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This document is applicable to all medical, midwifery and nursing staff caring for the newborn in hospital or community in the West of Scotland. The guideline should be used with reference to the relevant pharmacy monographs. Nursing staff should also refer to the Patient Group Direction (PGD) which covers the administration and supply of Konakion MM and NeoKay, by nursing and midwifery staff, for the prevention of Haemorrhagic Disease of the Newborn.
The administration of an Intramuscular dose of Vitamin K (Konakion MM) is recommended for all babies born in the West of Scotland. It should be administered soon after birth. This is a ONCE ONLY dose. The dose is:-
- 1mg Konakion MM (0.1ml) IM for term infants (36 weeks gestation or greater).
A lower dose is recommended for infants < 36 weeks gestation. Two dosage regimes are in use in neonatal units in the West of Scotland. The former is the recommended dose in GG&C
- 0.5mg Konakion MM (0.05ml) IM for all preterm infants less than 36weeks.
- 400 micrograms/kg (0.04 ml/kg) IM.
NB - A 1ml syringe must be used due to the very small volume for injection
If intramuscular injections are contraindicated (e.g. babies with inherited disorders of coagulation or babies with very low muscle mass) then vitamin K may be prescribed via the oral route or by intravenous injection if the enteral route is contraindicated or unreliable. See below.
Note - The oral route is not appropriate for high risk, sick, or premature infants. In addition, the manufacturers do not recommend this route for babies born to mothers who are taking carbamazepine, phenobarbital, phenytoin, rifampicin or warfarin at the time of delivery. If a mother of a baby in any of these categories declines parenteral vitamin K or if a mother declines vitamin K by any route - see later section – ‘Parents who decline vitamin K prophylaxis’.
Mothers of healthy, mature, infants who decline intramuscular vitamin K should be offered one of the following oral Vitamin K regimens.
NeoKay 1mg capsules - 1mg orally, once weekly for 12 weeks – Formulary Link
Administration - The contents of a single Neokay capsule should be administered by cutting the narrow tubular tip off the capsule and squeezing the liquid into the baby’s mouth. Another dose should be given if the first dose is spat out or the baby is sick within three hours of the dose being given. The preparation comes in packs of 12 capsules which is sufficient for a full course. Note that the capsule is made from Gelatin and although this is not ingested, this may be an issue for some vegan families.
Advice to Parents – The parents should be advised that all doses must be given to ensure adequate prophylaxis against both early and late onset haemorrhagic disease.
NeoKay information leaflet attached to this document.
If NeoKay is unavailable then Konakion MM may be used according to the following schedule.
Konakion MM Paediatric – 2mg (0.2ml) orally, Three doses at 1, 7 and 28 days – Formulary Link
Administration – Konakion MM Paediatric is supplied in glass ampoules. Arrangements will need to be made to allow administration by health professionals. This would usually be the community midwife or the health visitor.
Konakion MM may be administered intravenously but this is not recommended for routine treatment. Intravenous administration is not covered by the PGD and must be prescribed by a doctor.
Konakion MM must only be diluted with 5% glucose & not mixed with other intravenous medications or infusions. The line should be flushed with IV glucose 5% before and after administration.
As intravenous administration does not provide a depot of vitamin K the manufacturers recommend administration of additional doses at 7 days and 4 weeks of age.
The administration of Konakion MM (oral or IM) and NeoKay (orally) by midwives and nurses employed by Greater Glasgow & Clyde Health Board are covered by a Patient Group Directions (PGDs). The PGDs permit the administration of IM Konakion or oral NeoKay or Konakion MM on labour wards, the neonatal units and at home deliveries, without a medical prescription.
Parents are asked to provide verbal consent for the administration of intramuscular vitamin K. Staff should be aware of the following key points when discussing vitamin K administration, to ensure that this consent is fully informed.
Listed below are some important factors.
Parents of healthy term babies have the right to refuse consent for vitamin K prophylaxis by any or all routes. However, we have a duty to explore the reasons for complete refusal and ensure that they are correctly informed of the risks of Vitamin K deficient bleeding and the potential for serious long term morbidity or mortality. If, having explored the reasons for refusal and having ensured that they are correctly informed of the risks, they continue to refuse prophylactic vitamin K then this conversation and their decision should be clearly documented in the baby notes. It is not appropriate to get the parents to sign a medical ‘disclaimer’. This discussion should be with a Middle Grade or Consultant Paediatrician.
Where a baby is clearly at high risk of bleeding however, vitamin K is required as treatment rather than prophylaxis and should always be administered in the best interests of the baby.
Such cases would include:
Information to be given to parents if vitamin K prophylaxis is declined
Resources for Families
Families can be directed to the leaflet attached to the end of this document
Last reviewed: 14 October 2019
Next review: 01 October 2022
Author(s): Dr Zoe Porteous - ST6 Paediatric Trainee; Dr Andrew Powls - Consultant Neonatologist
Co-Author(s): Other Professionals consulted: Pharmacy - June Grant
Approved By: West of Scotland Neonatal Managed Clinical Network