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Vitamin K
Vitamin K
The "Vitamin K Shot" is a shot given to all newborns (unless the parents decline it). The idea is that since all babies are born with low vitamin K, and vitamin K is what's needed to help blood to clot, then giving a shot of it to the newborn will help prevent Vitamin K Deficient Bleeding (VKDB).
The American Academy of Pediatrics recommends that all newborns, whether breastfed or formula fed, receive a one-time intramuscular shot of vitamin K within 6 hours after birth. Nurses will typically administer the shot within the first hour, though. (CDC)
Risks of VKDB
Risks of VKDB
Internal Bleeding: this can include the brain, gastrointestinal tract, or other organs, which can be life-threatening.
Brain Damage: Intracranial hemorrhage (bleeding in the brain) is a serious complication of VKDB and can lead to developmental delays, seizures, or other neurological damage
Death: In severe cases, VKDB can be fatal.
Long-term Effects: VKDB can have long-term consequences, including developmental delays or other neurological issues, according to the National Institutes of Health (NIH).
https://pmc.ncbi.nlm.nih.gov/articles/PMC7041551/
Vitamin K and VKDB Facts
Vitamin K and VKDB Facts
VKDB is rare. (WHO 2018) (AAP 2003)
How rare?
How rare?
Without prophylaxis:
Classic VKDB occurs in about 0.25% - 1.7% of newborns
Late VKDB occurs in about 0.00004% - 0.0008% of babies
More Facts
More Facts
In order to absorb vitamin k, you have to have a functioning biliary and pancreas system. The infant's digestive system isn’t fully developed at birth which is why we give breastmilk and delay solids until about 6 months old. Too much vitamin k can tax the liver and cause brain damage (some of the reasons why low vitamin k levels at birth make more sense)
Cord blood contains stem cells, which protect a baby against bleeding and perform all kinds of needed repairs inside an infant's body. In order to get all these protective boosts, cord cutting has to be delayed until the cord turns white and blood needs to remain thin so stem cells can easily travel and perform their functions. So, babies have their own God-given design protective mechanism to prevent bleeding and repair damaged organs
Infants intestines are not yet colonized with bacteria needed to fully synthesize vitamin k. So, bypassing the gut and going straight into the muscle should help avoid this issue right? Except a baby's kidneys and liver aren't fully functional, either
Vitamin K Injection
Vitamin K Injection
Links to the FDA injection package insert:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/012223s042lbl.pdf
https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/012223orig1s039lbl.pdf
It has a black box warning:
"WARNING – HYPERSENSITIVITY REACTIONS WITH INTRAVENOUS AND INTRAMUSCULAR USE See full prescribing information for complete boxed warning. Fatal hypersensitivity reactions, including anaphylaxis, have occurred during and immediately after INTRAVENOUS and INTRAMUSCULAR injection of AquaMEPHYTON. Reactions have occurred despite dilution to avoid rapid infusion and upon first and subsequent doses. Avoid the intravenous and intramuscular routes of administration unless the subcutaneous route is not feasible and the serious risk is justified (5.1)"
For more information, please visit https://justtheinserts.com/vitamin-k/ for a reader-friendly explanation of the drug, its ingredients, its dosage, and listed adverse reactions.
Chances of VKDB is higher for newborns whose mother took anticonvulsants or certain antibiotics
The History of the Vitamin K Shot
The History of the Vitamin K Shot
Home births were very common until about the 1940s-1950s.
Forceps were very commonly used in vaginal hospital deliveries in the 1940s-1960s. Doctors often used forceps even in mild cases of "slow labor". Forceps can cause scalp and intracranial bleeding in newborns. Also around this time, the vacuum extractor was introduced and became widely used in the 1960s-1970s.
The more trauma the newborn experiences during the birth, the higher chance they will experience some kind of internal bleed.
The shot was first introduced in the early 1960's and soon after that became routine.
Is the Vitamin K Shot Right for Your Baby?
Is the Vitamin K Shot Right for Your Baby?
Some things to consider:
Some things to consider:
Was there significant birth trauma? It's normal for birth to be a bit traumatic- babies are squeezed tightly through the birth canal, but additional trauma (like instrumental deliveries or difficult extractions) can further raise the risk of bleeding.
Were you on any medicines that might raise your baby's bleeding risk? A few prescription drugs can lower newborn vitamin K levels.
When the nurses pricked the heal of your baby for the glucose test, was the blood from the prick slow coming? Or was it difficult to get the bleeding from the small prick to stop? If it was difficult to stop, you may want to consider the Vit K shot
Was the umbilical cord cut right away? Or was the cord clamping delayed?
Do the possible benefits of the shot outweigh the possible risks - for your baby and your values?
Am I comfortable with the existing safety data on the Vitamin K shot?
Do I want to review exactly what's in the injection and read the package insert for myself?
If I'm not sure I am comfortable with the shot, what other options are available to me? Oral vitamin K? Declining altogether?
Have I talked this through with my provider?
Sources & Additional Reading:
https://pubmed.ncbi.nlm.nih.gov/9492399/
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002776/full
https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/
Terms
Terms
Prophylaxis- action taken to prevent disease
VKDB- (newer term) Vitamin K Deficient Bleeding, also known as HDN
HDN- (older term) Hemorrhagic Disease of the Newborn, also known as VKDB
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