Department of Paediatrics
Vitamin K has been in routine use for newborn babies since the l950s. We use it to prevent a rare but very serious illness called Haemorrhagic Disease of the Newborn, which affects 1:100,000 babies and can cause bleeding in many places, including into the brain. All newborn babies are relatively deficient in Vitamin K, particularly those that are breastfed, which means that the production of proteins within the liver to help the blood clot may be impaired. By giving Vitamin K to the newborn baby the production of these clotting factors can remain at normal levels, and the risk of bleeding is prevented.
In l990 a study from Bristol caused a great deal of alarm by linking the injection of
Vitamin K to childhood cancer, but it is now recognised that there were serious problems with this research and it is by no means certain that the route of administration of Vitamin K was correctly documented in each case. More importantly, several subsequent studies have failed to show any association between
Vitamin K and childhood cancer.
Following the adverse publicity surrounding the Bristol study, many hospitals switched from using the injectable form of Vitamin K to giving it by mouth.
Unfortunately the oral form of Vitamin K is not as effective at preventing
Haemorrhagic Disease of the Newborn and also two further doses are required once the baby is at home. As a result, as the usage of oral Vitamin K increased, the number of reports of bleeding in babies also increased.
In this hospital we feel very strongly that all newborn babies should receive a single intramuscular injection of Vitamin K after delivery and that recent studies have adequately demonstrated that there is no link between Vitamin K and childhood cancer. Oral Vitamin K is available if you feel strongly that you do not wish your baby to have the injection but this is not as well absorbed and is not as effective in preventing Haemorrhagic Disease of the Newborn. In addition, a second dose will be required when your baby is one week old and, only if your baby is exclusively breast fed, a third dose at one month old.
If you have any questions about Vitamin K and its administration please do not hesitate to ask to speak to a member of the paediatric department.
Dr Fiona Thompson and Dr John Hewertson
On behalf of the Paediatric Department
FJT/LAW September 2008
Review 2 years
Gosset guidelines/Vitamin K

Department of Paediatrics
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All babies are born with low levels of Vitamin K in their bodies; this puts them at risk of serious bleeding, particularly into the brain.
 Giving Vitamin K to the newborn baby returns blood to normal, thus preventing the risk of bleeding.
In 1990 a research study suggested that giving Vitamin K by injection was linked to the later development of childhood cancer but subsequent research has now ruled out this possibility.
In this hospital we feel very strongly that all newborn babies should receive a single injection of Vitamin K after delivery as we know that the risk of brain damage through bleeding into the brain will be prevented.
Although Vitamin K can be given by mouth it is not as well absorbed.
It needs to be given once at birth, a second dose at one week and, only if the baby is exclusively breast fed, a third dose at one month.
This does not completely prevent serious bleeding problems.
If you have any questions about Vitamin K and its administration please do not hesitate to ask your midwife or a member of the paediatric department.
FJT/LAW September 2008
Review 2 years
Gosset guidelines/Vitamin K

Department of Paediatrics
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All mothers should be informed about Vitamin K prophylaxis by the midwife antenatally and given an information sheet.
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The midwife caring for the mother on Labour Ward should also confirm that consent has been given. If withheld this should be documented together with the reasons on the baby record.
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Following delivery the midwife should administer Vitamin K at the earliest opportunity.
Dose: 1.0 mg IM for babies >36/40
(0.1 ml Konakion MM Paediatric - 2 mg/0.2 ml)
1.0 mg IM for babies <36/40 but >2.5 kg
0.4 mg/kg (0.04 ml/kg) IV or IM for babies <36/40 and <2.5 kg
The box on the baby record should also be completed.
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Parents who wish their baby to receive Vitamin K by the oral route should have the risks explained to them by a member of the Paediatric Department and this should be documented in the notes. The Vitamin K should be administered by breaking open the ampoule, drawing the contents up into a syringe and dispensing directly into the baby's mouth.
Dose: 2 mg p.o. At birth
At one week
At one month - If exclusively breastfed
Follow up doses will be administered by the Community Midwife (one week), and the
Health Visitor (at one month). The oral Vitamin K will be prescribed as a TTO by the
Paediatrician and issued by the Pharmacy.
A standard letter is available on the postnatal wards. The original is parent held but copies will be sent to the Community Midwife, Health Visitor and GP. The ward clerk should check who the Health Visitor will be by telephoning Health Visitor Liaison on 4673
(bleep 4177), or Child Health Services on 4623. The Health Visitor will ensure that the correct oral doses have been given at the 6 week check.
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Babies particularly at risk of Vitamin K deficiency are:
- Those who have had a difficult delivery
- Those born by breech extraction
- Those born by forceps or Ventouse extraction or LSCS
- Those who are <36/40 or <2.5 kg
- Those born to mothers on Anticonvulsants
Antituberculous therapy
Anticoagulants
- Those who have liver problems
and therefore IM Vitamin K is strongly advised.
FJT/LAW September 2008
Review 2 years
Gosset guidelines/Vitamin K

Department of Paediatrics
The original of this letter is to be given to parent(s) at time of baby’s discharge.
Photocopies of this completed letter are sent to the GP, Community Midwife and Health Visitor.
To whom it may concern:
Re. Baby______________________________Sex_____Dob___/___/___
Address_
The parent(s) of the above child have opted to give them oral Vitamin K. This needs to be given as Phytomenadione (for oral use) where a 2mg dose is given as soon as possible after birth, a second dose at about one week, and, if the baby is exclusively breast fed, a third dose at one month. The oral Vitamin K preparation used is “Konakion MM Paediatric” 2mg in 0.2ml.
The first dose has / has not* been given.
The second dose is due on approximately ___/___/___ and will be administered by the Community Midwife.
A third dose is / is not* due. If it is to be given, this will be on approximately
___/___/___ and will be administered by the Health Visitor.
The following TTOs have been issued: 1 / 2 / 3* ampoules of Konakion MM
Paediatric.
Signed_____________________________ Date___/___/___
NOTES
If baby vomits the dose, this can safely be repeated (data sheet: “no overdose effects are known”).
Paediatrician: Letter to be completed by doctor discharging baby. Make appropriate deletions where indicated by “*” and please complete all relevant dates. Oral Vitamin K will need to be prescribed on a separate TTO form.
Ward clerk: Please ensure that photocopies of this completed letter are sent to the Community Midwife, GP and
Health Visitor. Health Visitor details can be obtained from Child Health ext 4623, or Health Visitor Liaison ext
4673, bleep 4177.
Midwife: Please handover any relevant information to Health Visitor re. further doses.
Health Visitor: Put reminder in “6 Week Check” page of Red Book to ensure all necessary doses of Vitamin K have been given
FJT/LAW September 2008
Review 2 years
Gosset guidelines/Vitamin K