Guidelines for vitamin K prophylaxis in newborns

Abstract

A joint statement with the College of Family Physicians of CanadaAll Canadian Paediatric Society position statements and practice points are reviewed regularly and revised as needed. Consult the Position Statements section of the CPS website www.cps.ca/en/documents for the most current version. Retired statements are removed from the website. AbstractNewborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk. Systematic review of evidence to date suggests that a single intramuscular (IM) injection of vitamin K at birth effectively prevents VKDB. Current scientific data suggest that single or repeated doses of oral (PO) vitamin K are less effective than IM vitamin K in preventing VKDB. The Canadian Paediatric Society and the College of Family Physicians of Canada recommend routine IM administration of a single dose vitamin K at 0.5 mg to 1.0 mg to all newborns. Administering PO vitamin K (2.0 mg at birth, repeated at 2 to 4 and 6 to 8 weeks of age), should be confined to newborns whose parents decline IM vitamin K. Health care providers should clarify with parents that newborns are at increased risk of VKDB if such a regimen is chosen. Current evidence is insufficient to recommend routine intravenous vitamin K administration to preterm infants undergoing intensive care.

Vitamin K Deficiency Bleeding in Infancy

“…PO vitamin K administration appeared less effective with higher failure rates than IM vitamin K administration [6,62]. The Canadian Pediatric Society recommends that healthcare providers should counsel parents on the serious risk of VKDB if parents decline IM administration [63]. However, if some parents refuse IM vitamin K prophylaxis, PO vitamin K administration might be more acceptable.…”

Cortical vein thrombosis in an infant with delayed vitamin K deficiency bleeding

“…4,5 Delayed VKDB is preventable with vitamin K given at birth (0.5 mg IM for infants <1500 g and 1 mg IM for infants >1500 g, or 2 mg by mouth), which this infant did not receive. 6 There is a strong association between delayed VKDB and hepatobiliary dysfunction. 2 Our patient had mild transaminitis initially concerning for cholestasis, but his labs improved spontaneously and all studies were negative for hepatobiliary disease.…”

Report on advances for pediatricians in 2018: allergy, cardiology, critical care, endocrinology, hereditary metabolic diseases, gastroenterology, infectious diseases, neonatology, nutrition, respiratory tract disorders and surgery

“…According to recent studies and international guidelines, intramuscular administration of vitamin K is clinically more effective than oral one especially in late forms, so it should be preferred at birth [30, 31]. The administration of oral 2 mg vitamin K at birth, repeated twice at 2–4 and 6–8 weeks of age, should be limited to newborns whose parents decline intramuscular vitamin K [32]. Moreover, it has been proposed to increase the dose of vitamin K prophylaxis with a 6-fold increase of daily regimen, demonstrating a significant although modest reduction of intracranial VKDB in a Dutch nationwide survey [33].…”