Vitamin k for newborn babies
Protect Your Baby from Bleeds – Talk to Your Healthcare Provider about Vitamin K
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Protect Your Baby from Vitamin K Deficiency Bleeding
Before having a baby, most parents don’t give much thought to the vitamin K injection (shot) for their newborn. It’s just not something that is talked about during prenatal checkups, even though babies have been routinely given this important shot at birth since the practice was first recommended by the American Academy of Pediatrics in 1961.
Vitamin K is needed for blood to clot normally. Babies are born with very small amounts of vitamin K in their bodies which can lead to serious bleeding problems. Research shows that a single vitamin K shot at birth protects your baby from developing dangerous bleeding which can lead to brain damage and even death. Ask your healthcare provider about the benefits of Vitamin K before your delivery. Protect your newborn by making sure he or she gets the shot after birth.
What is vitamin K deficiency bleeding (VKDB)?
Vitamin K deficiency bleeding or VKDB, is a condition that occurs when the baby does not have enough Vitamin K.
Without enough vitamin K, your baby has a chance of bleeding into his or her intestines, and brain, which can lead to brain damage and even death. Infants who do not receive the vitamin K shot at birth can develop VKDB up to 6 months of age.
How can I prevent VKDB?
The good news is that VKDB is easily prevented. The easiest and most reliable way to give babies vitamin K is by a shot into a muscle in the leg. One shot given after birth will protect your baby from VKDB.
What is vitamin K?
Vitamin K is a vital nutrient that our body needs for blood to clot and stop bleeding. We get vitamin K from the food we eat. Some vitamin K is also made by the good bacteria that live in our intestines.
Babies have very little vitamin K in their bodies at birth because:
Why does my baby need a vitamin K shot?
- Vitamin K from the mom is not easily shared with the developing baby during the pregnancy
- The intestine of the newborn baby has very little bacteria so they do not make enough vitamin K on their own.
Without enough vitamin K, blood cannot clot well. As a result, bleeding can occur anywhere in the body. This means not only that bleeding from a cut or bruise may continue for a long time, but that uncontrolled bleeding into the brain and other organs may occur.
About half of all babies who develop VKDB bleed into their brains.
Is Vitamin K safe?
A study from the early 1990’s found a possible link between getting vitamin K and developing childhood cancer. Pediatricians became very concerned about this and have done many studies since then, in many different ways, trying to see if this link was true. None of the studies found this link again, even though doctors and scientists looked very hard for it.
Does my baby get vitamin K from breast milk?
Yes, but not enough to prevent VKDB. There is only a little vitamin K in breast milk. Breastfed babies are low in vitamin K for several weeks until they start eating regular foods, usually at 4-6 months, and until the normal intestinal bacteria start making vitamin K.
Should all babies get a vitamin K shot at birth?
Yes. Babies do not have enough vitamin K at birth and are, therefore, at risk for having serious bleeding. Thus, it is very important that all babies get a vitamin K shot to prevent VKDB.
Where can I get more information?
For more information, please visit our website at:
http://www.cdc.gov/ncbddd/vitamink/index.html
FAQs About Vitamin K Deficiency Bleeding
Since 1961, the American Academy of Pediatrics has recommended supplementing low levels of vitamin K in newborns with a single shot of vitamin K given at birth. Low levels of vitamin K can lead to dangerous bleeding in newborns and infants. The vitamin K given at birth provides protection against bleeding that could occur because of low levels of this essential vitamin.
Below are some commonly asked questions and their answers. If you continue to have concerns about vitamin K, please talk to your pediatrician or healthcare provider.
Q: What is vitamin K, and how do low levels of vitamin K and vitamin K deficiency bleeding occur in babies?
A: Vitamin K is used by the body to form clots and to stop bleeding. Babies are born with very little vitamin K stored in their bodies. This is called “vitamin K deficiency” and means that a baby has low levels of vitamin K. Without enough vitamin K, babies cannot make the substances used to form clots, called ‘clotting factors.’ When bleeding happens because of low levels of vitamin K, this is called “vitamin K deficiency bleeding” or VKDB. VKDB is a serious and potentially life-threatening cause of bleeding in infants up to 6 months of age. A vitamin K shot given at birth is the best way to prevent low levels of vitamin K and vitamin K deficiency bleeding (VKDB).
Q: Why do ALL babies need a vitamin K shot – can’t I just wait to see if my baby needs it?
A: No, waiting to see if your baby needs a vitamin K shot may be too late.
Babies can bleed into their intestines or brain where parents can’t see the bleeding to know that something is wrong. This can delay medical care and lead to serious and life-threatening consequences. All babies are born with very low levels of vitamin K because it doesn’t cross the placenta well. Breast milk contains only small amounts of vitamin K. That means that ALL newborns have low levels of vitamin K, so they need vitamin K from another source. A vitamin K shot is the best way to make sure all babies have enough vitamin K. Newborns who do not get a vitamin K shot are 81 times more likely to develop severe bleeding than those who get the shot.
Q: Doesn’t the risk of bleeding from low levels of vitamin K only last a few weeks?
A: No, VKDB can happen to otherwise healthy babies up to 6 months of age. The risk isn’t limited to just the first 7 or 8 days of life and VKDB doesn’t just happen to babies who have difficult births.
In 2013, the Centers for Disease Control and Prevention (CDC) investigated 4 cases of infants with bleeding from low levels of vitamin K. All four were over 6 weeks old when the bleeding started and they had been healthy and developing normally. None of them had received a vitamin K shot at birth.
Q: Isn’t VKDB really rare?
A: VKDB is rare in the United States, but only because most newborns get the vitamin K shot. Over the past two decades, many countries in Europe have started programs to provide vitamin K at birth – afterward, they all saw declines in the number of cases of VKDB to very low levels. However, in areas of the world where the vitamin K shot isn’t available, VKDB is more common, and many cases of VKDB have been reported from these countries
In the early 1980s in England, some hospitals started giving vitamin K only to newborns that were thought to be at higher risk for bleeding. They then noticed an increase in cases of VKDB.
This tells us that giving vitamin K to prevent bleeding is what keeps VKDB a rare condition – when vitamin K is not given to newborns, cases of bleeding occur and VKDB stops being rare.
Q: What happens when babies have low levels of vitamin K and get VKDB?
A: Babies without enough vitamin K cannot form clots to stop bleeding and they can bleed anywhere in their bodies. The bleeding can happen in their brains or other important organs and can happen quickly. Even though bleeding from low levels of vitamin K or VKDB does not occur often in the United States, it is devastating when it does occur. One out of every five babies with VKDB dies. Of the infants who have late VKDB, about half of them have bleeding into their brains, which can lead to permanent brain damage. Others bleed in their stomach or intestines, or in other parts of the body. Many of the infants need blood transfusions, and some need surgeries.
Q: I heard that the vitamin K shot might cause cancer.
Is this true?A: No. In the early 1990s, a small study in England found an “association” between the vitamin K shot and childhood cancer. An association means that two things are happening at the same time in the same person, but doesn’t tell us whether one causes the other. Figuring out whether vitamin K might cause childhood cancer was very important because every newborn is expected to get a vitamin K shot. If vitamin K was causing cancer, we would expect to see the same association in other groups of children. Scientists looked to see if they could find the same association in other children, but this association between vitamin K and childhood cancer was never found again in any other study.
Q: Can the other ingredients in the shot cause problems for my baby? Do we really know that the vitamin K shot is safe?
A: Yes, the vitamin K shot is safe. Vitamin K is the main ingredient in the shot. The other ingredients make the vitamin K safe to give as a shot.
One ingredient keeps the vitamin K mixed in the liquid; another keeps the liquid from being too acidic. One of the ingredients is benzyl alcohol, a preservative. Benzyl alcohol is a common ingredient in many medications.
In the 1980s, doctors recognized that very premature infants who were in neonatal intensive care units might become sick from benzyl alcohol toxicity because many of the medicines and fluids needed for their intensive care contained benzyl alcohol as a preservative. Although the toxicity was only reported for very premature infants, since then doctors have tried to minimize the amount of benzyl-alcohol-containing medications they give. Clearly, the small amount of benzyl alcohol in the vitamin K shot is not enough to be dangerous, even when given in combination with other medications that also contain small amounts of this preservative.
Q: The dose of the shot seems high. Is that too much for my baby?
A: No, the dose in the vitamin K shot is not too much for babies.
The dose of vitamin K in the shot is high compared to the daily requirement of vitamin K. But remember babies don’t have much vitamin K when they are born and won’t have a good supply of vitamin K until they are close to six months old. This is because vitamin K does not cross the placenta and breast milk has very low levels of vitamin K.
The vitamin K shot acts in two ways to increase the vitamin K levels. First, part of the vitamin K goes into the infant’s bloodstream immediately and increases the amount of vitamin K in the blood. This provides enough vitamin K so that the infant’s levels don’t drop dangerously low in the first few days of life. Much of this vitamin K gets stored in the liver and it is used by the clotting system. Second, the rest of the vitamin K is released slowly over the next 2-3 months, providing a steady source of vitamin K until an infant has another source from his or her diet.
Q: Can I increase vitamin K in my breast milk by eating different foods or taking multivitamins or vitamin K supplements?
A: We encourage moms to eat healthy and take multivitamins as needed.
Although eating foods high in vitamin K or taking vitamin K supplements can slightly increase the levels of vitamin K in your breast milk, neither can increase levels in breast milk enough to provide all of the vitamin K an infant needs.
When infants are born, their already low levels of vitamin K fall even lower. Infants need enough vitamin K to (a) make up for their extra-low levels, (b) start storing it in the liver for future use, and (c) ensure good bone and blood health. Breast milk – even from mothers supplementing with vitamin K sources – can’t provide enough to do all of these things.
Q: My baby is so little. What can I do to make the vitamin K shot less painful and traumatic?
A: Babies, just like us, feel pain, and it is important to reduce even small amounts of discomfort. Babies feel less pain from shots if they are held and allowed to suck.You can ask to hold your baby while the vitamin K shot is given so that your baby can be comforted by you.
Breastfeeding while the shot is given and immediately after can be comforting too. All of these are things parents can do to ease pain and soothe their baby.
Remember that if your baby does not get the vitamin K shot, his or her risk of developing severe bleeding is 81 times higher than if he or she got the shot. Diagnosis and treatment of VKDB often involves many painful procedures, including repeated blood draws.
Q: Overall, what are the risks and benefits of the vitamin K shot?
The risks of the vitamin K shot are the same risks that are part of getting most any other shot. These include pain or even bruising or swelling at the place where the shot is given. A few cases of skin scarring at the site of injection have been reported. Only a single case of allergic reaction in an infant has been reported, so this is extremely rare.
Although there have been concerns about some other risks, like a risk for childhood cancer or risks because of additional ingredients, none of these risks have been proven by scientific studies.
The main benefit of the vitamin K shot is that it can protect your baby from VKDB, a dangerous condition that can cause long-term disability or death. In addition, the diagnosis and treatment of VKDB often includes multiple and sometimes painful procedures, such as blood draws, CT scans, blood transfusions, or anesthesia and surgery.
The American Academy of Pediatrics has recommended the Vitamin K shot since 1961, and has repeatedly stood by that recommendation because the risks of the shot don’t outweigh the risks of VKDB, which are based on decades of evidence and decades of experience with babies who were hospitalized or died from VKDB.
Your child’s doctor is the best person to talk to about vitamin K. Like you, your child’s doctor wants to see your children grow up safe and healthy and wants to support your efforts to make the best decisions for their health. If you have concerns about vitamin K, talk to your child’s doctor.
Why are newborns given vitamin K injections?
At Mother and Child clinics, we recommend vitamin K injections for all newborns to prevent hemorrhagic disease.
Hemorrhagic disease (HRD), or vitamin K-deficient hemorrhagic syndrome, is a disease manifested by increased bleeding in newborns and children during the first months of life, due to a deficiency of blood coagulation factors, the activity of which depends directly on vitamin K.
Vitamin K of plant origin, which is called vitamin K 1 or phylloquinone, enters the body with food - green vegetables, vegetable oils, dairy products. Another form of vitamin K, vitamin K2, or menaquinone, is of bacterial origin. Vitamin K 2 is mainly synthesized by the intestinal microflora, which is extremely poor in newborns.
In healthy newborns, the level of vitamin K-dependent coagulation factors in blood plasma is 30-60% of that in adults. Their concentration increases gradually and reaches the level of adults by the sixth week of life.
In almost all healthy full-term infants in the first five days of life, there is a decrease in the level of procoagulants, physiological anticoagulants and plasminogen.
For the newborn, the only source of vitamin K is mother's milk, formula or medicine. Moreover, the amount of vitamin K received by a child depends on the type of feeding. The level of vitamin K 1 in breast milk ranges from 1 to 10 µg/l, on average 2-2.5 µg/l, which is significantly lower than in artificial milk formulas (about 50 µg/l in mixtures for full-term babies; 60 -100 mcg / l - in mixtures for premature babies). Thus, newborns, due to their physiological characteristics of the coagulation system and vitamin K metabolism, are predisposed to the development of vitamin K-deficient hemorrhagic syndrome.
PLEASE NOTE! Poor blood clotting is a condition dangerous for the body, in which bleeding or hemorrhage is noted in various organs. This pathology develops in 0.25-0.5% of newborns.
RISK FACTORS FOR THE DEVELOPMENT OF RHD
• Exclusive breastfeeding
• Lack of prophylactic administration of vitamin K immediately after birth
• Chronic fetal hypoxia and asphyxia at birth
• Giving birth
• Intrauterine development delay
• Giving birth by Cesarean section
• Contentment
• The use of a wide range of
• Long -term parenteral power supply in the conditions of inadequate supply of
• Diseases and states of the child, which contribute impaired synthesis and absorption of vitamin K
• malabsorption syndrome (cystic fibrosis, diarrhea with fat malabsorption lasting more than one week)
• short bowel syndrome;
• cholestasis;
• pre-eclampsia
• maternal diseases (liver and intestinal diseases).
Vitamin K for the prevention of bleeding in newborns
Vitamin K is required for the synthesis of blood coagulation factors in the liver, which include factors II (prothrombin), VII, IX and X, as well as anticoagulant proteins C and S. In newborns at term, especially those who are exclusively breastfed may develop vitamin K deficiency and therefore associated bleeding because breast milk contains very low levels of vitamin K.
Problematic and management of bleeding in preterm infants
Premature infants are potentially at even higher risk of developing vitamin K deficiency-associated bleeding due to delayed feeding and subsequent delay in colonization of their gastrointestinal tract by microflora involved in vitamin K production, use of antibacterial drugs, as well as due to inferior liver function and hemostasis. The administration of vitamin K preparations to prevent bleeding associated with vitamin K deficiency has been described to some extent in both term and premature infants.
It is indicated that a single intramuscular injection of 1 mg of a vitamin K preparation after birth is effective in this regard.
There is evidence that not only injectable but also oral vitamin K supplementation improves biochemical parameters of coagulation in infants. However, none of these approaches has been studied in the framework of randomized trials for bleeding of various periods (early, classic and late) after birth. Concern has also been expressed about the prophylactic use of vitamin K preparations due to the presence of phenol in their composition, which has potentially carcinogenic properties. A systematic review of the literature did not reveal an increased risk of malignant neoplasms in children after intramuscular injections of vitamin K preparations, so the American Academy of Pediatrics (AAP) continues to recommend prophylactic intramuscular administration of 0.5-1 mg of a vitamin K preparation to infants after birth to prevent early, classic and late form of associated bleeding in term babies.
Recommendations for the use of vitamin K supplements in preterm infants are less specific because associated bleeding has not been widely discussed in the literature. This may be partly due to the fact that most preterm infants in intensive care units are routinely given prophylactic vitamin K supplementation, and that parenteral nutrition is started early, providing preterm infants with more than enough vitamin K. However, there are many reasons to believe that preterm infants may be at greater risk of associated bleeding, and that these bleeding may be more important, especially in relation to the risk of intraventricular hemorrhage.
Based on this, scientists in the United States of America conducted a systematic review of studies to determine the effect of vitamin K supplementation in preventing vitamin K deficiency-associated bleeding in preterm infants. The results of this work were published on February 5, 2018 in the Cochrane Database of Systematic Reviews.
Trial and participant selection criteria
Searched Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and electronic databases MEDLINE, PubMed, Embase, CINAHL, and others.
Scientists reviewed randomized and quasi-randomized controlled trials of any vitamin K supplement given to preterm infants. At the same time, intramuscular and intravenous injections, as well as oral use of various vitamin K preparations in various dosages, were compared with non-intervention. As a result, 899 records, of which scientists analyzed 7 full-text studies.
Primary outcomes
- Any bleeding.
- Any serious bleeding requiring immediate blood transfusion.
- Gastrointestinal bleeding.
- Intracranial hemorrhages.
*All types of bleeding in the primary outcomes were studied in two subgroups: infants less than 7 days of age and older.
Secondary outcomes included laboratory parameters (at and after the first week of life) and potential side effects of prophylactic vitamin K supplementation.
Findings and conclusions from a systematic review Compared with non-intervention, and in only one study, scientists have considered various dosages and routes of administration of vitamin K supplements in preterm infants.
The results obtained indicate that the majority of infants who received intramuscular or intravenous injections of vitamin K preparations at a dosage of 0.2 mg had supraphysiological levels of vitamin K in the blood on the 5th day of life. At the same time, it was found that intravenous administration of 0.2 mg of the drug is slightly more effective than intramuscular injection of 0.5 mg, according to analyzes of the level of vitamin K in the blood at the end of the observation. However, there were no significant differences between the use of 0.2 mg intravenous, 0.2 and 0.5 mg intramuscular vitamin K in relation to general pathologies associated with prematurity, including other clinical bleeding, sepsis, ventriculomegaly, as well as in relation to mortality. .
Another study looked at blood concentrations of vitamin K in infants 22 to 32 weeks of gestational age who received either 1 mg or 0.5 mg of a vitamin K preparation as part of prophylaxis, with the dosage determined by the attending physician at the infants' admission to the unit neonatal intensive care.
Infants were exclusively breastfed, with the exception of individual cases when this was not possible. It was found that the difference in the concentration of vitamin K in the blood of infants on the 2nd and 10th day of life was not statistically significant between the two groups.
In conclusion, the investigators concluded that preterm infants are currently receiving unreasonably high doses of vitamin K supplements in some cases. The investigators argue that, due to uncertainty, clinicians should extrapolate data from term newborns to preterm infants. Because there is no available evidence that vitamin K is harmful or ineffective, and because vitamin K is inexpensive, it would be prudent to follow the recommendations of expert bodies and prescribe vitamin K supplements to preterm infants. In this regard, further studies are needed on the appropriate dosages and routes of administration of vitamin K preparations, especially among preterm infants <30 weeks of gestational age, who are at high risk of developing hemorrhagic complications such as intraventricular hemorrhage.
