Does My Newborn Need A Vitamin K Shot?

Vitamin K deficiency bleeding, thought to be a problem of the past, has cropped back up the past few years.  During an 8-month period in 2013, five infants were admitted to Vanderbilt Children’s Hospital in Nashville, Tennessee, with life-threatening bleeding. The infants were diagnosed with late Vitamin K deficiency bleeding (VKDB)—four of the infants had bleeding in the brain, and one had bleeding in the intestines.  What did these infants have in common? The infants ranged in age from seven weeks to five months old; three were male and two were female. Three of the infants were born in hospitals, and two were born at home. All of them had uncomplicated, spontaneous vaginal births. All of the infants were exclusively breastfed. Most importantly, what these infants had in common was that all of their parents had declined Vitamin K shots at birth.


What is Vitamin K and what does it do in the body?  

Vitamin K is necessary for our bodies to activate certain molecules (also known as clotting factors) that help the blood to clot. The blood clotting factors are there in normal numbers at birth, but not activated fully due to low levels of Vitamin K.  If we do not have enough Vitamin K, then we cannot activate these molecules. So a Vitamin K deficiency makes our blood less able to clot.  A baby who does not have enough Vitamin K can start to bleed suddenly, without warning. This is known as Vitamin K deficiency bleeding.

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What is the history behind the Vitamin K shot?

In 1961, after nearly 2 decades of research had been published, the American Academy of Pediatrics recommended giving Vitamin K shots after birth. This practice has been the standard of care in the U.S. ever since.

When infants do not receive any Vitamin K at birth:

  • Statistics from Europe show 4.4 to 10.5 infants out of 100,000 will develop late VKDB. 
  • Rates are higher in Asian countries (1 out of every 6,000 infants).
  • When infants receive oral Vitamin K at least three times during infancy (typically at birth, one week, and four weeks), anywhere from 1.4 to 6.4 infants out of 100,000 will develop late VKDB.
  • When infants receive the Vitamin K shot at birth, there are virtually no cases of late VKDB.


How do I know if my baby has VKDB?  What are the treatment options?

One of the most dangerous things about VKDB is that you may not recognize it until it is too late. Infants cannot tell us what is going on, and symptoms of brain injury may be subtle, such as difficulty feeding, lethargy, or fussiness. Unfortunately, a brain bleed may reach a critical size before parents seek medical attention. And it can take even longer for health care professionals to figure out what is wrong.

The main treatment for VKDB is to give the infant Vitamin K. When an infant with VKDB receives a shot of Vitamin K1, this will usually slow or stop the bleeding within 20-30 minutes. However, if bleeding happens in the brain, the infant may already have brain damage by the time the shot is given.  Other treatments that have been used in infants with late VKDB include blood and plasma transfusions, brain surgery to remove the accumulated blood, and administration of anti-seizure medications 


Does circumcision increase the need for Vitamin K injection?

Circumcision sites are frequently listed as a site of bleeding when infants have classical (first-week) VKDB. Unfortunately, circumcision often takes place when Vitamin K levels in the infant are lowest - during days 2 and 3 of life.  Infants who are circumcised and whose parents decline Vitamin K may be more likely to experience bleeding at the circumcision site, especially if the baby is breastfed.  One study shows bleeding occurred after circumcision in 6 out of 240 infants (2.5%) who received Vitamin K; and 32 out of 230 infants (13.9%) who did not have the Vitamin K shot.  


Bottom Line

Every parent needs to weight the pros and cons of getting the Vitamin K shot (or giving their newborn oral doses of Vitamin K).  Parent are encouraged to talk to their healthcare provider during pregnancy for additional information about routine Vitamin K at birth before making their choice.  


Information taken from http://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/ 


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