Vitamin K--what, why, and when

Vitamin K, an update for the paediatrician

“…Ever since the discovery of vitamin K, it has been clear that premature infants are at particular risk of VKDB [22]. Although there is consensus on the fact that all premature infants should receive vitamin K, neonatology units use a variety of doses, dosing schedules, routes and formulations Key message 2 There is no doubt that all newborns need vitamin K Key message 3…”

“…In 1939, soon after the discovery of vitamin K, it was shown that treatment with vitamin K could abolish haemorrhagic disease of the newborn [16,22]. Routine prophylaxis with 1 mg vitamin K at birth was adopted as a universal measure in North America and most European countries, although 1 mg represents a massive dose compared to the daily requirement of 5-10 μg in infants [1].…”

“…Finally, menadion (or vitamin K 3 ) is a synthetic and water-soluble vitamin K without a side chain [38]. Use of menadion or vitamin K 3 has been abandoned after reports showing that its use in high doses was associated with haemolytic anaemia, indirect hyperbilirubinemia and kernicterus [22,27].…”

Canadian Paediatric Surveillance Program confirms low incidence of hemorrhagic disease of the newborn in Canada

“…In 1997, the CPS revised recommendations to indicate that a single intramuscular dose of 0.5 mg (birthweight 1500 g or less) or 1 mg (birthweight greater than 1500 g) should be given to all newborns within the first 6 h of life (12). While articles recommending continued use of oral vitamin K following birth continued to be published, the ideal dose, timing and formulation for oral prophylaxis were unclear and varied throughout (13)(14)(15)(16)(17).…”

Fat-soluble vitamins in breast-fed preterm and term infants

“…However, the concentration of fat-soluble vitamins in human milk is low, compared to the recommended intake, and VLBW infants need supplementation (Greer, 2001). Prophylactic vitamin supplementation is common, but the dosage and route of administration vary markedly (American Academy of Pediatrics, 1998;Shaw and Lawson, 2001;Hey, 2003). Most studies of fat-soluble vitamins have been conducted in formula-fed infants.…”