DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
INDICATIONS
Prophylaxis
- Babies are relatively deficient in vitamin K (phytomenadione). Those who do not receive supplements are at risk of bleeding (vitamin K deficiency bleeding, formerly known as haemorrhagic disease of the newborn)
- All babies should be given vitamin K with parental consent
Therapy
- After blood has been taken for clotting studies, vitamin K can also be used to treat any baby with active bleeding that might have resulted from vitamin K deficiency
- a prolonged prothrombin time (INR ≥3.5) that falls within 1 hr of treatment, with normal platelet count and fibrinogen concentration suggest the diagnosis. However, as INR is a poor indicator of vitamin K deficiency, PIVKA-II is a better investigation if available
ADMINISTRATION
Prophylaxis
- Vitamin K (Konakion MM Paediatric™) as a single IM dose (see Prophylaxis dosage below for dosage schedule)
- avoid IV administration for prophylaxis as it does not provide the same sustained protection as IM
- Give in accordance with manufacturer’s instructions in order to ensure clinical effectiveness
- If parents decline IM route, offer oral vitamin K as second line option (no evidence of increased childhood cancers with parenteral vitamin K)
- give 2 doses vitamin K 2 mg oral in the first week
- first: at birth
- second: aged 4–7 days
- third dose vitamin K 2 mg oral given aged 1 month, unless baby exclusively formula fed (formula feeds contain adequate vitamin K)
- give 2 doses vitamin K 2 mg oral in the first week
- If parents refuse prophylaxis, ask middle grade doctor to see and record discussion (including reason for refusal) in notes
IM use
- Do not dilute or mix with other parenteral injections
Oral use
- Break open ampoule and withdraw 0.2 mL (2 mg) into the oral dispenser provided. Drop contents directly into baby's mouth by pressing plunger
Prophylaxis dosage
Konakion MM Paediatric™ | |
Healthy babies of ≥36 weeks |
First line
Second line
|
Term babies at special risk
|
1 mg IM at birth or soon after Do not offer oral vitamin K |
Preterm babies <36 weeks but ≥2500 g | 1 mg IM at birth or soon after |
All babies <2500 g |
400 microgram/kg (0.04 mL/kg) IM shortly after birth (maximum dose 1 mg) Do not exceed this parenteral dose The frequency of further doses should depend on coagulation status |
Babies who have or may have Factor VIII or Factor IX deficiency or other coagulation deficiency | Unless results of Factor assays normal, give orally – consult with local haematologist |
For babies with birth weight ≥2500 g
- Administer Konakion MM Paediatric™ 1 mg (0.1 mL) IM
- this is approximately half of the ampoule volume and should be drawn up using syringe supplied with ampoule
For babies with birth weight <2500 g
- Administer 400 microgram/kg (0.04 mL) with a maximum of 1 mg (0.1 mL) of Konakion MM Paediatric™ IM
- round up the dose to nearest hundredth [e.g. 300 microgram (0.03 mL), 500 microgram (0.05 mL) etc.]
- draw up the dose using syringe supplied with ampoule
Weight |
Dose |
Injection volume |
1 | 0.4 | 0.04 |
1.5 | 0.6 | 0.06 |
2 | 0.8 | 0.08 |
2.5 | 1 | 0.1 |
>2.5 | 1 | 0.1 |
Therapy dosage
- If not already given IM, give vitamin K 100 microgram/kg IV up to 1 mg maximum dose
- Further doses as required, depending on clinical picture and coagulation status
- may need to be accompanied by a more immediately effective treatment such as transfusion of fresh frozen plasma
IV administration
- If necessary, dilute
- dilution in glucose not recommended for IV administration due to reactions with syringes, but drug can be added to lower port of syringe giving set administering glucose 5% at rate ≥0.7 mL/min (= 42 mL/hr)