From prophylactic eye ointment (in the US) to a routine physical, vaccinations and maybe even a bath, babies only hours old are subjected to a host of interventions. One procedure you may take in your stride is the routine vitamin K injection at birth, which is nearly a universal part of neonatal care.
However, research shows that most parents don’t even know why it is given, and may refuse vitamin K for newborns due to mistaken beliefs.
Learning more about the indications for the use of vitamin K at birth is crucial in making an informed choice for your baby.
What Is Vitamin K?
Vitamin K is the name given to a group of fat-soluble vitamins that are essential to blood clotting, as well as being important to bone density. Consuming dark green leafy vegetables give us the greatest proportion (about 90%) of the vitamin K in our system, with the rest coming from our gut bacteria. Because only small amounts of vitamin K are needed for blood coagulation, deficiencies are rare in adults.
Newborns, however, are naturally deficient because vitamin K doesn’t easily cross the placenta, and the infant’s immature liver isn’t efficient at using what the body does have. Because infants are not eating food sources of vitamin K, they risk being deficient enough to be at risk for serious bleeding and associated complications.
Why Is Vitamin K Important?
Once called ‘haemorrhagic disease of the newborn’, vitamin K deficiency bleeding (VKDB) is a very serious neonatal complication that can lead to brain damage or even death. It most often occurs in the week after birth, but can happen as late as 3 months of age. The risk, however, is very minimal.
According to Stanford Medical School’s ‘Guidelines for Vitamin K Prophylaxis’, “Incidence of VKDB reported varies from 1.5% to 0.001%, depending on population studied and feeding patterns.”
Early onset VKDB (in the first 24 hours of life) happens most often in infants whose mother were taking medications that inhibit vitamin K, such as blood thinners, some antibiotics, tuberculosis treatments, and anti-convulsants.
Classical VKDB (in the first week of life) is usually mild, but can lead to significant blood loss. Most often this bleeding occurs at the umbilical cord or circumcision site.
Late-onset VKDB (after the first week of life) tends to be the most damaging, with a mortality rate of 20%. Half of infants with late-onset VKDB develop bleeding in the brain, which may cause long-term brain damage.
Routine administration of vitamin K to all newborns within the first 24 hours of life has nearly eradicated VKDB.
Who Is Most At Risk?
Spontaneous bleeding happens without warning in babies with vitamin K deficiency. And often it’s not caught until after major health consequences have already happened.
Levels of vitamin K are very low in breastmilk, and no research has demonstrated that increasing maternal intake (through diet or supplementation) improves vitamin K levels in breastfeeding infants.
Suboptimal breastfeeding is a risk factor for developing VKDB. Other risk factors include instrumental delivery (forceps or vacuum/ventouse), prematurity, and maternal medications that interfere with vitamin K production or synthesis. Babies who are exclusively breastfed and whose parents have refused vitamin K prophylaxis are most at risk of late-onset VKDB.
Is Vitamin K Prophylaxis Safe?
The administration of vitamin K to all babies without indications of disease is not without controversy. Some people wonder: if vitamin K is naturally so low in newborns, why this is seen as pathologic? The fact that it’s naturally low in breastmilk only bolsters their disbelief that babies are meant to have higher levels.
Others are concerned that the injections may lead to serious complications, or may contain unwanted ingredients. The known side effects of the injection include pain, bleeding, and bruising at the injection site. A theory that the vitamin K injection causes cancer has been disproven. A preservative-free dose of injectable vitamin K is available for parents who worry about potential toxins in vaccines.
Keep in mind that you as the parent have the right to refuse any intervention when it comes to your child. An informed choice allows you to weigh up the pros and cons with the help of your healthcare professionals to make the best decision for your own family.
If you do decide to opt out of the vitamin K injection for your baby, watch for any signs of bleeding, including bruising or blood in the stool or urine. If your baby exhibits any changes in behaviour – such as listlessness, pale skin colour, irritability, poor appetite, or irritability ” check with your healthcare provider right away and be sure to mention that your baby did not receive neonatal vitamin K.
- Eventov-Friedman, S., Vinograd, O., Ben-Haim, M., Penso, S., Bar-Oz, B., & Zisk-Rony, R. Y. (2013). Parents’ Knowledge and Perceptions Regarding Vitamin K Prophylaxis in Newborns. Journal of pediatric hematology/oncology, 35(5), 409-413.
- Lippi, G., & Franchini, M. (2011). Vitamin K in neonates: facts and myths. Blood Transfusion, 9(1), 4.
- Van Winckel, M., De Bruyne, R., Van De Velde, S., & Van Biervliet, S. (2009). Vitamin K, an update for the paediatrician. European journal of pediatrics, 168(2), 127-134.