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December 6, 1985

Breast-feeding, α1-Antitrypsin Deficiency, and Liver Disease?

JAMA. 1985;254(21):3036-3037. doi:10.1001/jama.1985.03360210050022

To the Editor.—  The May 10, 1985 article1 on the role of breast-feeding in protecting infants with α1-antitrypsin (α1-AT) deficiency from severe liver disease neglected to mention the risk of bleeding diathesis secondary to vitamin K deficiency in such infants. Breast milk is low in vitamin K content when compared with commercially prepared formulas. The cholestasis associated with α1-AT deficiency prevents these children from absorbing the fat-soluble vitamins A, D, E, and K well. Thus, the low vitamin K content of human milk coupled with the decreased absorption of vitamin K puts these children at risk for the coagulopathy that accompanies that vitamin deficiency. We recently had a case that demonstrates this problem.

Report of a Case.—  An entirely breast-fed female infant, who had reportedly received 1 mg of vitamin K intramuscularly at birth, was seen at age 5 weeks with bloody stools