Paediatric Drugs

, Volume 3, Issue 1, pp 1–8

Vitamin K in Neonates

How to Administer, When and to Whom

Authors

    • Department of Clinical Pharmacology, Hôpital BretonneauUniversity François Rabelais
  • Annie-Pierre Jonville-Béra
    • Department of Clinical Pharmacology, Hôpital BretonneauUniversity François Rabelais
Leading Article

DOI: 10.2165/00128072-200103010-00001

Cite this article as:
Autret-Leca, E. & Jonville-Béra, A. Paediatr Drugs (2001) 3: 1. doi:10.2165/00128072-200103010-00001

Abstract

Vitamin K-dependent factors are lower in neonates than in adults, and these anomalies are more prevalent in preterm neonates and in breast-fed infants. Vitamin K deficiency can account for vitamin K deficiency bleeding (VKDB) which occurs in 3 forms — early, classic and late. Vitamin K should be administered to all neonates at birth or immediately afterwards. However, the protocols for administration (route of administration, dosage, number of doses) remain a subject of discussion.

Oral administration of a single dose of vitamin K protects against classical and early VKDB, but is less effective than intramuscular (IM) prophylaxis for the prevention of late VKDB. Although an increased risk of solid tumour, associated vitamin K administration, can be definitively excluded, a low potential risk of lymphoblastic leukaemia in childhood can not be ruled out.

For formula-fed neonates without risk of haemorrhage, a 2mg oral dose of vitamin K at birth, followed by a second 2mg oral dose between day 2 and 7, is probably sufficient to prevent VKDB.

For infants who are exclusively or nearly exclusively breast-fed, weekly oral administration of 2mg (or 25 μg/day) vitamin K after the initial 2 oral doses is justified at completion of breast-feeding. For neonates at high risk of haemorrhage (premature, neonatal disease, birth asphyxia, difficult delivery, any illness which will delay feeding, known hepatic disease, maternal drugs inhibiting vitamin K activity), the first dose must be administered by the IM or slow intravenous route. Doses should be repeated, particularly in premature infants, by a route of administration decided for each dose according to the clinical state of the infant.

For infants of mothers treated with drugs inhibiting vitamin K activity, antenatal maternal prophylaxis (10 to 20 mg/day orally for 15 to 30 days before delivery) prevents early VKDB. After neonatal prophylaxis, as for infants at high risk of haemorrhage, doses need to be repeated at a rate and route of administration decided for each dose, according to the clotting factor profile specific for each infant.

Copyright information

© Adis International Limited 2001