Vitamin K at Birth: To Inject or Not

Before my wife gave birth to our first child, our primary midwife asked us to think about whether we wanted our child to receive a vitamin K shot after he was born or not.

Vitamin K shots are routinely administered to newborn babies because 1.8 out of every 100,000 babies who do not receive vitamin K injections suffer permanent injury or death due to uncontrolled bleeding in the brain that may be the result of having extremely low levels of vitamin K in their systems.

Our instinct was to decline the shot for our baby, but after our midwife gave the vitamin K shot a strong endorsement due to an experience she had of seeing an non-injected baby die from intracranial bleeding, we felt enough uncertainty to go with her recommendation.

Most fortunately, our son had no problems with his injection and is thriving as he approaches 22 months of age.

In preparing to welcome our second child this coming summer, we recently decided to do some more research into the pros and cons of giving vitamin K shots to newborns. After reading through several papers and discussing the matter over many days, we decided that for our second child, we will decline the vitamin K shot.

After reading about some of the potential problems that can result from administering vitamin K shots to newborns, we decided that we feel more comfortable having my wife each plenty of vitamin K-rich foods late in her pregnancy and while she nurses our baby.

What follows is the most balanced and informative article on this topic that we encountered during our research. If this topic is of interest to you, please be sure to read the entire article that follows. Do not be alarmed when you first encounter the references to vitamin K shots being linked with an increased risk of developing cancer. When you get to the section that is subtitled "The Numbers," you will see that the statistics do not clearly favor giving or not giving a vitamin K shot to newborns.

If you are expecting to have a baby, we hope that you find this information to be useful as you make a decision that feels right for your unique circumstances.

***

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.