Vitamin K deficiency bleeding (VKDB) is a potentially life-threatening condition that is preventable by routine vitamin K administration after birth. Effective prophylaxis is particularly important for preterm infants, as they may be at higher risk of VKDB. Following reports of diversity in vitamin K prophylaxis regimens in other European countries [1–3], we surveyed current practices in preterm infants at neonatal units throughout north-west England.The north-west region is one of the largest in the UK with around 74 000 deliveries annually. It comprises 26 special care neonatal units in district general hospitals, three tertiary level neonatal centers, two regional neonatal surgical and two midwifery-led units. In December 2001, a leading pediatrician at each unit was sent a questionnaire to enquire about local guidelines and practice for vitamin K prophylaxis in infants below 37 weeks gestational age. Three units not routinely admitting newborn preterm infants were excluded. The requisite information was obtained from all eligible units surveyed (30; 100%).
Table 1 summarizes the findings of our questionnaire. All units had a written policy for neonatal vitamin K prophylaxis, but eight (26.7%) gave no special consideration to preterm or low birth weight infants. Nineteen units (63.3%) utilized the intravenous (IV) route as a regular method of vitamin K administration, but only one routinely administered subsequent doses of vitamin K when using this route. Twelve units (40%) offered oral vitamin K prophylaxis to preterm infants, either routinely or after parental request. Doses of vitamin K prescribed for preterm infants varied up to 10-fold within and between units, affected by factors which included gestational age, birth weight, presence of an IV cannula, and ability to tolerate enteral feeds. Results of vitamin K questionnaire Formulation Konakion® Neonatal Ampoules (injection) exclusively16 (53.3) Konakion® Neonatal Ampoules or oral preparation*8 (26.7) Konakion® MM (pediatric) exclusively4 (13.3) Konakion® Neonatal Ampoules or Konakion® MM (pediatric)†2 (6.7)Route of administration Intramuscular injection exclusively9 (30.0) Intramuscular or intravenous16 (53.3)‡ Intramuscular, intravenous or oral§2 (6.7) Intramuscular or oral†2 (6.7) Intravenous or oral1 (3.3)Dose prescribed 1 mg for all infants8 (26.7) 0.5 mg for all infants4 (13.3) 0.5 mg or 1 mg¶11 (
36.7) 0.4 mg kg−1 or 1 mg or 2 mg2 (6.7) 0.4 mg or 1 mg¶2 (6.7) 0.2 mg or 1 mg¶1 (3.3) 0.1 mg or 1 mg2 (6.7)We have found a considerable variation in practice of vitamin K prophylaxis for preterm infants, with marked inconsistencies between units in terms of formulation, dose, and route of administration. The wide variation in current dosage schedules presumably reflects the paucity of clinical data for this vulnerable population. The most recent national recommendations for prophylaxis of VKDB in neonates in the UK [4] offer no specific guidance regarding preterm infants and it has been the responsibility of professionals locally to devise suitable regimes. North American countries provide official recommendations for preterm infants of intramuscular (IM) doses ranging from 300–500 µg [6]. Studies show that a 1 mg IM dose is protective but probably excessive [7] and that a parenteral dose of 200 µg maintains normal prothrombin activity during the first 6 weeks of life [8].
Konakion® Neonatal is no longer licensed for use in preterm infants in the UK and yet remains widely used. The reluctance of clinicians to change long-established prescribing policies may reflect the lack of clinical data pertaining to the newer mixed-micellar preparation in preterm infants and its higher cost (sixfold).Over half the units surveyed allowed a choice between IV and IM administration, the decision usually being at the discretion of attendant medical or nursing staff. The IV route was preferred for the smallest and least mature infants, being considered ‘kinder’ than IM injection. However, vitamin K cannot be stored in vivo in significant amounts, has a short half-life following IV injection and cases of late onset VKDB have been reported in association with this route [9]. Oral vitamin K may be associated with a higher risk of VKDB and its use for routine prophylaxis at birth is probably unsuitable in preterm infants due to less predictable absorption.Exclusively breast-fed preterm infants probably receive inadequate dietary vitamin K and may require further supplementation to protect against late-onset VKDB.
With uncertainty surrounding the optimal protective dose and efficacy of the IV route, it is perhaps alarming to find that only one unit surveyed routinely gives further vitamin K supplements to infants who received IV prophylaxis.Our study confirms a wide variation in local protocols and lack of consensus for vitamin K prophylaxis in preterm neonates, as exists elsewhere in Europe. It is perturbing that preterm infants may be at conceivable risk from either excessively high or inadequately low doses. The posology of vitamin K in preterm infants is far from defined and clinical trials are urgently needed to clarify these issues.Description and Brand NamesDrug information provided by: MicromedexUS Brand Name DescriptionsVitamins are compounds that you must have for growth and health. They are needed in only small amounts and usually are available in the foods that you eat. Vitamin K is necessary for normal clotting of the blood. Vitamin K is found in various foods including green leafy vegetables, meat, and dairy products.
If you eat a balanced diet containing these foods, you should be getting all the vitamin K you need. Little vitamin K is lost from foods with ordinary cooking. If you are taking anticoagulant medicine (blood thinners), the amount of vitamin K in your diet may affect how well these medicines work. Your doctor or health care professional may recommend changes in your diet to help these medicines work better. Lack of vitamin K is rare but may lead to problems with blood clotting and increased bleeding. Your doctor may treat this by prescribing vitamin K for you. Vitamin K is routinely given to newborn infants to prevent bleeding problems. This medicine is available only with your doctor's prescription. This product is available in the following dosage forms: Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.