,2014）,however,a causal relationship has not yet been established.

Fatigue is not associated with vitamin D deficiency in inflammatory bowel disease patients

AIM To investigate if vitamin D deficiency is associated with fatigue in patients with inflammatory bowel disease(IBD).METHODS IBD patients were recruited from nine hospitals in the southeastern and western regions of Norway to participate in a multicenter cross-sectional study lasting from March 2013 to April 2014. Data were collected by interviews, from medical records and laboratory tests. The Fatigue Questionnaire(FQ) was used to measure fatigue. Linear and logistic regression models were applied to explore the possible association between vitamin D deficiency and total fatigue scores and chronic fatigue, respectively. The analyses were adjusted for age, gender, disease activity, depressive symptoms and sleep disturbance.RESULTS In total, 405 patients were included in the analyses, of which 227(56%) had Crohn's disease(CD) and 178(44%) had ulcerative colitis(UC). Vitamin D deficiency(< 50 nmol/L) was present in half(203/405) of the patients. Chronic fatigue was reported by 116(29%) of all included patients with substantial fatigue reported by 194(48%). Vitamin D levels were neither associated with total fatigue nor with chronic fatigue. Higher total fatigue scores and chronic fatigue were both associated with increased disease activity scores in patients with UC and CD, but not with increased CRP or fecal calprotectin. In UC patients, female gender was associated with fatigue in the univariate analysis, but no such difference was found when adjusted for elevated disease activity scores. Sleep disturbance and more depressive symptoms were associated with total fatigue scores in both UC and CD patients, but with chronic fatigue only in CD patients.CONCLUSION In this study, no significant association between fatigue and vitamin D deficiency in IBD patients was revealed.

Predictors of vitamin D deficiency in inflammatory bowel disease and health: A Mississippi perspective

AIMTo identify the predictors of vitamin D deficiency in patients with and without inflammatory bowel disease (IBD).METHODSPatients with ulcerative colitis (UC) or Crohn’s disease (CD) related diagnostic codes who received medical care at University of Mississippi Medical Center between July 2012 and 2015 were identified. After thorough chart review, we identified patients with biopsy proven IBD who had also been tested for serum 25-hydroxyvitamin D [25(OH)D] concentration. We compared these patients to a previously studied cohort of healthy controls who also had vitamin D concentration checked. Logistic regression analysis was performed to determine the association between vitamin d deficiency and UC, CD, race, age, gender and body mass index (BMI).RESULTSWe identified 237 patients with confirmed IBD. Of these, only 211 had a serum 25(OH)D concentrations available in the medical record. The group of healthy controls consisted of 98 individuals with available serum 25(OH)D concentration. 43% of IBD patients were African American (AA). Patients with CD were more likely to have vitamin D concentration checked. Bivariate analysis showed that AA (51% vs 21%, P = 0.00001), subjects with BMI >30 kg/m2 (39% vs 23% P = 0.01) and CD (40% vs 26%, P = 0.04) were more likely to be vitamin D deficient than vitamin D sufficient. Those with Age > 65 were more likely to be vitamin D sufficient (46% vs 15%, P = 0.04). Multiple regression showed that only BMI > 30 kg/m2 and AA race are associated with vitamin D deficiency.CONCLUSIONBMI > 30 kg/m2 and AA race are predictive of vitamin D deficiency. Gender, age and diagnosis of IBD are not predictive of vitamin D deficiency.

Life threatening vitamin B_(12) deficiency:will timely screening make a difference?

INTRODUCTION While Vit.B12 deficiency is common,with aprevalence of about 15% in the elderly,andrecommendations for treatment available,detectionof deficiency at the pre-clinical stage by appropriatescreening does not always take place.Our report isan example of life threatening Vit.B12 deficiencydiagnosed at age 56,with the onset of Vit.B12depletion likely to have begun in the

Vitamin B12 deficiency and gastric histopathology in older patients

AIM: To compare upper gastric endoscopic and histopathologic findings in older adults in the presence and absence of B12 deficiency.METHODS: A prospective analysis of upper gastric endoscopic and gastric histopathologic findings from 30 newly identified B12-deficient patients (11 males,19 females) and 16 controls with normal B12 status (6males, 10 females) was performed. For all subjects, the indication for upper endoscopy and gastric biopsy were unrelated to B12 status. A single pathologist, blinded to B12 status, processed and interpreted the biopsy samples. Endoscopic and histopathologic findings were correlated with age, gender, hematocrit (Hct), MCV and B12 status.RESULTS: The B12-deficient group had significantly lower mean serum B12 levels compared to the controls (P＜0.00005) while their mean Hct, MCV and serum albumin levels were similar. Iron deficiency (ferritinbased) was present in 21% of B12-deficient patients and intrinsic factor antibodies were present in29% (5/17) of B12-deficient patients. The endoscopic findings revealed significantly different rates of gastritis and atrophy between the B12-deficient and control groups (P= 0.017).B12-deficient patients had significantly less superficial gastritis (62% vs 94%) and significantly more atrophic gastritis (28% vs 0%) as compared to the controls (P= 0.039). Intestinal metaplasia was similar in both groups. Helicobacter pyloriinfection rates were similar in the B12-deficient patients and controls (40% vs31%).CONCLUSION: Significantly different endoscopic findings and types of gastritis could often be observed in the presence and absence of B12 deficiency. Atrophy,based on endoscopy, and atrophic gastritis, based on histopathology, suggest the presence of B12 deficiency.Gastric histopathology is not influenced by the age,gender, Hct or MCV of the patients.

Clinical and genetic study of ataxia with vitamin E deficiency: A case report

BACKGROUND Ataxia with vitamin E deficiency(AVED)is a type of autosomal recessive cerebellar ataxia.Clinical manifestations include progressive cerebellar ataxia and movement disorders.TTPA gene mutations cause the disease.CASE SUMMARY We report the case of a 32-year-old woman who presented with progressive cerebellar ataxia,dysarthria,dystonic tremors and a remarkably decreased serum vitamin E concentration.Brain magnetic resonance images showed that her brainstem and cerebellum were within normal limits.Acquired causes of ataxia were excluded.Whole exome sequencing subsequently identified a novel homozygous variant(c.473T>C,p.F158S)of the TPPA gene.Bioinformatic analysis predicted that F185S is harmful to protein function.After supplementing the patient with vitamin E 400 mg three times per day for 2 years,her symptoms remained stable.CONCLUSION We identified an AVED patient caused by novel mutation in TTPA gene.Our findings widen the known TTPA gene mutation spectrum.

Treatment of vitamin K-dependent coagulation factor deficiency and subarachnoid hemorrhage

BACKGROUND： In adults, vitamin K-dependent coagulation factor deficiency （VKCFD） increases in the recent years. We treated a VKCFD patient with subarachnoid hemorrhage, with favorable outcomes.METHODS： A 19-year-old male student with VKCFD was treated at our hospital. The initial treatment was injection of a large dose of vitamin K and fresh plasma, and then with oral high dose of vitamin K4.RESULTS： At 4 weeks after admission, the focus of hemorrhage subsided, neurological examination was normal, and the patient was discharged.CONCLUSIONS： VKCFD is rare and its diagnosis should be based on the history of the patient and the results of laboratory examinations. A large dose of vitamin K is the fi rst choice of treatment.

The Role of Vitamin A in Iron Deficiency Anemia and Implications for Interventions

This presentation will describe the various reports on the interdependence of vitamin A and Fe

Prevalence and factors associated with vitamin C deficiency in inflammatory bowel disease

BACKGROUND Patients with inflammatory bowel disease(IBD) are prone to several nutritional deficiencies. However, data are lacking on vitamin C deficiency in Crohn’s disease(CD) and ulcerative colitis(UC) patients, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.AIM To determine proportions and factors associated with vitamin C deficiency in CD and UC patients.METHODS In this retrospective study, we obtained clinical, laboratory and endoscopic data from CD and UC patients presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. All patients had an available plasma vitamin C level. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency(≤ 11.4 μmol/L) rates in IBD. Secondary analyses compared proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.RESULTS Of 301 IBD patients, 21.6% had deficiency, including 24.4% of CD patients and 16.0% of UC patients. Patients with elevated C-reactive protein(CRP)(39.1% vs 16.9%, P < 0.001) and fecal calprotectin(50.0% vs 20.0%, P = 0.009) had significantly higher proportions of deficiency compared to those without. Penetrating disease(P = 0.03),obesity(P = 0.02) and current biologic use(P = 0.006) were also associated with deficiency on univariate analysis. On multivariate analysis, the objective inflammatory marker utilized for analysis(elevated CRP) was the only factor associated with deficiency(odds ratio = 3.1, 95%confidence interval: 1.5-6.6, P = 0.003). There was no difference in the presence of clinical symptoms of scurvy in those with vitamin C deficiency and those without.CONCLUSION Vitamin C deficiency was common in IBD. Patients with elevated inflammatory markers and penetrating disease had higher rates of vitamin C deficiency.

Vitamin D Deficiency and Insufficiency in Northeast Tennessee

Background: The role of vitamin D in population subgroups throughout the world continues to be a topic of interest among researchers. Current evidence demonstrates that treating vitamin D deficiency plays a significant role in improving mortality in hospitalized patients, reducing hospital length of stay, and boosting innate immune system. Vitamin D levels vary with age, gender, body mass index (BMI) and geographical area. The purpose of this study is to evaluate vitamin D levels in a cohort of patients in Northeast Tennessee. Study: This institutional review board-approved, retrospective study evaluated vitamin D levels of patients obtained from Mcleod Cancer and Blood Center. Vitamin D levels were collected over a 2-year period and classified as deficient (<20 ng/mL), insufficient (20 - 30 ng/mL), or replete (>30 ng/mL). Data were then stratified based on patient characteristics (age, gender, body mass index (BMI), race, seasons, and place of residence) and compounds of vitamin D (D2 and D3). Results: There were 2011 individuals included, with only 44.3% having replete levels and 21.4% with levels less than 20 ng/mL. Females with vitamin D deficiency are more likely to have levels below 20 ng/ml compared to males (18.6% vs. 23%, respectively, p = 0.003). Regarding BMI, the highest levels were reported in normal weight and overweight. With regards to age, advanced age (≥70) was associated with the highest levels and most replete patients. Winter months were associated with the lowest levels of vitamin D. Higher vitamin D levels were found in individuals over 70 years, normal weight and overweight category. Conclusion: Testing vitamin D levels in high-risk groups becomes of utmost importance in areas with longer winter months, obese and underweight patients. Vitamin D levels should be routinely tested and treated in vulnerable populations.

CT examination, clinical situation and experimental characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency

BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatment of intracranial hemorrhage in time become a key factor for improving healing rate and reducing fatality rate and incidence of sequela. OBJECTIVE: To investigate the clinical situation, experimental characteristics, CT examination and terminative characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency. DESIGN: Case analysis. SETTING: Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 17 infants with intracranial hemorrhage induced by delayed vitamin K deficiency aged 1-3 months including 11 boys and 6 girls were selected from Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University from January 1994 to December 2005. All infants had drowsiness, rejective milk, spiting milk, gaze of both eyes, tic, coma, full anterior fontanelle, high muscular tension and cerebral hernia, etc. Experimental examination demonstrated that infants had anemia at various degrees; prothrombin time and partial thromboplastin time were prolonged; platelet count was normal. CT examination indicated that screenages of subarachnoid hemorrhage, subdural hematoma, cerebral parenchyma hemorrhage and intraventricular hemorrage were changed. Hemorrhage was stopped by the application of vitamin K. All patients provided informed consent. METHODS: ① Clinical situation and physical sign of infants were observed after hospitalization and scanned with rapid spiral CT scanning system. The thickness and average space of layers were 8-10 mm and the scanning time was 5 s with window width of 30-80 Hu and window position of 28-35 Hu. ② After hospitalization, four items of blood coagulation was measured with Futura meter and biochemical indexes of blood, such as serum calcium, serum alkaline phosphatase, total bilirubin, direct bilirubin and indirect bilirubin, were detected with Roche Modular PPI automatic biochemistry analyzer. ③ After hospitalization, infants were given 5-10 mg vitamin K1 for 3-5 days, and then, they were transfused with 10-15 mL/kg fresh plasma or whole blood for 1-3 times and received other relative therapies. Therapeutic effects were evaluated based on clinical diagnosis and criteria. MAIN OUTCOME MEASURES: ① Clinical situation, physical sign and CT examination; ② results of experimental examination; ③ treatment and termination. RESULTS: A total of 17 infants with intracranial hemorrhage were involved in the final analysis. ① Clinical situation, physical sign and CT examination: All infants had pale facial expression and full or bossing anterior fontanelle. Among them, 13 infants had drowsiness or dysphoria, 12 rejective milk or emesis, 11 tic, 13 injection site hemorrhage, 2 gastrointestinal hemorrhage, 3 cerebral hernia, 11 high muscular tension and 6 cervical rigidity. CT examination demonstrated that most infants (88%, 15/17) had subarachnoid hemorrhage; 10 (59%, 10/17) had subdural hematoma; 8 (47%, 8/17) had cerebral parenchyma hemorrhage; few had intraventricular hemorrhage. In addition, results of CT examination also indicated that 17 infants had intracranial hemorrhage. Hemorrhage sites of 12 infants were equal to or more than 2, which was accounted for 70% (12/17); meanwhile, partial cases accompanied with a large area of focus of cerebral infarction or cerebral hypoxia-ischemia lesion. ② Results of experimental examination: There were 6 infants with elongation of prothrombin time, 5 with partial elongation of prothrombin time, 4 with decrease of serum calcium (1.69-2.25 mmol/L), 3 with increase of serum alkaline phosphatase, 3 with increase of total bilirubin, 3 with increase of direct bilirubin, and 3 with increase of indirect bilirubin. ③ Treatment and termination: After treatment, 12 infants were cured well, 3 improved, 1 given up and 1 died. Later, ten infants received CT re-examination at 3 months after treatment. The results indicated that 3 infants had simple subarachnoid hemorrhage and 4 had subarachnoid hemorrhage accompanying with subdural hematoma. Their focuses were absorbed well and not show as obvious sequela. One infant had subdural hematoma accompanying with subarachnoid hemorrhage, cerebral parenchyma hemorrhage, intraventricular hemorrage and cerebral hypoxia ischemia, and then, after hematom absorption, obvious cerebral malacia focus, hydrocephalus, brain atrophy and inferior accumulating fluid of dura mater were observed; 2 had subdural hematoma accompanying with subarachnoid hemorrhage and cerebral hypoxia ischemia, and then, after bleeding absorption, brain atrophy was changed remarkably; changes of hydrocephalus were observed in one infant. CONCLUSION: ① Symptoms of pale facial expression, full or bossing anterior fontanelle, drowsiness and dysphoria are observed in infants with delayed vitamin K deficiency . ② Experimental indexes demonstrate that prothrombin time and partial prothrombin time are prolonged, and numbers of infants having decrease of serum calcium are in the third place. ③ Poly-intracranial hemorrhage is a notable characteristic of CT examination. Partial infants who have poly-intracranial hemorrhage always accompany with cerebral hypoxia-ischemia lesion or cerebral infarction. Clinical situation and prognosis of infants who have a large area of intracranial hemorrhage and cerebral hypoxia-ischemia changes are poor; however, those of infants who have simple subarachnoid hemorrhage or combination of subarachnoid hemorrhage with subdural hematoma are well. ④ Effect of vitamin K on this kind of disease is well.