Neonatal Drug Therapy Manual

Vitamin K1

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
March 1992
Revised Date: 
Aug 2023
  • Prevention/treatment of hemorrhagic disease of the newborn
  • IV direct: rate not to exceed 1 mg/min (undiluted)
  • IV intermittent infusion: over 15 minutes (see below for recipe)
  • IM
  • SC
  • PO

Prophylaxis (Preterm and Term neonates):


  • < 1.5 kg: 0.5 mg IM within 6 hours of birth
  • > 1.5 kg: 1 mg IM within 6 hours of birth

Oral (note that IM therapy is preferred, see Notes section*):

  • Oral therapy may be considered if parenteral vitamin K preparations are not available or it is not possible to administer IM (eg, parental refusal). Incomplete oral therapy may leave infant at risk for late-onset vitamin K deficient bleeding
  • Dose: 2 mg vitamin K at the time of the first feeding, to be repeated at 2 to 4 and 6 to 8 weeks of age.


  • 1 mg/dose IM/IV
Side Effects: 
  • CVS: flushing and hypotension
  • Local: pain and swelling at injection site
  • Respiratory: dyspnea
Parameters to Monitor: 
  • HR, RR, BP
  • Prothrombin time with repeated doses
Reconstitution and Stability: 

IV intermittent infusion:

  • Vitamin K 1 mg/0.5 mL
    • Take 0.5 mL (1 mg) and add to 0.5 mL D5W
    • Final concentration: 1 mg/mL



  • Injection solution may be given by mouth, undiluted

- Solutions Compatible: dextrose, 0.9 % NaCl, dextose-saline combinations

- Y-site Compatible: calcium gluconate, dobutamine, dopamine, fentanyl, furosemide, heparin, indomethacin, KCl, midazolam, morphine, ranitidine, sodium bicarbonate

  • Severe reactions resembling anaphylaxis or hypersensitivity have occurred rarely during or immediately after IV and IM administration.
  • *PO vitamin K is less effective than IM vitamin K for preventing VKDB
  • For preterm infants undergoing intensive care, limited data suggest that a single IV dose of 0.2 mg at birth may not be as protective against late Vitamin K deficiency as a 0.2 mg or 0.5 mg dose of vitamin K delivered IM. Therefore, current evidence is insufficient to recommend routine use of IV vitamin K in this population.

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

-American Society of Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: ASHP; 2017

- The Canadian Pediatric Society Guidelines for vitamin K prophylaxis in newborns, accessed August 2023.

- Ivan Hand, Lawrence Noble, Steven A. Abrams; COMMITTEE ON FETUS AND NEWBORN, SECTION ON BREASTFEEDING, COMMITTEE ON NUTRITION, Vitamin K and the Newborn Infant. Pediatrics March 2022; 149 (3): e2021056036.

- Lippi G, Franchini M. Vitamin K in neonates: facts and myths. Blood Transfus. 2011 Jan;9(1):4-9. doi: 10.2450/2010.0034-10


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