Can vitamin K (Vit K) be administered orally to newborns?

Oral Vitamin K Administration in Newborns

Yes, vitamin K can be given orally to newborns, but intramuscular administration is strongly preferred because it is more effective at preventing all forms of vitamin K deficiency bleeding (VKDB), particularly late VKDB. 1, 2

Recommended Oral Regimens (When IM is Declined)

If parents refuse intramuscular vitamin K after adequate counseling, the following oral protocols are acceptable alternatives 1, 2:

Option 1: Three-Dose Regimen

• 2 mg orally at birth
• 2 mg orally at 4-6 days of age
• 2 mg orally at 4-6 weeks of age 1, 2

Option 2: Extended Weekly Regimen

• 2 mg orally at birth
• 1 mg orally weekly for 3 months 1, 2

Important caveat: If the infant vomits or regurgitates within 1 hour of administration, the oral dose should be repeated 2

Critical Limitations of Oral Administration

The oral route has significant limitations that must be understood 2, 3:

• Single oral doses do NOT prevent late VKDB (occurring between 2 weeks and 6 months), whereas a single IM dose does 3, 4
• Effectiveness depends entirely on parental compliance with multi-dose protocols, which varies significantly between populations 2, 4
• Daily oral doses of 25 mcg are insufficient and should not be used 3

Absolute Contraindications to Oral Administration

Oral vitamin K is NOT appropriate for 2, 5:

• Preterm infants 2
• Infants with cholestasis or impaired intestinal absorption 2, 5
• Infants too unwell to take oral medications 2
• Infants whose mothers took medications interfering with vitamin K metabolism (anticonvulsants, anticoagulants, antituberculosis drugs) 2, 5
• Infants at high risk of hemorrhage (premature, birth asphyxia, difficult delivery, neonatal disease) 5

These high-risk infants must receive IM or slow IV vitamin K 5

Why Intramuscular is Preferred

The intramuscular route (1 mg at birth) is the gold standard because 2, 4:

• Single IM dose effectively prevents all forms of VKDB (early, classic, and late) 2, 4
• Reliability of administration is guaranteed - no compliance issues 2
• No need for follow-up doses in healthy term infants 4

The ESPGHAN guidelines explicitly state that "intramuscular application is the preferred route for efficiency and reliability of administration" 2

Documentation and Parental Counseling

Critical practice points 2:

• Document the date, dose, and route of administration in the medical record 2
• If parents decline IM vitamin K, document their refusal after providing adequate information about increased VKDB risk 2, 4
• Prenatal education improves compliance with vitamin K protocols 2

Special Populations

Exclusively Breastfed Infants

• At highest risk for late VKDB because breast milk contains very low vitamin K concentrations 1, 3
• Require either IM prophylaxis OR extended oral supplementation (not just the 3-dose regimen) 3, 5

Infants of Mothers on Vitamin K-Inhibiting Drugs

• Should receive 1 mg IM as soon as possible after birth 3, 5
• Maternal antenatal prophylaxis (10-20 mg/day orally for 15-30 days before delivery) can prevent early VKDB 5
• Repeated doses may be needed based on coagulation studies 5

Common Pitfalls to Avoid

• Do not assume a single oral dose is sufficient - it only prevents classic VKDB, not late VKDB 3, 4
• Do not use oral route in infants with unrecognized cholestasis - these infants remain at risk even with oral protocols 3, 6
• Do not rely on dietary vitamin K in breastfed infants - breast milk is an inadequate source 1, 3

Monitoring Considerations

• Routine vitamin K level monitoring is not recommended 7, 8
• PIVKA-II (undercarboxylated proteins) is the most sensitive marker for subclinical deficiency when clinical suspicion exists 7, 1, 8
• Classical coagulation tests (PT/PTT) can be used in low-risk infants but are not specific for vitamin K deficiency 7, 1