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Newborn Vitamin K Injections

What is it?

In the United States, the practice of newborn vitamin k injections has become almost universal.  However, this routine newborn procedure is unique to the US and is controversial in other nations.  This practice was born (pun intended) during the hospital age of routine separation of mothers from their babes, before rooming-in was an accepted practice. 

Why is this done?

The rationale for newborn vitamin K  injection at birth is that newborns are born with a "deficiency" of vitamin K. This perceived "deficiency" can lead to decreased clotting ability of the blood, that can leave the newborn more susceptible to hemorrhage.  The risk is quite small, only about 1 in 200, but it does exist.  The following factors increase risk of hemorrhage in newborns:

Risk Factors for Cerebral Hemorrhage

• Precipitous Labor
• Prolonged Labor
• Significant Fetal Head Molding
• Birth Trauma
• Forceps Delivery
• Vacuum Extraction
• Variable Heart Decelerations in Late Labor
• Circumcision
  

Points to Ponder on Routine Injection

While newborn vitamin K  injection may sound like an acceptable intervention, there are several points to ponder.  

The amount of Vit K injected is 20,000 times the needed dose.  Yes, I kid you not.  20,000 times.  Additionally, the injection may also contain preservatives which are known toxins to the infant.

1.  Large doses of Vit K are a cause of jaundice in the newborn.  A "cure" for one perceived ailment then becomes the cause of another.  

2. Colostrum, which precedes breastmilk, is rich in Vit K.  Thus, an infant who is breastfed immediately at birth will receive a natural source of Vit K, in most cases significantly raising the Vit K level.

3. Vit K is typically designed to be absorbed by the gut from foods we eat.  However, the injection is an intramuscular one, which bypasses the gut and delivers the Vit K in a way the body wasn't designed to receive.

4. Birth is an overwhelming sensory experience for the baby - it has never before been cold, hungry, been blinded by light, felt the touch of cloth or the pull of gravity.  Sticking a needle into its body and inflicting pain isn't the best way to allow the sensory system to gradually adjust to the outside world.  Not a very warm welcome, is it?

5.  Subconsciously, it sends the message that nature is inadequate, that medical interventions are are necessary to save us from ourselves.

Simple Solutions

1. Request an oral dose rather than an injection.
   
   This eliminates the overdose and lessens the risk of hemorrhage and jaundice, as well as the pain of the injection and exposure to harmful preservatives.  Also, the Vit K is absorbed through the gut, as it was intended to be.  While this may seem like an easy solution, be sure to discuss this option first with your care provider.  Since hospitals are accustomed to standard operating procedure, it can be difficult for them to correctly determine the oral dosage for your infant.  We personally had to wait for several hours while the correct dose was determined.  To give the hospital the benefit of the doubt here, our daughter was born on a weekend, which means that less staff is available and even simple procedures take longer than usual.
   
   

2. Nurse immediately after the birth with no supplementation given.
   
   

3. During the last few weeks of pregnancy, load your diet with foods rich in Vit K.
   
   While this hasn't been shown to improve newborn vitamin  K levels, it has been shown to increase the amount of Vit K in breastmilk.  

By following these simple solutions, you can receive the benefits of an accurate newborn vitamin K dose while avoiding all the negatives of an injection.  It's too easy a solution for the medical establishment to consider it.

For references: Read more: http://www.givingbirthnaturally.com/newborn-vitamin-k.html#ixzz0ND486wK1

 4 days old

Reprinted from the International Chiropractic Pediatric Association Newsletter, September/October 2002 Issue

UPDATED May 19, 2004

by Linda Folden Palmer, DC (http://babyreference.com)

Newborn infants routinely receive a vitamin K shot after birth in order to prevent (or slow) a rare problem of bleeding into the brain weeks after birth. Vitamin K promotes blood clotting. The fetus has low levels of vitamin K as well as other factors needed in clotting. The body maintains these levels very precisely.(1) Supplementation of vitamin K to the pregnant mother does not change the K status of the fetus, confirming the importance of its specific levels.

Toward the end of gestation, the fetus begins developing some of the other clotting factors, developing two key factors just before term birth.(2) It has recently been shown that this tight regulation of vitamin K levels helps control the rate of rapid cell division during fetal development. Apparently, high levels of vitamin K can allow cell division to get out of hand, leading to cancer.

What's the Concern?

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 (3) because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.

The cause of this bleeding trauma is generally liver disease that has not been detected until the bleeding occurs. Several liver problems can reduce the liver's ability to make blood-clotting factors out of vitamin K; therefore extra K helps this situation. Infants exposed to drugs or alcohol through any means are especially at risk, and those from mothers on anti-epileptic medications are at very high risk and need special attention.

Such complications reduce the effectiveness of vitamin K, and in these cases, a higher level of available K could prevent the tragic intracranial bleeding. This rare bleeding disorder has been found to be highly preventable by a large-dose injection of vitamin K at birth.

The downside of this practice however is a possibly 80% increased risk of developing childhood leukemia. While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely.(4,5) 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.(6)

Apparently the cell division that continues to be quite rapid after birth continues to depend on precise amounts of vitamin K to proceed at the proper rate. Introduction of levels that are 20,000 times the newborn level, the amount usually injected, can have devastating consequences.

The Newborn's Diet

Nursing raises the infant's vitamin K levels very gradually after birth so that no de-regulation occurs that would encourage leukemia development. Additionally, the clotting system of the healthy newborn is well planned, and healthy breastfed infants do not suffer bleeding complications, even without any supplementation.(7)

While breastfed infants demonstrate lower blood levels of vitamin K than the "recommended" amount, they show no signs of vitamin K deficiency (leading one to wonder where the "recommended" level for infants came from). But with vitamin K injections at birth, harmful consequences of some rare disorders can be averted.

Infant formulas are supplemented with high levels of vitamin K, generally sufficient to prevent intracranial bleeding in the case of a liver disorder and in some other rare bleeding disorders. Although formula feeding is seen to increase overall childhood cancer rates by 80%, this is likely not related to the added vitamin K.

The Numbers

Extracting data from available literature reveals that there are 1.5 extra cases of leukemia per 100,000 children due to vitamin K injections, and 1.8 more permanent injuries or deaths per 100,000 due to brain bleeding without injections. Adding the risk of infection or damage from the injections, including a local skin disease called "scleroderma" that is seen rarely with K injections (8), and even adding the possibility of healthy survival from leukemia, the scales remain tipped toward breastfed infants receiving a prophylactic vitamin K supplementation. However, there are better options than the .5 or 1 milligram injections typically given to newborns.

A Better Solution

The breastfed infant can be supplemented with several low oral doses of liquid vitamin K9 (possibly 200 micrograms per week for 5 weeks, totaling 1 milligram, even more gradual introduction may be better). Alternatively, the nursing mother can take vitamin K supplements daily or twice weekly for 10 weeks. (Supplementation of the pregnant mother does not alter fetal levels but supplementation of the nursing mother does increase breast milk and infant levels.)

Either of these provides a much safer rate of vitamin K supplementation. Maternal supplementation of 2.5 mg per day, recommended by one author, provides a higher level of vitamin K through breast milk than does formula (10), and may be much more than necessary.

Formula provides 10 times the U.S. recommended daily allowance," and this RDA is about 2 times the level in unsupplemented human milk. One milligram per day for 10 weeks for mother provides a cumulative extra 1 milligram to her infant over the important period and seems reasonable. Neither mother nor infant require supplementation if the infant is injected at birth. (11)

The Bottom Line

There is no overwhelming reason to discontinue this routine prophylactic injection for breastfed infants. Providing information about alternatives to allow informed parents to refuse would be reasonable. These parents may then decide to provide some gradual supplementation, or, for an entirely healthy term infant, they may simply provide diligent watchfulness for any signs of jaundice (yellowing of eyes or skin) or easy bleeding.

There appears to be no harm in supplementing this vitamin in a gradual manner however. Currently, injections are provided to infants intended for formula feeding as well, although there appears to be no need as formula provides good gradual supplementation. Discontinuing routine injections for this group alone could reduce cases of leukemia.

One more curious look at childhood leukemia is the finding that when any nation lowers its rate of infant deaths, their rate of childhood leukemia increases.(12) Vitamin K injections may be responsible for some part of this number, but other factors are surely involved, about which we can only speculate.

Note from Ben Kim: To learn more about Dr. Linda Folden Palmer and her work, please visit: BabyReference.com.

Notes

1. L.G. Israels et al., "The riddle of vitamin K1 deficit in the newborn," Semin Perinatol 21, no. 1 (Feb 1997): 90-6.

2. P. Reverdiau-Moalic et al., "Evolution of blood coagulation activators and inhibitors in the healthy human fetus," Blood (France) 88, no. 3 (Aug 1996): 900-6.

3. A.H. Sutor et al., "Late form of vitamin K deficiency bleeding in Germany," Klin Padiatr (Germany) 207, no. 3 (May-Jun 1995): 89-97.

4. 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.

5. 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.

6. 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.

7. M. Andrew, "The relevance of developmental hemostasis to hemorrhagic disorders of newborns," Semin Perinatol 21, no. 1 (Feb 1997): 70-85.

8. E. Bourrat et al., "[Scleroderma-like patch on the thigh in infants after vitamin K injection at birth: six observations]," Ann Dermatol Venereol (France) 123, no. 10 (1996): 634-8.

9. A.H. Sutor, "Vitamin K deficiency bleeding in infants and children," Semin Thromb Hemost (Germany) 21, no. 3 (1995): 317-29.

10. S. Bolisetty, "Vitamin K in preterm breast milk with maternal supplementation," Acta Paediatr (Australia) 87, no. 9 (Sep 1998): 960-2.

11. K. Hogenbirk et al., "The effect of formula versus breast feeding and exogenous vitamin K1 supplementation on circulating levels of vitamin K1 and vitamin K-dependent clotting factors in newborns," Eur J Pediatr 152, no. 1 (Jan 1993): 72-4.

12. A. Stewart, "Etiology of childhood leukemia: a possible alternative to the Greaves hypothesis," Leuk Res (England) 14, nos. 11-12 (1990): 937-9.

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