Does A Newborn Need Additional Vitamin K?

(Q16 on the birthplan: Would I like my baby to be given a vitamin K injection?)

During my pregnancy with Ameli, I learned everything I could about everything pregnancy and birth related! I wrote a book full of notes, typed it all up and kept it with my birth plan so that if I had to have a justification for my decisions at any point, I’d have it on hand. I was blessed with an amazing midwife who didn’t even question my choices, so I never needed them, but here are my notes on Vitamin K… maybe you’ll find them useful. These notes formed the basis of my decision and are only intended to provide reference materials to start you off on your own research.

Vitamin K is routinely given because:

“The problem of bleeding into the brain occurs mainly from 3 to 7 weeks after birth in just over 5 out of 100,000 births (without vitamin K injections); 90% of those cases are breastfed infants because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.”Linda Folden Palmer, DC in International Chiropractic Pediatric Association Newsletter September/October 2002 Issue

Vitamin K may be needed when:

• Premature clamping of the umbilical cord deprives babies of up to 40% of their natural blood volume, including platelets and other clotting factors
• The use of vacuum extractor or forceps causes bruising or internal bleeding, which uses up the baby’s available clotting factors
• Antibiotics are used in the birth, as they inhibit the baby’s generation of clotting factors.
• C-Section

There are alternatives to a vitamin K shot:

For breastfed infants, an oral vitamin K preparation (Konakion MM) given in 3 doses of 2mg at birth, 7 days, and 30 days of life results in higher plasma vitamin K concentrations than a single injected dose at birth (although my current midwife doesn’t agree with this statement). The preparation must be Konakion MM, which contains lecithin and glycocoholic acid; vitamin K require emulsification and the presence of bile salts for its absorption.

For formula fed infants, formula contains enough vitamin K that no supplement should be necessary.

Arguments against the routine use of vitamin K – three main observations (Falcao):

Nature seems to go to a lot of trouble in regulating the baby’s vitamin K levels: the level at birth gradually rises over the eight days following birth to a higher level. It is almost as if nature very specifically wants the baby to have a specific level of clotting factors at birth, followed by a higher level of clotting factors a week after the birth.

This may be related to the fact that in a physiological birth, where the baby gets all the blood from the placenta, the baby’s blood is a little thicker; this is especially true in the 72 hours following birth, since the babies naturally become a little dehydrated until the mother’s milk changes to a higher volume flow, so the blood is thicker.

There has been some association between vitamin K injection and childhood leukaemia. (Parker) Theoretical observations are that precise levels of vitamin K are required to regulate the rate of cell division in newborns and that excessive levels of vitamin K disrupt this regulatory process, thus increasing the possibility of leukaemia and other childhood cancers. (While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely^1,2.The most current analysis of six different studies suggests it is a 10% or 20% increased risk. This is still a significant number of avoidable cancers.³)

Follow up research indicated that the leukaemia might have been related to mercury used to preserve the vitamin K solution. Further research in 2003 found that there was no definitive link between childhood leukaemia and Vitamin K, but also that ‘small effects cannot be ruled out’.

Research shows that babies who contract meningitis are more likely to die if they have higher clotting factors. It’s not clear whether this is due to genetic factors or whether it applies to all babies who receive vitamin K. ( I can’t find any actual links to this research, despite it being mentioned all over the web!)

The warning label on Vitamin K injections is pretty scary too:

Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of Phytonadione. Typically these severe reactions have resembled hypersensitivity or anaphylaxis, including shock and cardiac and/or respiratory arrest. Some patients have exhibited these severe reactions on receiving Phytonadione for the first time. The majority of these reported events occurred following intravenous administration, even when precautions have been taken to dilute the Phytonadione and to avoid rapid infusion. Therefore, the INTRAVENOUS route should be restricted to those situations where another route is not feasible and the increased risk involved is considered justified.

Dangers of excess Vitamin K:

When a baby is born gently, without any intervention, antibiotic, or trauma, and no apparent bruising, and is breastfed, there is no need for Vitamin K. Administering vitamin K to these babies – especially if they are formula fed – can lead to excess Vitamin K, which in turn may lead to newborn jaundice.

Signs Suggesting Need for Vitamin K after birth:

• bleeding from the umbilicus, nose, mouth, ears, urinary tract or rectum
• any bruise not related to a known trauma
• pinpoint bruises called petechiae
• black tarry stools after meconium has already been expelled
• black vomit
• bleeding longer than 6 minutes from a blood sampling site even after there has been pressure on the wound
• symptoms of intracranial bleeding including paleness, glassy eyed look, irritability or high pitched crying, loss of appetite, vomiting, fever, prolonged jaundice.

(This list is written by Jennifer Enoch. Midwifery Today. Issue 40.)

Natural alternatives:

Keep the umbilical cord attached until it stops pulsing. Do not cut it prematurely, as average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. (As Vitamin K doesn’t cross the placenta, this should make no difference to Vit K levels, but will help with iron levels etc.)

When breastfeeding (or just before starting), make sure to eat plenty of leafy greens or take a vitamin K supplement – vitamin K does not cross the planceta in pregnancy, but does enter breast milk in feeding. Anti-acids (used for heartburn) decrease the absorption of Vitamin K in the body – bare this in mind if you have lots of indigestion during pregnancy and be sure to increase with Vitamin K intake from around 38 weeks of pregnancy, as this will help prevent against haemorrhaging too.

Nettles are rich in Vitamin K – made into a tea you’ll get everything you need. Otherwise try a Nettle soup.

Conclusion:

My conclusion on this sensitive matter, based on the information available to the public and its potential impact on my own family, is thus:

Nature says a baby doesn’t need large amounts of Vitamin K, but that delayed cord clamping and the transfer of oxygenated blood gives the child enough resources to cope with the effects of a ‘normal’ birth. If the mother has been consuming Vitamin K in some form or another, it will immediately begin transferring through her colostrum, which is rich in Vitamin K and breastmilk and by eight days of age, baby will have the ‘right’ amount of Vitamin K (and since formula is fortified with vitamin K, formula fed babies shouldn’t require it at all) – since the disease it is meant to prevent doesn’t tend to occur until between 3 and 7 weeks I personally question the need for the injection.

At the same time, bleeding kills almost 2 in 10,000 babies, and this is the closest I could find to statistics as to deaths from the injections ** although we know that they have occurred. It says so on the label.  So really, the conclusion is inconclusive.

Every parent has to make their own decisions on this, but for me and mine, we’ve decided against vitamin K injections unless something in the birth necessitates it. We’ve also decided to follow natural alternatives, such as breastfeeding and a high maternal Vitamin K intake and to keep a close eye on the signs of bleeding as described above. 

** The FDA database contained a total of 2236 adverse drug reactions reported in 1019 patients receiving vitamin K by all routes of administration. Of the 192 patients with reactions reported for intravenous vitamin K, 132 patients (69%%) had a reaction defined as anaphylactoid, with 24 fatalities (18%%) attributed to the vitamin K reaction. There were 21 patients with anaphylactoid reactions and 4 fatalities reported with doses of intravenous vitamin K of less than 5[emsp4 ]mgs. For the 217 patients with reactions reported due to vitamin K via a non-intravenous route of administration, 38 patients had reactions meeting the definition of anaphylactoid (18%%), with 1 fatality (3%%) attributed to the drug.

References:

^{L. Parker et al., “Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study,” BMJ (England) 316, no. 7126 (Jan 1998): 189-93.}

^{S.J. Passmore et al., “Case-control studies of relation between childhood cancer and neonatal vitamin K administration,” BMJ (England) 316, no. 7126 (Jan 1998): 178-84.}

^{E. Roman et al., “Vitamin K and childhood cancer: analysis of individual patient data from six case-control studies,” Br J Cancer (England) 86, no. 1 (Jan 2002): 63-9}

Further Reading: 

• Points to Ponder on Routine Injections (of vitamin K)
• Vitamin K for neonates: the controversy (BMJ 1994)
• Any of the links above!