- 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)
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
- CVS: flushing and hypotension
- Local: pain and swelling at injection site
- Respiratory: dyspnea
- HR, RR, BP
- Prothrombin time with repeated doses
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