Vitamin K Prophylaxis

Babies born within LTH NHS Trust

• Infants ≥36 weeks gestation or weighing ≥2.5kg
• Infants <36 weeks gestation or weighing <2.5kg
• Babies born before arrival to hospital
• Planned Home Delivery

The department of Health recommends that all new- born babies are given vitamin K supplement at birth, aimed at the prevention of the rare but serious (sometimes fatal) disorder called “Vitamin K deficiency bleeding” (VKDB). This guideline supersedes any other local document in circulation on the administration of Vitamin K to the newborn. All parents will be informed through an information leaflet. A single preparation of Vitamin K (Konakion MM paediatric) will be used regardless of route. The route of administration will depend on the clinical indication and parental choice as outlined below:

Preparation: Konakion MM Paediatric (2 mg/0.2 ml ampoule)

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Infants ≥36 weeks gestation or weighing ≥2.5kg:

Konakion MM Paediatric 1 mg (0.1 mls) IM injection given at birth by midwife into thigh. Further doses are not routinely needed if the first dose has been given IM at birth. This is our recommended route.

If parents choose the oral route, the baby will require two or three doses to be prescribed as follows:

• 1st dose: Konakian MM paediatric 2mg PO given at birth using dispenser provided with ampoule.
• 2nd dose: Konakian MM paediatric 2mg PO given on day 7, regardless of bottle /breast feeding. Administered by parent or midwife.
• 3rd dose: Konakian MM paediatric 2mg PO , given on day 28 if baby is breast fed. Administered by parent. This dose can be omitted if fully bottle fed, as formula milk is supplemented with vitamin K.
  All three doses will be dispensed by the hospital at discharge.

Exceptions:

• Maternal liver disease
• Maternal anticonvulsants
• Maternal tuberculosis treatment [Expected] liver disease in baby
• Mo derate to severe peripartum asphyxia
• Any newborn admitted to NICU

These infants should all receive the intramuscular preparation: Konakion MM Paediatric 1 mg (0.1 mls) IM given at birth by midwife into thigh. Further doses may be needed at the discretion of the neonatologist.

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Infants <36 weeks gestation or weighing <2.5kg:

Konakion MM Paediatric 400 micrograms/kg (0.04 mls/kg) (maximum 1mg) IM given at birth by intramuscular injection into thigh by midwife / attending doctor after the baby has been weighed. (Dose may need to be rounded to nearest 0.05 mls)
Do not use IV route as bioavailability is unreliable
Consider further dose(s) if prolonged jaundice or liver disease.

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Babies born before arrival to hospital

These infants should receive the appropriate dose of Vitamin K, depending on the category above, as soon as they are admitted to the hospital. This should be administered by the admitting midwife.

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Planned Home Delivery

Infants born by planned home delivery should be offered a choice of oral or IM Vitamin K as above. These infants are the responsibility of the midwife and GP. We recommend these infants should therefore
all receive Konakion MM Paediatric (either IM or orally, depending on
parental choice)

IM: 1mg (0.1mls) Konakion MM Paediatric given at birth intramuscularly into thigh by midwife. No further doses needed.

Oral: Draw up 2mg (0.2mls) Konakion MM Paediatric from the glass ampoule. A dispenser is provided with the ampoule. Administer orally to baby. Further doses will be needed at 7 days and 28 days as above, and these must be prescribed by the GP or midwife.

Notes

• infants of HIV or Hepatitis B positive mothers should not get IM injection until the skin has been thoroughly cleaned to remove all maternal blood.
• Vitamin K administration must be documented in baby’s notes by person who administered
  Vitamin K.
• If parents do not consent to any form of Vitamin K, the midwife (post natal wards) or neonatal doctor (TC or NNU) should ensure parents have received and read the Vitamin K leaflet (available online) and are aware of the increased risk of vitamin K deficient bleeding. If their informed decision is still to refuse Vitamin K then this must document in baby’s notes and GP must be notified in the K2  or Badger discharge summary.
• Community Midwife
  • will record Vitamin K administration in Child Health Record (Red Book) and baby’s notes in case of home delivery;
  • must refer to the community guideline for obtaining Konakion.