Vitamin K Prophylaxis - Babies Born within LTH NHS Trust

Publication: 01/03/2005  
Next review: 25/01/2023  
Clinical Protocol
CURRENT 
ID: 1655 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Vitamin K Prophylaxis

Babies born within LTH NHS Trust

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, please ask a senior paediatrician to discuss this with them; if refused, then the midwife/doctor must document in baby’s notes and GP must be notified.
  • 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.

Provenance

Record: 1655
Objective:
Clinical condition: Vitamin K Prophylaxis
Target patient group: Neonates
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

N/A


Evidence base

  • BNFc online accessed Jan 2020
  • Konakion MM Paediatric 2 mg/0.2 ml Summary of Product Characteristics. Last updated 22/02/2019
  • Drugs and Therapeutics Bulletin. Which Vitamin K preparation for the newborn ? Vol 36 No 3
    March 1998.
  • Formulary Medicines for Children - 2003 - Royal College of Paediatrics and Child Health and the
    Neonatal and Paediatric Pharmacists Group.
  • DOH. Vitamin K information for parents -to- be.
  • Chief Medical Officer and Chief Nursing Officer letter, DOH. Vitamin K for newborn babies (5th May
    1998).
  • E. Hey. Vitamin K - what, why, and when. Arch Dis Child Fetal Neonatal Ed 2003; 88:F80–F83.
  • JH Tripp, AW Mcninch. The vitamin K debacle: cut the Gordian knot but first do no harm Arch.
    Dis. Child. 1998; 79:295-297.
  • U Wariyar, S Hilton, J Pagan, W Tin, E Hey. Six years' experience of prophylactic oral vitamin K.
    Arch. Dis. Child. Fetal Neonatal Ed. 2000; 82:64F-68F.
  • P Ansell, E Roman, NT Fear, MJ Renfrew. Vitamin K policies and midwifery practice: questionnaire survey. BMJ 2001; 322:1148-1152.

Document history

LHP version 1.0

Related information

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