The Case for Vitamin K

Did you know that your breastfed baby is at a higher risk for a brain bleed than a formula-fed baby? Regardless of how your newborn is fed, this life-saving shot of Vitamin K is recommended to prevent early, classic, and late VKDB, which stands for Vitamin K Deficient Bleeding. All three types of VKDB can lead to intestinal bleeding, or worse, intracranial hemorrhage, which can cause brain damage and/or death.

The Vitamin K shot that your pediatrician wants your newborn to have so she won't have a spontaneous brain hemorrhage, is NOT a vaccine. It won't trigger an immune response. It offers a critical clotting factor that your baby won't produce on her own for half a year. Skipping the shot leaves your baby vulnerable to uncontrolled bleeding, and when that occurs in her brain, your first warning sign will occur when it is too late to stop the catastrophic damage.

Since 1961, the standard of care recommended by the American Academy of Pediatrics has been an IM injection of Vitamin K shortly after birth. Many of today's parents have never heard of VKDB, because since the routine injection was implemented, and with high compliance for many generations, this devastating complication became extremely rare. Protected babies who receive the injection are 81 times less likely to suffer from late VKDB,¹ with the incidence of severe bleeding dropping to 1 in 1 million babies. However, cases are currently on the rise due to an increase in parents' refusal of the shot.

What is Vitamin K and why do babies need it?

Vitamin K is a fat-soluble vitamin that is found in green leafy vegetables. It activates clotting factors that control bleeding, and also contributes to bone and vascular health. Unfortunately it crosses the placenta in very small amounts, so babies are born without any significant amount of Vitamin K on board. Vitamin K is produced naturally by bacteria in the intestine, however, the sterile gut of the newborn is incapable of manufacturing Vitamin K until it matures, which takes at least 6 months. Breast milk is low in Vitamin K, so babies aren't gifted much from their mothers as they feed and grow, and even when moms increase their dietary intake of Vitamin K, it isn't reflected in their milk, like some other vitamins.

By contrast, formula is fortified with Vitamin K, so formula fed babies will have higher circulating levels of Vitamin K. So can you just give your breastfed baby some supplemental formula to help them control any bleeding that may occur? No, because even fully formula fed babies should receive a shot of Vitamin K to boost their low levels. Also, consider that offering formula to your breastfed baby isn't recommended unless medically indicated, since it can interfere with milk supply and disrupt the ideal gut biome that is fostered by a diet of only breastmilk. This intestinal flora within the exclusively breastfed baby lays down the foundation of gut health, for life.

OK, but why does Vitamin K have to be given in a shot? Can't babies swallow a dose of it? Yes, but it has to be given orally several times and as much as weekly for breastfed babies, and still does not protect well against late VKDB, which is the particularly lethal kind. Also, oral Vitamin K is not approved by the FDA.

If it's so critical, then how did babies survive before we started administering it?

A large percentage of them DIDN'T survive...the infant mortality rate in the U.S. has gone from 200 deaths per 1,000 live newborns in the early 1800's, to 3-5 deaths per 1,000 live babies, in the 2000's. That is due to the combined effect of public health measures, Vitamin K shot included. It's now even available preservative-free.

But I don't want my newborn to be immediately jabbed with a needle in the delivery room!

Better a split second discomfort, than the alternative! I think back to all the trauma that my babies survived. Without coverage from their Vitamin K shot, I would have worried myself sick and not slept a wink, when:

1) We became parents after 1 ½ days of labor, and every hour was visible on our daughter's cone-shaped head. She looked like she had been through battle. She even had a circular bruise from the vacuum extractor that lasted a week. (It's not just the passage through the vagina that causes trauma - even C-section babies get aggressively handled to scoop them out of the womb) Thank goodness Madeleine got her Vitamin K shot right there in the delivery room so it could begin protecting her immediately!

2) At 5 months Madeleine started sitting up, but regularly lost her balance and toppled over, banging her head on the floor. I was vigilant about staying close to her and catching her, but I know daycare wasn't.

3) Luke arrived on the scene as the second child and endured the clumsy handling of his "loving" big sister, who just wanted to "help" us care for him. He was tough and seemed not only to endure, but ENJOY any attention she gave him, no matter how rough; for example, she put him into her doll carriage and zipped around the house with him. Without Vitamin K available, I can't imagine how he would have survived being a little brother; I would have had to bubble wrap him to protect him from Madeleine!

4) Our third baby, Suzannah, spent so much time in her car seat as a passenger while I drove her big sister and brother around to all of their activities. I always drove extra carefully, but have you seen all these other maniacs on the road texting while driving?? One tiny fender bender could have jostled her head, and without protection from Vitamin K, I shudder to think what could have happened.

A lot of parents can relate to those stories, but consider that your baby doesn't even need any trauma, for VKDB to occur. It can happen spontaneously. There is no preventing it without the shot, and once it becomes apparent, the injury has already happened, and you are left with a brain-damaged child for life.

DON'T TAKE THE RISK! GET YOUR BABY THEIR VITAMIN K!

References:

1. McNinch AW, Tripp JH. Haemorrhagic disease of the newborn in the British Isles: two year prospective study. BMJ. 1991 Nov 2;303(6810):1105-9. doi: 10.1136/bmj.303.6810.1105. PMID: 1747578; PMCID: PMC1671305.

2. Van Winckel M et al. Vitamin K, an update for the paediatrician. Eur J Pediatr 2009; 168: 127- 34