Vitamin K prophylaxis in newborns : 2018 Canadian Guidelines

Key Recommendations are-

• The Canadian Paediatric Society continues to recommend the routine administration of vitamin K to newborns, preferably by IM injection, to prevent vitamin K deficiency bleeding (VKDB).


• Administering one intramuscular (IM) dose of vitamin K (0.5 mg for infants weighing ≤ 1500 g or 1.0 mg for infants weighing > 1500 g) routinely to all newborns within the first 6 hours post-birth and following initial stabilization and appropriate maternal/newborn interaction, is now the recommended best practice.


• Implementing strategies that minimize the procedural pain associated with IM injections for all newborns is also recommended.


• For parents who decline injection, counselling on the serious health risks of VKDB is advised. If they still decline, health care providers should recommend an oral (PO) dose of 2.0 mg vitamin K at the time of the first feeding, to be repeated at 2 to 4 and 6 to 8 weeks of age.

Recommendations for Healthcare providers -

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  They should advise parents that PO vitamin K is less effective than IM vitamin K for preventing VKDB,

  
  


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  They should make sure their infant receives all follow-up doses is important.

  
  


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  They should advise parents that their infant remains at risk for developing late VKDB (potentially with intracranial haemorrhage) despite the use of the parenteral form of vitamin K for PO administration, which is the only alternate formulation available at this time.

  
  

For preterm infants undergoing intensive care, limited data suggest that a single IV dose of 0.2 mg at birth may not be as protective against late VKDB as a 0.2 mg or 0.5 mg dose of vitamin K delivered IM. Therefore, current evidence is insufficient to recommend the routine use of IV vitamin K in this population.