Does neonatal Vitamin K (Vitamin K) injection affect coagulation markers?

From the Guidelines

Vitamin K injections given to infants do not elevate coagulation markers beyond normal physiological levels; rather, they restore them to normal ranges. Newborns typically receive a single intramuscular injection of vitamin K1 (phytonadione) at a dose of 0.5-1 mg shortly after birth, as recommended by the American Academy of Pediatrics 1. This prophylactic treatment prevents Vitamin K Deficiency Bleeding (VKDB), a potentially life-threatening condition in newborns. Infants are naturally vitamin K deficient at birth because this vitamin crosses the placenta poorly and breast milk contains low levels. The injection works by enabling proper functioning of clotting factors II, VII, IX, and X, which require vitamin K for activation. Without supplementation, infants have decreased activity of these factors, resulting in prolonged prothrombin time and partial thromboplastin time, as noted in cases of vitamin K deficiency bleeding 1. The vitamin K injection normalizes these parameters rather than elevating them above normal levels.

Some key points to consider include:

• The importance of vitamin K supplementation in preventing VKDB, which can present with bleeding in the skin or from mucosal surfaces, generalized ecchymoses, large intramuscular hemorrhages, or intracranial hemorrhage (ICH) 1.
• The role of vitamin K in activating clotting factors, and the potential for bleeding disorders in infants with vitamin K deficiency 1.
• The standard preventive measure of administering vitamin K to all newborns, with an excellent safety profile and minimal side effects beyond occasional local irritation at the injection site.

Overall, the administration of vitamin K to infants is a crucial preventive measure that restores normal coagulation parameters, rather than elevating them beyond normal physiological levels, and is supported by the most recent and highest quality evidence 1.

From the FDA Drug Label

A prompt response (shortening of the prothrombin time in 2 to 4 hours) following administration of vitamin K1 is usually diagnostic of hemorrhagic disease of the newborn, and failure to respond indicates another diagnosis or coagulation disorder. The infant vitamin K injection elevates coagulation markers, as evidenced by the shortening of prothrombin time in 2 to 4 hours after administration, indicating a positive response to the treatment of hemorrhagic disease of the newborn 2.

• The prothrombin time is a key coagulation marker that is affected by vitamin K injection.
• The dosage of phytonadione (0.5 to 1 mg) given to newborns is intended to correct coagulation disorders caused by vitamin K deficiency.

From the Research

Coagulation Markers and Vitamin K Injection

• The administration of vitamin K to newborns is essential for the formation of factors in the clotting cascade 3.
• Vitamin K deficiency can lead to bleeding in the skin or gastrointestinal tract, and in severe cases, intracranial bleeding 3, 4.
• The injection of vitamin K can help prevent vitamin K deficiency bleeding (VKDB) by promoting the production of clotting factors 5, 6.
• Studies have shown that parenteral vitamin K prophylaxis can reduce the incidence of VKDB and the proportion of intracranial hemorrhages 6, 7.

Effect of Vitamin K Injection on Coagulation Markers

• The concentration of PIVKA II, a functional coagulation marker, can be used to assess the need for prevention of late bleeding associated with vitamin K deficiency 5.
• Administration of vitamin K can lead to a shortening of the prothrombin time, which is a measure of coagulation 6.
• Vitamin K injection can also lead to an increase in the activity of VK-dependent coagulation factors (II, VII, IX, X) 6.

Clinical Implications

• The American Academy of Pediatrics recommends the administration of intramuscular vitamin K at birth to prevent VKDB 3, 4, 7.
• Parental refusal of vitamin K prophylaxis can increase the risk of VKDB, highlighting the importance of educating parents on the benefits of vitamin K injection 4, 7.
• Healthcare professionals should be aware of the epidemiology of VKDB and counsel parents on the importance of vitamin K prophylaxis to prevent bleeding in newborns 3, 4.