Oral vitamin K for neonates

• there is evidence that Konakion MM (a licensed oral preparation of vitamin K for prophylaxis of haemorrhagic disease of the newborn) is likely to be as effective as the intramuscular preparation.
• 156 infants were enrolled in the study.
• infants were randomised either to one dose of 1mg intramuscular vitamin K1, or oral doses of Konakion MM at birth and again at 7 and 30 days.
• Blood samples were taken at birth, 14 days, 30 days and 56 days. There was no difference between prothrombin times between the groups. The oral medication group had slightly higher vitamin K levels at 14 and 56 days.

With respect to use of vitamin K in preterm infants:

• preterm infants may be at particular risk from either inadequate or excessive vitamin K prophylaxis
  • a study (2) revealed that vitamin K (vitamin K1) prophylaxis with 0.2 mg administered intramuscularly maintained adequate vitamin K status of preterm infants until a median age of 25 postnatal days. This dose of vitamin K1 also did not cause early vitamin K1 2,3-epoxide (the epoxide metabolite of vitamin K1) accumulation
  • in contrast, 0.2 mg administered intravenously and 0.5 mg administered intramuscularly led to vitamin K1 2,3-epoxide accumulation, possibly indicating overload of the immature liver
  • the authors suggest that in order to protect against late vitamin K1 deficiency bleeding, breastfed preterm infants given a 0.2-mg dose of prophylaxis should receive additional supplementation when feeding has been established

Reference:

1. Arch Dis Child 1998;79: 300-5.
2. Clarke P et al. Vitamin K prophylaxis for preterm infants: a randomized, controlled trial of 3 regimens. Pediatrics. 2006 Dec;118(6):e1657-66