Phytonadione (Vitamin K1): Nursing pharmacology

Vitamin K1, is a fat-soluble vitamin that helps regulate the process of blood coagulation. Vitamin K is found in abundance in green leafy food, like spinach, kale, and chard; and it’s also produced by the gastrointestinal microbial flora.

Neonates are particularly susceptible to vitamin K deficiency because breast milk is low in vitamin K.

In addition, there is an absence of gastrointestinal flora at birth that synthesize vitamin K. Moreover, the newborn's immature liver is less able to produce coagulation factors.

Now, vitamin K deficiency results in impaired coagulation cascade and blood clotting formation. This can potentially lead to hemorrhage, or vitamin K deficiency bleeding or VKDB for short, which is a condition previously known as hemorrhagic disease of newborn.

VKDB is most likely to occur between days 1 and 7 of life; by day 7, most healthy newborns start producing their own vitamin K.

Vitamin K deficiency in newborns can be prevented by giving phytonadione, also known as vitamin K1, which is the most active form of vitamin K.

Phytonadione is administered intramuscularly in the newborn setting, typically within one hour after birth.

Once administered, phytonadione acts as a cofactor to an enzyme found in the liver called gamma glutamyl-carboxylase, which converts the inactive forms of coagulation factors II, VII, IX, and X into their active forms.

Now, IM administration phytonadione to a newborn may have potential side effects. The most common ones include pain and erythema at the injection site, as well as a skin rash or urticaria.

Other potential side effects include hypersensitivity reactions, as well as hyperbilirubinemia, which is more likely to occur in premature infants.

Before administering phytonadione to a newborn, there are a number of nursing considerations to keep in mind.

First, educate the newborn’s family about why the medication is needed. Explain how during the first week of life, newborns are at risk for bleeding because their gastrointestinal tract hasn’t yet begun producing the vitamin K needed by the liver to make certain coagulation factors.

Be sure to address any questions or concerns they may have. During administration, stabilize the infant’s leg to prevent injury.