Use of oral vitamin K for prevention of late vitamin k deficiency bleeding in neonates when injectable vitamin K is not available.

Abstract

OBJECTIVE:

To evaluate the literature describing use of oral vitamin K(1) (phytonadione) to prevent late vitamin K deficiency bleeding (VKDB) in neonates when injectable vitamin K preparations are not available.

DATA SOURCES:

Articles were retrieved through MEDLINE (1946-February 2012) using the terms vitamin K, vitamin K deficiency bleeding, newborn, neonate, and prophylaxis. Reference citations from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION:

All articles published in English on the use of prophylactic oral vitamin K in neonates were evaluated. The largest epidemiologic studies discussing the efficacy of continuous oral vitamin K prophylaxis were reviewed. Individual, smaller clinical trials were not reviewed.

DATA SYNTHESIS:

For prevention of early, classic, and late VKDB, use of intramuscular vitamin K 1 mg is preferred over oral administration because of superior efficacy. Single oral doses protect against early VKDB, but multiple oral doses are needed for late VKDB prophylaxis, especially in exclusively breast-fed neonates. Continuous oral dosing regimens used in the literature vary; European epidemiologic data suggest the lowest rates of late VKDB with oral vitamin K 1 mg at birth followed by 25 μg daily for 13 weeks, or 2 mg at birth followed by 1 mg weekly for 3 months. Limited data describe the use of oral prophylactic vitamin K in high-risk patients (eg, premature neonates, biliary abnormalities).

CONCLUSIONS:

While there are data supporting effective oral vitamin K dosing regimens for prevention of late VKBD in exclusively breast-fed neonates, lack of an appropriate oral dosage form prevents routine use of this technique in the US. In times of drug shortage, injectable vitamin K preparations should be reserved for use in neonates. If injectable vitamin K is not available, clinicians should choose the most practical method of administering oral vitamin K based on the oral products available.

• Authors: Heather J Ipema
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 46 Issue 6 Pg. 879-83 (Jun 2012) ISSN: 1542-6270 [Electronic] United States
• PMID: 22619475 (Publication Type: Journal Article, Review)

Chemical References

• Vitamin K

Topics

• Administration, Oral
• Humans
• Incidence
• Infant, Newborn
• Injections
• Vitamin K (administration & dosage)
• Vitamin K Deficiency Bleeding (epidemiology, prevention & control)