Vitamin K Injection and the Newborn

Vitamin K….

So I have been requested to do a blog on Vitamin K injection and the newborn. And here I sit…facing the same ‘problem’ I face every time I try to write an educational blog post: the information has already been written, they won’t learn anything from me that they can’t learn elsewhere, there’s so much information how can I condense it all into a reasonable sized blog post.

So I am just going to hit some of the major points and then direct you to more information at the end…

What is Vitamin K? It is a fat-soluble substance that triggers the blood clotting process. It is offered to every single newborn baby born in the US – specifically for the preventative/treatment of a very rare condition called “newborn hemorrhagic disease” – or, more recently they have changed the terminology to “Vitamin K deficiency bleeding (VKDB)”.
How rare? College of Midwives of Manitoba state the occurrence as…

  • Early VKDB (first week of life): 0.4 to 1.7 %
  • Disabling or fatal hemorrhage: 2.2 per 100 000 births
  • Late VKDB (weeks 2-12 of life): 4.4 to 10.5 per 100 000 births

Rare? You bet…especially when you consider that there are several factors that increase your baby’s risk of having this condition – they include

  • hepatitis
  • cystic fibrosis
  • chronic diarrhoea
  • bile duct atresia
  • alpha-1-antitrypsin deficiency
  • celiac disease of insufficient plasma transport capacity

It is also associated with babies whose mothers took anticonvulsant, antituberculous or anticoagulant drugs while she was pregnant. Newborns who are premature, or who have had a traumatic birth (such as forceps or vacuum extraction) are also at an increased risk of bleeding.

So you have a baby that does not have one of the above listed conditions, and you are a mother who has not taken the above listed medications….then obviously the risk of your baby having VKDB is notably LOWER than the already low rates listed above.

What if we don’t give it? The fear is that if we don’t give your baby Vit K, then s/he could have that rare VKDB condition and bleed (especially into the brain) and cause brain damage or death.
NOTE: All babies are born with lower levels of Vitamin K…so how can we call them “deficient”?

A baby’s natural Vitamin K production (since a lot of it is synthesized in the baby’s gut) doesn’t really kick in until the 8th day of life. Even then, breastfed babies almost consistently have lower levels of Vitamin K than formula fed babies as formula has such high levels of Vitamin K added to them.
ANOTHER NOTE: If you are having a boy AND you plan to circumcise your baby AND you are having a pediatrician perform the circumcision – I do not know a pediatrician in my state who will agree to perform it if the baby has not received a Vitamin K shot. A Jewish Mohel performs circumcisions on the 8th day of life according to Jewish law – coincidence that this is when the baby’s own production of Vitamin K kicks up?

What if we choose to give it? Then you have another consideration that most people don’t know about or realize – do you want to give it via injection (routine/standard) or orally? Studies have shown both delivery methods to be equally effective! Why then inject the baby? Quick, easy, don’t have to worry about baby spitting it out…?

So lets say you birth your baby in a hospital and you want your baby given Vitamin K but don’t want an injection. You mention this to the staff and they say that they don’t HAVE oral Vitamin K anywhere in the hospital, only the injectable. The injectable Vitamin K is the same as the oral – all they need to do is draw it up in the syringe, take off the needle, and squirt it into the baby’s cheek. Oral dosages tend to ‘wear off’ faster than their injectable counterparts, so it’s recommended that it be repeated later as well.

NOTE: Studies show that a mother’s diet/supplementation of Vit K prior to the birth of her baby DOES NOT effect Vitamin K levels in her newborn – suggesting that the levels in the baby are highly specific and highly regulated by the baby.

Are there risks to the Vitamin K? Here is where the true debate lies. To quote vaclib.org, “There has been some debate over the years as to whether or not HDN is actually caused by vitamin K deficiency. Certainly, giving vitamin K does arrest bleeding in the majority of cases, but this does not mean that vitamin K deficiency causes HDN. One may as well say that an antibiotic deficiency causes bacterial infection.”
There have been studies that show a NOTABLE link between Vit K and Leukemia (Vitamin K has been shown to be involved in regulating the rate of cell division in the fetus. It’s possible that abnormally high levels of vitamin K can allow cell division to get out of hand, leading to cancer) – but then there have been follow up studies that show no correlation. A question commonly asked is…if all babies are born with low Vit K levels, then isn’t there probably a REASON, whether we know it or not?

Conclusion– I’m going to make my job easy and simply point you to websites with SCADS of references and information. Below you will find some good well-researched information that should answer any questions I was unable to here.

The good news is that there’s not a huge risk either way – the bad news is that it’s not a black/white issue and so you will have to make that decision for yourself. I will fulfill my legal obligation and offer the injection to every baby I am the midwife for, but I have no problem whatsoever if a client chooses to refuse it (and, in fact, the vast majority of my clients do as the vast majority have relatively gentle births and the vast majority of them do not circumcise)

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If you would like further information than the VERY short/limited information I have provided, please visit the websites listed below. They offer EXCELLENT food for thought and are very well sourced!

http://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/ – Evidence Based Birth is a great resource

http://www.nichd.nih.gov/cochrane/puckett/review.htm – this is a GREAT source of information on some of the larger studies that have been done. Scan down about ¾ of the way and you will see the studies layed out neatly in table form for you.

http://www.vaclib.org/basic/vitamin-k.htm – thought provoking, well-done….83 different studies and papers referenced (so you see why it’s a daunting task for ME and why I prefer to simply point you to them!) I thought that this was an excellent read!!

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