Phytomenadione

=Phytomenadione= //Vitamin K1 //

How it works
Vitamin K is needed by humans to cause blood to clot. Without vitamin K small cuts can go on bleeding for a long time, small injuries can cause a lot of bruising, and bleeding can occur in many parts of the body, including in the brain, causing a stroke //Essential cofactor in the synthesis of blood clotting factors II, VII, IX and X, and proteins C and S; antagonist of oral anticoagulants.//

__Haemorrhagic Disease of the Newborn__ - All newborn babies have low levels of vitamin K. - Only a little vitamin K goes through the placenta to the baby, and at birth a baby's gut is sterile (there are no bacteria in the gut) - After birth there is little vitamin K in breast milk and breast fed babies can be low in vitamin K for several weeks until the gut bacteria start to make it.

Questions to Ask
What medications? - medical conditions? - allergies?

//Pregnancy:// Few data available; use if required; does not readily cross placenta (newborn requires injection or oral after delivery) Phytomenadione may be used from 36 weeks gestation in women taking liver enzyme-inducing antiepileptics (eg phenobarbitone, phenytoin and carbamazepine).

Damage to red blood cells causing anemia (hemolysis) has been reported rarely in infants and children with the use of the vitamin K preparation Menadiol (not available in the United States). This type of vitamin K should be avoided in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency because vitamin K may cause hemolytic episodes. Vitamin K deficiency decreases blood factors needed for clotting and increases the risk of bleeding.

How to take
__Prevention of haemorrhagic disease of the newborn__ //Use Konakion MM Paediatric® injection.// //IM//, 1 mg (0.1 mL) on day 1 postpartum; 0.5 mg (0.05 mL) in infants with a birth weight <1.5 kg. //Oral//, 2 mg (0.2 mL) given at birth, then at time of newborn screening (3–5 days of age) and in the fourth week; the last dose is not required in predominantly formula fed infants.

__Treatment of haemorrhagic disease of the newborn__ //Slow IV//, 1 mg; replacement of clotting factors and additional doses of vitamin K may be required.

Side effects

 * Common:** pain, tenderness and erythema (IM injection)
 * Infrequent:** allergic reactions including anaphylaxis (especially with rapid IV injection)
 * Rare:** haemolytic anaemia, hyperbilirubinaemia, kernicterus (in neonates, especially if preterm)

Other advice?
- vitamin K may not be required in all cases of excessive anticoagulation; temporarily stopping warfarin and readjustment of warfarin dose may be all that is necessary - anticoagulant effect of warfarin may be difficult to re-establish for several days to weeks after large doses of vitamin K; if intending to restart warfarin, use lowest possible dose of vitamin K - an extensive review of medical literature has concluded that there is no association between vitamin K and childhood cancer, regardless of the route of administration - IM administration is the preferred route for prevention of haemorrhagic disease of the newborn because of reliability of administration and level of compliance; oral administration may be as effective as IM administration if there is full compliance with dosage schedule - injection is commonly used orally for small doses needed to reverse oral anticoagulant effect

- The current recommendations from many specialist organizations such as the National Health and Medical Research Council and the Health Policy Unit of the Royal Australasian College of Physicians and the World Health Organisation is that **all newborn children should receive vitamin K at birth by injection, but that parents also be given information about the injection and reasons for it,** and that the injection is recorded in the baby's health record. - Parents can refuse the injection but they need to be well informed, to be clear that giving vitamin K orally does not provide as good protection as injections, and also be very clear about how they will ensure that their baby gets the oral doses needed - They also need to be aware that babies who are ill or premature need vitamin K by an injection as they will not be able to absorb an oral dose. All babies can have vitamin K by injection, even if they are premature or ill.

CMI
[|AMH] [|Parenting and Child Health - Vitamin K] [|MedlinePlus - Vitamin K]