What is the recommended treatment for vitamin K deficiency in newborns?

Treatment of Vitamin K Deficiency in Newborns

The recommended treatment for vitamin K deficiency in newborns is a single intramuscular dose of 0.5 to 1.0 mg vitamin K1 (phytonadione) within one hour of birth. 1, 2

Prophylactic Treatment Options

• Intramuscular administration is the preferred route for efficiency and reliability of administration, with a single dose of 1 mg vitamin K1 at birth 3
• Alternative oral regimens may be used in healthy term newborns when parents refuse intramuscular injection:
  • 3 doses of 2 mg vitamin K1 orally at birth, at 4-6 days, and at 4-6 weeks 3
  • 2 mg vitamin K1 orally at birth, followed by weekly doses of 1 mg for 3 months 3

Treatment of Established Vitamin K Deficiency Bleeding

• For treatment of hemorrhagic disease of the newborn, administer 1 mg vitamin K1 either subcutaneously or intramuscularly 1
• Higher doses may be necessary if the mother has been receiving oral anticoagulants 1
• A prompt response (shortening of prothrombin time within 2-4 hours) is usually diagnostic of hemorrhagic disease of the newborn 1
• Whole blood or component therapy may be indicated if bleeding is excessive, but vitamin K1 should be given concurrently to address the underlying disorder 1

Special Considerations

• Preterm infants on parenteral nutrition should receive 10 μg/kg/day of vitamin K 4
• The intramuscular route is not appropriate for preterm infants who:
  • Have cholestasis or impaired intestinal absorption 3
  • Are too unwell to take oral vitamin K1 3
  • Have mothers who have taken medications that interfere with vitamin K metabolism 3

Monitoring

• Classical coagulation tests (PT, PTT) can be used in low-risk infants for indirect evaluation of vitamin K status, but are not specific to vitamin K deficiency 4
• Undercarboxylated Serum Vitamin K-Dependent Proteins (PIVKA-II) are a more useful biomarker of subclinical vitamin K deficiency for at-risk patient groups and should be used when locally available 4, 5

Risk Factors for Vitamin K Deficiency

• Exclusively breastfed infants (breast milk contains low levels of vitamin K) 4, 6
• Infants whose mothers have taken medications that interfere with vitamin K metabolism (anticonvulsants, anticoagulants, antituberculosis drugs) 4, 7
• Infants with underlying diseases such as cystic fibrosis, alpha-1-antitrypsin deficiency, or cholestasis 4
• Premature infants 8

Important Precautions

• Document the date, dose, and mode of administration of vitamin K prophylaxis 3
• Record parental refusal of vitamin K prophylaxis after adequate information is provided, especially because of the risk of late vitamin K deficiency bleeding 3
• If an infant vomits or regurgitates an oral formulation within 1 hour of administration, repeating the oral dose may be appropriate 3
• Benzyl alcohol as a preservative in vitamin K preparations has been associated with toxicity in newborns, so preservative-free diluents should be used 1
• Intravenous administration should be considered only when other routes are unavailable, and the drug should be injected very slowly, not exceeding 1 mg per minute 1

Efficacy of Different Administration Routes

• Intramuscular administration provides more reliable protection against late vitamin K deficiency bleeding compared to oral regimens 3, 6
• The success of an oral administration protocol depends on compliance, which may vary between populations and healthcare settings 3
• Parenteral (1 mg) K1 prevents late hemorrhagic disease of the newborn, while single or repeated doses of oral vitamin K reduces the incidence but does not eliminate all cases 5