Newborn birth procedures: Vitamin K

When it comes to post birth procedures the world seems to be divided into two. Those who have everything blindly and those who reject everything equally blindly. Both are equally wrong, birth and the first three months afterwards can be a dangerous time for both mother and baby and medical science has done a lot to make that safer. On the flip side, post-birth procedures for a healthy birth are done on a population level and sometimes don't have a lot of evidence behind them. They usually cause no harm but in a period of time where you will be feeling particularly vulnerable it is best to inform yourself.
The attempt to inform yourself, however, will bring zealots on both sides and for many of those procedures it can be tricky to find impartial information. Vitamin K injections are one such procedures.

What is it?
Vitamin K is a group of fat soluble vitamins which are vital in many body processes incluidng blood clotting. Vitamin K deficiency in adults is extremely rare and only occurs in conjunction with other serious diseases. However due to the small amount of vitamin K stores in the baby and relatively low levels of vitamin K in breastmilk it is more common in babies up to the age of 3 months. Vitamin K deficiency in a newborn results in a rare but life threatening condition known as Vitamin K deficiency related bleeding (VKDB). It is now considered that there is a reason why these newborn develop vitamin K deficiency related bleeding such as liver problem.  In order to prevent this a synthetic form of vitamin K1 is offered to all newborns at birth. This is usually provided via a vitamin K injection although oral supplementation is usually available.

What condition is it preventing?
There are three different forms of vitamin K deficiency related bleeding

  • Early: 
    • Presents within 24 hours of birth
    • Exclusively seen in babies who's mothers are taking medications that inhibit vitamin K
    • Clinical presentation is severe with bleeding into the brain and the abdomen
    • Occurs in 6- 12% of babies whose mothers are taking vitamin K inhibiting drugs and do not receive vitamin K supplementation
  • Classical
    •  Occurs between 1 and 7 days of birth
    • More likely in babies whose feeding is delayed or insufficient
    • Presentation is usually mild but there can be significant blood loss and bleeding into the brain
    • Occurs in up to 0.44% of newborns with vitamin K supplementation
  • Late
    • Occurs between 2 weeks and 12 weeks
    • Most common in babies who are exclusively breastfeeding
    • Presentation is severe with a 20% mortality rate and 50% suffering bleeding in the brain 
    • Babies who survive often have neurological damage
    • Occurs in between 1 in 15000 and 1 in 20 000 babies.

Why do people reject it?
Vitamin K deficiency is a result of medical interventions at birth.
    Partially true. Interventions such as circumcision on a newborn and delaying early breastfeeding are considered to increase the risk for vitamin K deficiency related bleeding. However cases of vitamin K deficiency related bleeding have occurred in families who home birthed and had no medical intervention at birth.
Babies can get sufficient vitamin K from breast milk if you eat properly
   Partially true. There certainly is a nutrition aspect to vitamin K excretion in breast milk and levels currently are about 4 times higher than they were before the vitamin K injection was implemented. However babies who get vitamin K deficiency related bleeding often have a small intake of breast milk that may not be apparent or have some other issue that limit their absorption of vitamin K. Almost all cases of vitamin K deficiency related bleeding since implementation of the injection have occurred in babies who were exclusively breastfeeding.
Side effects: Cancer
  False: There was some poorly done research 15 years ago that suggested that vitamin K injections cause cancer. This is biochemically implausible and there has been no new evidence to support it in the last 15 years.
Pain in newborn
   True but....  A short period of pain in a newborn baby is not associated with any psychological damage. Those suggesting it is are conflating damage known to occur due to ongoing pain such as a premature baby being placed on a respirator without sufficient pain relief. If you really wish to avoid the distress associated with the injection, you can try some of the proven techniques for lowering pain association with vaccination.
Side effects: Vitamin K levels too high
   True but.... Babies who receive the intramuscular injection, particularly those who are preterm, do end up with vitamin K levels a hundred times greater than those seem in adults. However there is no evidence to link this to any harm.

What about the oral dosage?
Well its tricky. For one thing unlike the injection which is a standard dosage, oral vitamin K has a highly variable dosage with medical centers varying widely in the dose, how many oral doses are offered and the timing of these doses.  Although this has improved a little in recent years, it is still less than ideal.
If you are choosing to have your child get the oral dose there are some best practice guidelines to follow. The studies which have investigated it have found the best results when 1 mg a week is offered from birth until 3 months of age. Some babies on lower doses of oral vitamin K have suffered from vitamin K deficiency related bleeding.
Vitamin K is best absorbed when combined with fat so it should be offered in combination with breast milk or formula for improved absorption.



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