Both newborn babies and breast milk are said to be deficient in vitamin K1, and injection of this vitamin into newborns is standard practice in US hospitals. The diagnosis of vitamin K deficiency for newborns, however, is in comparison with adult levels and that of breast milk by comparison of human milk with cow`s milk. There are numerous biological differences between adults and babies (bodily proportions is one example), and these are not considered pathological. Do the differences in vitamin K levels suggest pathology? There are also, obviously, biological differences between human and cow`s milk. Our standard for normal breast milk should not come from comparisons with another species. Perhaps these low vitamin K levels are optimum vitamin K levels for babies. If so, systematic injection of newborns with almost 9000 times the adult level might be questionable as standard practice.
Nevertheless, this injection is life-saving in some instances. One in 20,000 babies will suffer from Hemorrhagic Disease of the Newborn (HDN), where internal bleeding can cause brain damage or death. This bleeding can be stopped or prevented entirely by the vitamin K injection, which enhances blood clotting. But as the name implies, the cause of Hemorrhagic Disease of the Newborn is not clear.
Vitamin K deficiency is often cited as the cause, but the claim seems inadequate, almost like claiming that aspirin deficiency causes headaches. That is not to say that aspirin, or the vitamin K shot, should never be used. Causes of HDN are more likely to be found among the risk factors which include the following:
*exposure of the baby or fetus to drugs or alcohol or anticonvulsants, antibiotics or anticoagulants
*a family history of liver disease
*diseases in the baby such as hepatitis, cystic fibrosis or celiac disease
*a difficult birth such as one including the use of vacuum extractor, forceps or c-section
*low birth weight
*premature clamping/cutting of the umbilical cord
If any of these factors applies to you or your baby, you might want to seriously consider the shot. Oral supplementation is also an option but must to be done according to a specific protocol to be effective – to learn the specifics of this protocol, discuss it with your obstetrician or midwife.
The observation that natural levels of vitamin K are low in babies and that vitamin K does not pass into the placenta suggests that our physiologies are fine tuned to keep this vitamin low initially. What does the injection of a high dose of a synthetic form of this vitamin into babies do? One concern is the increased risk of severe jaundice with the vitamin K shot for which there is anecdotal evidence. More worrisome is a possible association with leukemia, plausible because vitamin K1 is also involved in the regulation of cell division. Early studies found such a risk, but the most recent found no correlation between the shot and the likelihood of developing leukemia, clearing the shot on that charge for the moment.
Eating foods high in vitamin K1, such as leafy green vegetables, deep yellow vegetables, and broccoli, among others, should be helpful, because vitamin K is passed from mom to baby in breast milk. Be sure to breast feed on cue and to allow the baby to nurse as long as preferred on each breast so as to ensure that she receives the higher fat `hind milk` which will be higher in vitamin K. Vernix, the milky white substance covering baby at birth, is also a high in vitamin K, so parents may want to consider allowing this substance to be absorbed by their baby rather than washed off.
Also, wait! Immediate clamping or cutting of the umbilical cord results in a loss of up to 40% of the baby`s blood volume. Valuable platelets and coagulation factors are also lost. Indeed, a 2006 study in the journal Pediatrics showed that in low birth weight babies (less than 3 pounds 5 ounces and born before week 32) a delay of 35-40 seconds allowed an 8 to 24% increase in the baby`s blood volume compared to those with their cords clamped at 5-10 seconds. Two of the 23 male infants (about 9%) in the delayed-clamping group suffered from brain hemorrhaging while 8 of the 19 (42%) in the immediate-clamping group did. How much better off might they have been if the delay had been two or three minutes instead of 40 seconds?
Early cord clamping may partially explain the association between traumatic birth and HDN as well: forceps and vacuum births often cause bruising or internal bleeding, which uses up the baby`s available clotting factors; then baby is immediately cut off from his blood and oxygen source (the placenta) in order to be rushed off for resuscitation. In any of these events, as in normal births, delayed clamping ought to be standard practice.
None of the above is meant to minimize the reality of HDN. No matter what your decision is about the vitamin K shot, be sure to be vigilant about certain symptoms; late onset HDN can occur into the sixth week of life. Here are problems to look out for:
*bleeding longer than 6 minutes from a blood sampling site even after there has been pressure on the wound
*similar bleeding from the umbilicus, nose, mouth, ears, urinary tract or rectum and broken skin sites
*any bruise not related to a known trauma
*pinpoint bruises called petechiae
*black tarry stools after meconium has been expelled
*symptoms of intracranial bleeding including paleness, a glassy eyed look, irritability or high pitched crying, loss of appetite, vomiting, fever, or prolonged jaundice
Unfortunately, in about 1/3 of cases, hemorrhage occurs without prior warning.
Ultimately, whether or not to have this shot administered is a decision for parents. Plan your birth and post-partum carefully; Do you want the vitamin K shot or do you want to waive the shot? Do you want the vernix to remain on your baby? Do you want delayed cord clamping? Be sure to call your hospital, even if you`re planning a home birth, and ask their policy on these procedures. It is a good idea to have these plans in writing before your baby`s birth.
Roman, E. et al., (2002). Vitamin K and childhood cancer: analysis of individual patient data from six case-control studies, Br J Cancer (England) 86: 63-9.
Fear, N.T. et al., (2003). Vitamin K and childhood cancer: a report from the United Kingdom Childhood Cancer Study. Br. J. Cancer (England) 89: 1228-1231.
McNinch, A. et. al., (1985). Plasma concentrations after oral or intramuscular vitamin K1 in neonates. Arch Dis Child 60: 814-818.
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