Vitamin K at Birth: To Inject or Not

I’m leaving the below post up but recommend this well-referenced article:  Evidence Based Birth: Evidence for the Vitamin K Shot in Newborns. There is more evidence available now about the various alternatives. Oral vitamin K is clearly much better than no vitamin K for preventing the very rare bleeding events, and the risks with the shot appear to be the smallest.

 

Reprinted from International Chiropractic Pediatric Association Newsletter
September/October 2002 Issue
by Linda Folden Palmer, DC 

UPDATE to below article: A very large 2003 study in the British Journal of Cancer (Fear et al.) has suggested that there is no link between bolus vitamin K provision at birth and leukemia or other cancers. (The study eliminated 2% of cancer cases in their study group that were diagnosed prior to 3 months of age. They additionally did not count Down’s syndrome babies and some others.) I’m inclined to believe that the risk is slight if it exists. Still, the conflicts in findings lead me to want to see an analysis of premature babies only, as any effect will be enhanced in this set and may provide a more definitive answer for older babies — not to question provision in preemies as the benefits of vitamin K administration are more important in premature infants.

 

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 Vitamin K is involved in regulating the rate of cell division in the fetus. It’s possible that abnormally 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,³because 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 A more recent analysis of six different studies suggests it may be 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 disregulation 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,⁸and 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 breastmilk 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 breastmilk 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.

 

On 10/8/2010 8:40 AM, Kelly wrote:

Hi Dr. Palmer,

Thank you for your informative article on Vitamin K. I found it to be very helpful in making a decision for my newborn. I would like to take a supplement myself after the baby is born (1 mg a day for 10 weeks), since I’ll be nursing. I’m just wondering if you recommend that the baby also receive an oral dose at birth? If so, how much should they get? I’ve seen so many different recommendations out there. Thanks for your help.

 

Dr. Palmer wrote:

 

Hi Kelly and congratulations on your upcoming delight. He/she is a lucky baby when having a mom who does her research.

 

Babies are given an injection of 1 mg at birth and this is calculated to be 20,000 times their naturally intended level. The plan is that they will store a large portion of this to carry them through any upcoming needs in the next months. Anyway, no, you shouldn’t need to supplement both baby and yourself. If you are supplementing yourself, you are bringing up baby’s levels gradually through your breastmilk and that’s how it should be. I imagine that 1mg/day for mom, the amount one study suggests moms can take, is well beyond ample, but not harmful.

 

However, if baby is born with vacuum extraction, forceps, or suffers some other bleeding or bruising trauma, or is receiving circumcision (I know you aren’t planning for most of these events), I would give a little vitamin K to baby as soon as any of these are recognized, to reduce any bleeding. I’m unable to prescribe dosages but I’ll say that, if it were me, I’d probably go for 1/10th mg or less, for an immediate boost in baby’s clotting ability.

 

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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BirthWithLove.com
Sells liquid vitamin K, and has other great information regarding this supplement.