Prophylaxis

• Babies are relatively deficient in vitamin K (phytomenadione). Those who do not receive supplements are at risk of bleeding (vitamin K deficiency bleeding, formerly known as haemorrhagic disease of the newborn)
• All babies should be given vitamin K with parental consent

Therapy

• After blood has been taken for clotting studies, vitamin K can also be used to treat any baby with active bleeding that might have resulted from vitamin K deficiency
  • a prolonged prothrombin time (INR ≥3.5) that falls within 1 hr of treatment, with normal platelet count and fibrinogen concentration suggest the diagnosis. However, as INR is a poor indicator of vitamin K deficiency, PIVKA-II is a better investigation if available

Prophylaxis

• Vitamin K (Konakion MM Paediatric™) as a single IM dose (see Prophylaxis dosage below for dosage schedule)
  • avoid IV administration for prophylaxis as it does not provide the same sustained protection as IM
• Give in accordance with manufacturer’s instructions in order to ensure clinical effectiveness
• If parents decline IM route, offer oral vitamin K as second line option (no evidence of increased childhood cancers with parenteral vitamin K)
  • give 2 doses vitamin K 2 mg oral in the first week
    • first: at birth 
    • second: aged 4–7 days
  • third dose vitamin K 2 mg oral given aged 1 month, unless baby exclusively formula fed (formula feeds contain adequate vitamin K)
• If parents refuse prophylaxis, ask middle grade doctor to see and record discussion (including reason for refusal) in notes

IM use

• Do not dilute or mix with other parenteral injections

Oral use

• Break open ampoule and withdraw 0.2 mL (2 mg) into the oral dispenser provided. Drop contents directly into baby's mouth by pressing plunger 

Prophylaxis dosage

For babies with birth weight ≥2500 g

• Administer Konakion MM Paediatric™ 1 mg (0.1 mL) IM
  • this is approximately half of the ampoule volume and should be drawn up using syringe supplied with ampoule

For babies with birth weight <2500 g

• Administer 400 microgram/kg (0.04 mL) with a maximum of 1 mg (0.1 mL) of Konakion MM Paediatric™ IM
  • round up the dose to nearest hundredth [e.g. 300 microgram (0.03 mL), 500 microgram (0.05 mL) etc.]
  • draw up the dose using syringe supplied with ampoule

Therapy dosage

• If not already given IM, give vitamin K 100 microgram/kg IV up to 1 mg maximum dose
• Further doses as required, depending on clinical picture and coagulation status
  • may need to be accompanied by a more immediately effective treatment such as transfusion of fresh frozen plasma

IV administration

• If necessary, dilute
  • dilution in glucose not recommended for IV administration due to reactions with syringes, but drug can be added to lower port of syringe giving set administering glucose 5% at rate ≥0.7 mL/min (= 42 mL/hr)