20150905 vitamin K

With the birth of my last child, I was given a two page questionnaire to fill out when we pre-registered for the hospital.  On this “birth plan,” I was asked about my preference for everything from medications, to music I wanted to be played in the labor room, to if I wanted mirrors strategically placed for delivery.  And once your baby arrives, the choices keep on coming.  Do you want to breastfeed?  How about circumcision for boys?  Will you sign the consent form for the Hepatitis B vaccine?  There are many blogs and websites out there that discuss all of these options for newborns, and in recent years, there has been a barrage of sites encouraging moms to decline many of the interventions once viewed as “standard.”  But as a pediatrician, there is one thing I beg of you to not even consider refusing…a single dose injection of vitamin K.

Vitamin K is one of the fat soluble vitamins that is vital for our blood to clot or stop bleeding appropriately.  Vitamin K can be found in foods including green, leafy vegetables, and it is also made by the good bacteria that live in our gut.  However, for newborns, they are not born with the appropriate levels of vitamin K.  You see, vitamin K does not transfer from mommies to their babies very well while in utero or through breast milk for that matter.  Also, those good bacteria that live in the gut that produce Vitamin K are not really present in the newborn, and last time I checked, newborns are not chomping down on kale and spinach leaves!

“This single injection can provide the appropriate levels of vitamin K to protect the newborn from all forms of VKDB.”

So what happens if your newborn doesn’t have the correct levels of vitamin K?  The greatest concern is something called Vitamin K deficiency bleeding (VKDB), previously known as hemorrhagic disease of the newborn, which means that infants can start bleeding from places like their umbilical cord, inside their intestines, around the circumcision site in males, and most worrisome, in the brain.  This bleeding can begin suddenly, and it can start within hours of birth (early onset), during the first week of life (classic onset), or even up to 6 months after birth (late onset).  For all of these reason, in 1961 the American Academy of Pediatrics made the recommendation that all newborns should receive a single shot of vitamin K shortly after birth.  This single injection can provide the appropriate levels of vitamin K to protect the newborn from all forms of VKDB.

“…so having a version of vitamin K that does not provide protection from late onset VKDB, in my mind, is really not an acceptable option at all.”

Many of the sites that encourage declining the vitamin K injection suggest that newborns can receive oral vitamin K doses instead of the shot and have the same protection from VKDB.  However, what is not explained on these sites is that while oral vitamin K may provide adequate vitamin K levels in the short-term (i.e. eliminate the risk for early onset or classic VKDB), these oral doses do not appear to protect newborns from late onset of the disease.  Also, there is no FDA approved oral vitamin K available here in the US (other countries do have licensed and regulated oral versions of vitamin K).  Finally, there are questions about how well infants can absorb vitamin K through the GI tract.  For those infants who have late onset VKDB, it is often very severe leading to at least 50% of infants having bleeding in the brain and up to a 20% mortality rate, so having a version of vitamin K that does not provide protection from late onset VKDB, in my mind, is really not an acceptable option at all.

When I see websites that recommend against the vitamin K injection, I often find the site make reference to a newspaper article from 1990 out of Great Britain that claimed that researchers found a link between vitamin K injection and childhood leukemia.  As you can imagine, such a claim brought routine vitamin K injections to a halt and prompted immediate research into the possibility of such as link.  Over the next 20 years, many studies have been done including two high quality, large studies from 2002 and 2003 that, combined, included more than 15,000 children, and these studies found that there was no link between vitamin K injection in newborns and childhood leukemia or any other kind of cancer.  

When parents tell me they want to refuse the vitamin K shot because they read on the internet that this shot is just “not natural” and babies really don’t need it, you can probably imagine the immediate pang of fear that comes over me.  Fear for the health of their newborn as bleeding into the brain is just not an acceptable option in my opinion.   If you are considering declining the vitamin K injection after the birth of your child, please take the time to discuss this with your pediatrician first.  What may seem routine and just another injection newborns get is of vital importance to prevent a very serious and real disease.  If you would like to read a bit more in depth about the evidence behind vitamin K injection in the newborn, click here to read a great summary article.