Thursday, March 24, 2011

Vitamin K at Birth

I'm here to talk about vitamin K deficiency bleeding in the newborn and its prevention. Is this a topic of general interest? Does it even concern you as a parent? Perhaps not, if your child is already two months of age or older. However, if you are expecting a baby, or have a newborn, this is something you should know about.

After birth an injection of vitamin K will be given to your baby. This routine, injected supplementation of vitamin K into the thigh muscle of a healthy newborn is extremely effective in preventing vitamin K deficiency bleeding and its resulting catastrophic effects. This practice is based upon reliable, scientific evidence that has been tested and retested over many years. I fully endorse, recommend, and request that all my patients accept the practice of providing an injection of vitamin K to newborns shortly after birth. My own children received their injection of vitamin K after birth with my full knowledge and consent. I rested easier knowing I had greatly reduced their risk of unpredictable severe hemorrhage or death due to vitamin K deficiency. I still am in awe, and filled with the wonder of a simple vitamin injection's ability to prevent such a terrible outcome.

Vitamin K deficiency bleeding in the newborn was formerly known as hemorrhagic disease of the newborn. There are several forms, which are usually described as "early" (or classic), and "late." Vitamin K deficiency can cause serious, life-threatening bleeding because vitamin K is an essential part of the blood's ability to form clots. Without vitamin K the blood will not clot properly, and the affected person will bleed excessively. Vitamin K deficiency bleeding is usually discovered when something catastrophic happens to the infant, such as bleeding into the brain (central nervous system hemorrhage).

Vitamin K deficiency bleeding has been recognized in infants for decades. In briefly reviewing the medical literature on this topic I found published articles dating as far back as the 1960s (I may have even seen the 1940's!) which deal with this topic.

The incidence (rate of occurrence) of unexpected bleeding due to vitamin K deficiency in apparently healthy neonates during the first week of life ("early") is 0.25% to 1.7% (ranging from 1 in 400 to 1 in 50 to 100 newborns). Late vitamin K deficiency bleeding (ages 2 to 12 weeks) rates have been reported from 4.4 to 7.2 per 100,000 births.

For some reason (and fairly often), there are newborns who are born deficient in vitamin K. This is discovered when they have a severe bleeding episode. These are major episodes of bleeding, such as bleeding into the brain. Although attempts have been made to correct this by giving supplements prenatally to the mother, this has not been consistently effective. Vitamin K does not cross the placenta well enough to ensure adequate vitamin K in the baby. In addition, breast milk does not reliably contain enough vitamin K to prevent vitamin K deficiency bleeding. Supplementing vitamin K to a breastfeeding mother will not consistently give enough vitamin K to prevent vitamin K deficiency bleeding. There is no readily available test that can be done on a newborn to tell if the infant is at risk for vitamin K deficiency bleeding. Obtaining a family history does not help determine if an infant is at higher risk for this condition.

The only way to be sure to reduce the risk of vitamin K deficiency bleeding in a newborn is to supplement with vitamin K. The most reliable and effective way to do this is a single injection of vitamin K shortly after birth. Oral supplementation has been presented as another option. However, the evidence shows that it is either less effective than injected vitamin K, or there is not enough evidence to be sure it is effective. Weighing the possible severe damage that can occur from vitamin K deficiency bleeding against unreliable evidence about how effective oral vitamin K will be in preventing it, it is clear that the best way to protect a newborn from early or late vitamin K deficiency bleeding is injected vitamin K.

For a while there was a flurry of concern about a possible link between injected vitamin K and childhood cancer. This evidence has been reexamined, and other studies have been done which show no association between the two. This concern has been put to rest by strong scientific evidence and should not factor into decisions regarding injections of vitamin K.

This is how I see it: A simple, small, one-time injection of a vitamin (vitamin K) into the thigh muscle of a newborn will drastically reduce the real risk of catastrophic, life-threatening, brain-damaging bleeding that can occur due to the fairly common state of vitamin K deficiency that occurs in newborns. Other methods of supplementing vitamin K have little evidence to recommend them, or have been found to be much less effective than injected vitamin K. How can we deny this simple, effective, preventative treatment to the most vulnerable and precious beings on earth, our newborns?

I have included some links which will give you a window into the world of scientific evidence on this topic.

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