Newborn Vit K Shot
Whether to give a newborn a Vit K shot or not is a topic of interest to many of you as it keeps cropping up on a regular basis. I wanted to give a brief summary of the “what, why, where, how?” of Vit K then you make up your own mind. Frankly, this is still a free country, no?
We hear quite a stir when a baby who does not get Vit K shot ends up in the ICU with a brain bleed. The risk of this happening in this sort of situation is around 1 chance in 20,000 deliveries. In contrast is the baby who does get the Vit K shot right at birth where the risk is 1 in a million deliveries. In between somewhere is the infant who gets a single oral dose of Vit K where the risk is around 1 in 70,000. Interestingly, if given a dose weekly for three months, the risk is very close to that of the single shot at birth. So, keep these numbers in mind when decision-making.
So what is this Vit K issue about anyway? This Vitamin is used by the body to assist in blood clotting. Without this, a person can develop spontaneous bleeding. In our everyday lives, we get Vit K from our food. It does not take much to keep our blood clotting appropriately. However, the newborn does not have the luxury of eating Vit K – rich foods like dark leafy greens, broccoli, asparagus, nuts, olive oil, etc. The second source for non-infants is normal gut flora. For formula – fed infants, Vit K is fortified into the formula. For nursing infants, the breast milk supply is not nearly enough to sustain good clotting in those first months of life. So goes the argument, anyway.
One hundred years ago, this deficiency was discovered when testing revealed a much lower level of blood clotting factors in newborns. Certainly some of the practices back then of forceps delivery and early circumcisions with their added stressors contributed to interest in the increased bleeding rates. The solution was to give a vit K shot to boost that part of liver function. The career of Vit K was an up and down proposition. Initially it was given orally. This fell into disfavor when it appeared to cause increased jaundice and hemolytic anemia (breakage of red cells), at least by the particular type of vit K used. The shot then gained favor until the 1990s. This practice was shaken a bit with a study that appeared to link this vit K shot with childhood leukemia. So the oral form started gaining traction again. Here in the States, the shot has remained due to the expense and lack of interest in doing studies to see what form, if any, is best. Other countries such as Denmark continue to use the oral form of Vit K1 with good outcomes comparable to the shots done in this country. The problem is that there is no FDA approved oral form in the US. We really do make an educated guess when we use oral Vit K due to lack of US studies using US products. We can use the Danish data but we do not have access to their vit K brand. Hence the bit of dilemma.
There are two types of potential consequences for this Vit K deficiency in newborns. The first is the classic Hemorrhagic Disease of the Newborn which occurs in the first week of life. It seems to be manifest in infants with traumatic deliveries such as vacuum extractions. The second is the late onset Hemorrhagic Disease which can occur anywhere from week 1 to month six. This is the main focus for giving the Vit K shot. There is one other that occurs in the first few hours of life and is related to other factors such as medications that mom is taking during pregnancy and labor such as anticonvulsants. We are not primarily dealing with this set of bleeders. Interestingly, the cause of bleeding in up to 60% of these late bleeders is some undiagnosed metabolic issue such as biliary atresia, alpha-1 antitrypsin deficiency, cystic fibrosis, etc. and not primarily Vit K deficiency.
n our previous Facebook threads, arguments were put forth about the “unnatural” nature of these vit K shots. This, frankly, is also true for the oral dose. Surely babies are born with the correct amount of Vit K for their needs. There does appear to be some evidence that higher vit K may stimulate cancer cell proliferation. There is also the argument that it takes about a week for the newborn gut to colonize with an adequate number of bacteria that then can start producing Vit K2. Certainly there are complex genetic factors that puts the rare infant at risk for bleeding and we do not have any way with our current technology to predict who will get into trouble, so…… we give a shot to every baby. You may disagree with the philosophy of this approach. It is one from the “public health” perspective. You are the mother and father of your one child at the moment and need to do decision making for that one child. It is a bit of a different perspective for sure. Everything we do in life follows a risk/benefit analysis. We get into our car and drive daily knowing full well that there is a defined statistic of highway deaths. We choose to take that risk.
So, what to do? I certainly cannot advise other than the Vit K shot at birth because that is the standard of care and if your child died due to a brain bleed after I advised you not to give your baby the vit K shot, your attorney would be after me faster than a lightning bolt! You still have a choice. If you choose to give the oral form, just know that we do not have an FDA approved form in the US and the best we can come up with is the product which is linked below. Following the Danish experience and studies, you give 2 mg the first dose (4 drops) then follow up with 2 drops weekly, or 1 mg per dose, for the first 3 months of life. The particular product is the Biotics Research Vit K1 with concentration of ½ mg (same as 500 micrograms) per drop.
Some of the concerns parents give for worry are the other ingredients such as polysorbate-80, propylene glycol, glacial acetic acid, etc. These have generally been classified as safe in the doses used. As we get more savvy with genomics, we are starting to realize that there are those genetically vulnerable kids that make have a bit higher risk for reacting to these. Nevertheless, given our current state of knowledge, the risk is still small.