Anemia of Prematurity - Portal Neonatal

Drug Name
Pediatric Dose
Phytonadione (Phytomenadione, AquaMEPHYTON) -- Vitamin K, a fatsoluble
vitamin that is a cofactor in the synthesis of clotting factors. May
be ineffective if liver disease is severe. Coagulation factors should
increase in 6-12 h after PO dosing and in 1-2 h after parenteral
administration. Monitor efficacy with PT.
Aqueous (for injection): 2 mg/mL and 10 mg/mL diluted in 5-10 mL D5W
or NS; maximum concentration 10 mg/mL; infuse over 15-30 min;
maximum rate of infusion 1 mg/min
Prophylaxis: 0.5-1 mg SC/IM
Treatment: 1 mg SC or 1-10 mg IV
Note: Use IM or IV administration routes only when SC is not feasible
and condition justifies risk
Contraindications Documented hypersensitivity
Interactions
Incompatible with phenytoin; antagonizes actions of warfarin; mineral oil
decreases enteral absorption
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
IV administration rate should not exceed 1 mg/min because of reported
anaphylactoid reactions; IM administration can result in hematomas,
particularly in infants with evidence of bleeding; hemolytic anemia and
hyperbilirubinemia rarely occur with larger doses (10-20 mg)
FOLLOW-UP Section 8 of 10
Further Outpatient Care: Follow-up interval after discharge depends on the nature and severity of
bleeding, hematocrit at discharge, and any neurologic complications. Mild VKDB that has been treated
successfully can be monitored at routine newborn visits.
Transfer: Infants with evidence of intracranial bleeding may require transfer to a level III nursery after
stabilization with SC or IV vitamin K.
Deterrence/Prevention:
• IM vitamin K prophylaxis at birth is the standard of care in the United States.
• Commercial infant formulas in the United States contain supplemental vitamin K.
• These measures have served to make VKDB a rarity. However, parental refusal of
prophylaxis and an increasing frequency of breastfeeding may cause a resurgence of VKDB in
developed countries.
Complications:
• ICH is the primary serious complication of VKDB.
• Complications of treatment include anaphylactoid reactions to IV vitamin K, hyperbilirubinemia
or hemolytic anemia after high-dose vitamin K, and hematomas at the site of injection if
administered IM.
Prognosis: In the absence of ICH, the prognosis for VKDB in an otherwise healthy infant is excellent.
Prognosis after ICH depends on the extent and location of the hemorrhage. Long-term sequelae of
ICH may include motor and intellectual deficits.