What IS it?

Soon after the birth of your baby you’ll be offered an injection of Vitamin K for your baby to prevent a rare complication called Vitamin K Deficiency Bleeding (VKDB).  It is not a vaccination.

In a nutshell Vitamin K is a fat-soluble substance stored in the liver that we need to reduce bleeding and help our blood clot.  It’s essential for life so it’s called a vitamin. It’s metabolized and stored in the liver so hardly any of the Vitamin K in your diet gets to your growing baby before birth (even if you’re eating buckets of kale). 

Why does may baby need it?

Babies are born with low levels of Vitamin K (we’re still trying to figure out if that’s a good thing or not - it’s probably not a problem but at the moment best practice is to give Vitamin K at birth). A very small number of babies experience VKDB. It’s very rare but very serious and we can’t predict which babies will have it so it’s routinely given to all babies. 

Did nature get it so wrong that it left the human race at risk of this complication?  It doesn’t really make sense.  Why should newborns have adult level Vitamin K levels?  Are these levels actually normal but we just haven’t figured out why yet? Does early cord clamping or baby’s gut bacteria have anything to do with this complication? There’s lots of theories out there but nothing concrete in the research. Is breastmilk REALLY low in Vitamin K and if so is that a problem or totally normal? (Breastmilk seems to have gotten everything else right when it comes to nourishing the planet before formula was developed so why would our magnificent bodies get Vitamin K so wrong?)

To complicate things even further there’s different kinds of VKDB

Early onset usually occurs within 24 hours of birth and is more likely to be seen in babies born to moms who have been taking certain medications such as blood thinners, antibiotics or drugs for epilepsy.

Classic Onset – usually occurs between day 2 and day 7 after birth.

Late Onset (between 8 and 14 days and potentially up to 6 months).  All of the above scenarios can result in bleeding in the skin, brain and gut.

How effective is the injection?

The injection is considered to be almost 100% effective.  The effectiveness of oral Vitamin K will depend on the dosage, how often it’s given and how it’s given (always with a feed).

 What happens if my baby has VKDB? 

Your baby will be taken care of in NICU.  How long your baby will need to stay will be determined by how sick your baby is. The most severe complication is bleeding in the brain and in some cases that leads to death.  Most babies won’t have bleeding on the brain and do really well when treated with Vitamin K (as long as baby’s liver is healthy).

Can’t I just get more Vitamin K from my food? 

Around 90% of our vitamin K comes from our diet (mostly leafy green vegetables) and about 10% from some helpful gut bacteria but it doesn’t cross the placenta well. 

I’m not sure about giving my baby Vitamin K - How common is VKDB?

Depending on the research done before Vit K was giving routinely it was thought that late onset was about 1 in 10,000.  A 2016 study by Sankar et al suggests it’s between 10-18 babies out of 100,000 (with rates higher in less developed countries).   According to Vitamin K Expert Dr Sarah Wickham about 1 in 11,000 babies who don’t receive Vitamin K may experience VKDB.

I will be breastfeeding exclusively – does that help?

Some research suggests that when breastfeeding supplementing with 5mg of Vitamin K every day may increase the levels your baby receives through your breastmilk. Talk to your careprovider.

How painful is the injection?

 Seeing your baby in pain has to be one of the hardest things a parent has to go through.  But thankfully it’s very quick and if you keep  your baby skin to skin with you and even better if he’s nursing it’s less likely to be stressful for you or your newborn. When your baby gets the shot of medication it ‘sits’ in the muscle and gets into baby’s system over a few weeks.

My friend gave it orally – can’t I do that instead?

With oral administration parents don’t always remember when to give it (blame the fog of postpartum exhaustion) and babies sometimes spit it out due to the taste and ¾ of it is excreted in their pee and poop within a few days.  Remember it’s a fat soluble vitamin so it’ll be absorbed better if it’s given with a feed.  Ask your careprovider about the Danish protocol for oral Vitamin K and their recommended dosages.

Are there any known risks to this medication?

Known side effects to Vitamin K are very rare but there are other ‘ingredients’ to stabilize the medication that could pose a risk but there hasn’t been enough research and it’s unlikely to happen in the future when we know it’s such an effective way to reduce this rare problem.  Talk to your careprovider about what else is in the Vitamin K medication offered by your hospital (different brands are offered around the world).

Is my baby at risk of having VKDB?

 Some babies are at higher risk:

Babies who are circumcised are considered to be at higher risk and babies/moms who have antibiotics at birth.  According to Dr Sara Wickham getting a tongue tie snipped may also be a factor.

Exclusively breastfed babies. BUT BUT BUT only if you are comparing amazing breastmilk to cows milk and the research was done at a time when feeds were restricted. It’s quite possible and in my opinion and many others quite likely that we just haven’t figured out in scientific terms why these seemingly ‘low’ levels are important for the health of our newborns.

A friend told me I only need Vitamin K if I have an instrumental birth? 

Not true – some homebirth babies have developed VKDB and beautiful hospital births.  We have no way of predicting which babies will be affected.

Is Vitamin K made from animal products?

It depends on the medication and country.  Ask at your next prenatal appointment.

I’ve decided not to give my baby Vitamin K – What signs should I look out for if he get’s sick?

• Fussiness and/or vomiting

• Jaundice that isn’t going away.

• Baby not feeding well in the first 48 hours.

• Bleeding and/or bruising.

• Poop that is pale (not the yellow poop) and dark pee.

More information on signs to look for if you decide not to give Vitamin K  

Don’t wait – call your careprovider if you’ve already been discharged from hospital or from the care of your midwife. If there is active bleeding take your baby to the emergency room immediately.

For an even deeper dive into the history, research and current recommendations for Vitamin K read Dr Sara Wickham’s short book Vitamin K and the Newborn available here - https://amzn.to/2H4yOMP

How did you make the decision to give or refuse Vitamin K medication?