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Neonatal Intensive Care Drug Manual
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| bet | 647/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Incompatibility
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Fluids: Fat emulsion (intravenous)
Y-site: Amphotericin (conventional), ampicillin, dantrolene sodium, diazepam, diazoxide, dobutamine, haloperidol lactate, hydralazine, magnesium sulfate, methylprednisolone, phenytoin, promethazine, sulfamethoxazole-trimethoprim.
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Stability
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Use immediately.
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Storage
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Store below 25OC. Protect from light.
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Check ampoule carefully as an adult 10 mg ampoule (Konakion MM Adult) is also available.
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Evidence summary
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Australian NH&MRC Guideline: All newborn infants should receive vitamin K prophylaxis.
Healthy newborn infants should receive vitamin K1 either:
By intramuscular injection of 1 mg (0.1 mL) of Konakion® MM Paediatric at birth.
This is the preferred route for reliability of administration and level of compliance.
Or
As three 2 mg (0.2 mL) oral doses of Konakion® MM Paediatric, given at birth, at the time of newborn screening (usually at three to five days of age) and in the fourth week. 1
Newborns who are too unwell and are unable to take oral vitamin K1 (or whose mothers have taken medications that interfere with vitamin K metabolism) should be given 1 mg of Konakion® MM Paediatric by intramuscular injection at birth. A smaller intramuscular dose of 0.5 mg (0.05 mL) should be given to infants with a birth weight of less than 1.5 kg.1
Efficacy:
A single dose (1.0 mg) of intramuscular vitamin K1 after birth is effective in the prevention of classic HDN. Either intramuscular or oral (1.0 mg) vitamin K prophylaxis improves biochemical indices of coagulation status at 1–7 days. Neither intramuscular nor oral vitamin K1 has been tested in randomised trials with respect to effect on late HDN. When three doses of oral vitamin K1 are compared to a single dose of intramuscular vitamin K1, the plasma vitamin K1 concentrations are higher in the oral group at two weeks and two months, but, again, there is no evidence of a difference in coagulation status. (LOE II, GOR B)2
Continuous oral prophylaxis with weekly doses of 1 mg or daily doses of 25 microgram for 3 months appears to be the most effective dosing strategy. Studies using 3 x 2 mg (days 1, 4–10, and 28–42) reported an incidence of late VKDB at 0.4–0.87 per 105 infants. (LOE III-2, GOR B).3, 4
Failure of prophylaxis occurs principally with parental refusal of infant vitamin K1 and in infants with cholestasis (prolonged jaundice). (LOE III-2, GOR B) 4, 5
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