What is the correct route and dose for Vitamin K injection in a newborn?

AIIMS Delhi NO - 2018

Child Health Nursing (Pediatrics)

Easy

Appeared in: AIIMS Delhi NO - 2018

Explanation

Newborns have physiologically low levels of vitamin K, as it transfers poorly across the placenta and breast milk contains low amounts.
A deficiency places the infant at risk for Vitamin K Deficiency Bleeding (VKDB), which can cause life-threatening hemorrhage, particularly intracranial bleeding.
The standard prophylactic dose for a healthy, full-term newborn is a single 1 mg injection of vitamin K.
The intramuscular (IM) route is preferred because it provides a depot effect, ensuring sustained, reliable absorption and is proven to be most effective in preventing late VKDB.
The vastus lateralis muscle in the thigh is the recommended site for IM injections in newborns, as depicted in the provided image.

Option A: This option is incorrect because the dose (0.1 mg) is too low to provide adequate protection against VKDB for a term infant. The subcutaneous (SC) route is also not preferred as absorption can be less reliable than the IM route.
Option C: This option represents a massive overdose (1 gm = 1000 mg) and an incorrect route for routine prophylaxis. A 1000-fold overdose would be extremely dangerous. The intravenous (IV) route is reserved for emergency treatment of active bleeding, not for prevention, and carries a higher risk of anaphylactoid reactions.
Option D: This option is incorrect. While oral vitamin K preparations exist, a single IM dose is the recommended standard in most countries because oral regimens are less effective at preventing late VKDB, which is the most dangerous form. Furthermore, 5 mg is an excessive dose for prophylaxis.

Clinical Relevance

Nursing practice connection: Knowing Neonatal Prophylaxis and Medication Administration helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's primary role includes administering this injection correctly and safely within the first few hours of life.
Patient education is critical. Nurses must explain the reason for the injection to parents, clarifying that it is a vitamin, not a vaccine, to prevent a serious bleeding disorder. This helps ensure informed consent and addresses parental concerns.
Accurate documentation of the administration (dose, route, site, date, time) is a legal and professional requirement.

How to Approach the Question

First, identify the keywords in the question: 'newborn', 'Vitamin K', 'correct route and dose'. This is a factual recall question about a standard neonatal procedure.
Analyze the image provided. It shows an injection being given in the thigh of a baby, which is characteristic of an intramuscular (IM) injection in the vastus lateralis muscle.
Recall the standard protocol for vitamin K prophylaxis in newborns. Think about why it's given (to prevent VKDB) and the established guidelines.
Evaluate each option based on this knowledge. Option A has too low a dose. Option C has a dangerously high dose and incorrect route for prophylaxis. Option D uses a less effective route and an incorrect dose.
Option B (1 mg IM) aligns perfectly with the standard of care for dose and route, and the route is consistent with the visual evidence in the image.
Confirm your choice by cross-referencing the dose (1 mg) and route (IM) as the gold standard for preventing VKDB in term newborns.

Concept Tested & Keywords

Concept Tested: Neonatal Prophylaxis and Medication Administration
Stem keywords: newborn, Vitamin K injection, route, dose
Lead-in keywords: correct
Clinical cues: The question asks for the standard of care for a common and critical neonatal procedure.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 527-529, 1138-1140