Family Medicine Resident
In the Nov. 15, 2013, issue of Mortality and Morbidity Weekly Report, the Centers for Disease Control and Prevention (CDC) reported four cases of newborn babies in Nashville, Tenn., who suffered from life-threatening spontaneous hemorrhaging between February 2013 and September 2013. Three of these babies suddenly had diffuse bleeding in their brain, and one had gastrointestinal bleeding. After further investigation, it was discovered that the common factor in these cases was the refusal of the vitamin K injection at birth by these infants’ parents. All four newborns had been developing normally for at least six weeks after birth, until they were suddenly diagnosed with late vitamin K deficiency bleeding (VKDB).
Understandably alarmed by this outbreak, the Tennessee health department recruited CDC to delve further into the matter. Data from Tennessee hospitals from 2007 to 2012 revealed zero cases of late VKDB out of the 493,259 births during that time. In 2013, a random sampling of records of infants born from January to October 2013 showed that only 3.4 percent of infants were not administered the vitamin K injection compared with the notably higher 28 percent at birthing centers.
As more and more families are opting for a more “natural” and tailored birthing approach, there has been an emerging trend of parents declining standard preventive measures such as the vitamin K shot, hepatitis B vaccine, and antibiotic eye ointments.
When CDC questioned the parents of the four infants about why they chose to refuse the shot at birth, their reasons included concern for the risk of leukemia from the shot, impression that the injection was not necessary, and the desire to minimize exposure to toxins. In today’s technologically savvy age, “Google medicine” seems to be feeding into parental concerns and fears. Upon surfing through numerous “mommy blogs” on the Internet that advocate refusing vitamin K injections, many other issues that concern parents surface as well, including pain from the injection, the use of synthetic vitamin K, and that breast feeding provides sufficient amounts of vitamin K.
As a primary care physician, preventive medicine is a cornerstone of my practice. It seems like a no-brainer to take simple measures to avoid life-threatening situations and dire consequences. Simply put, the vitamin K injection is a safe and necessary standard of health care that is crucial to protecting babies from a deadly disease. In hopes of alleviating the fears of many parents, and more importantly, to help educate the public about the issue, here are answers to some major questions regarding vitamin K injections.
- What is the vitamin K shot, and why do babies need it?
The vitamin K shot has been a standard of practice since 1961. Vitamin K is needed for blood to clot, and babies are born with low vitamin K levels. They cannot get enough through diet, and their gastrointestinal tracts are not able to produce vitamin K via bacteria like adults. Infants that do not receive vitamin K at birth have an 81 times greater risk of developing vitamin K deficiency bleeding.
- What are the current recommendations?
According to the American Academy of Pediatrics, “Vitamin K1 should be given to all newborns as a single, intramuscular dose of 0.5 to 1 mg. Additional research should be conducted on the efficacy, safety, and bioavailability of oral formulations and optimal dosing regimens of vitamin K to prevent late VKDB. Health care professionals should promote awareness among families of the risks of late VKDB associated with inadequate vitamin K prophylaxis from current oral dosage regimens, particularly for newborns who are breastfed exclusively.”
- Is breastfeeding enough to provide my baby sufficient amounts of vitamin K?
No. Breastfed infants are actually at a higher risk for vitamin K deficiency compared with those fed with vitamin K-fortified formula because there is very little vitamin K content in breast milk and colostrum.
- Can I just increase the amount of vitamin K in my diet?
No. No evidence shows a correlation between the vitamin K status of mothers and their infants.
- Does it cause leukemia?
No. In 1992, there were small studies that linked vitamin K injections to leukemia. However, multiple subsequent studies over the past 20 years have discredited these findings. The American Cancer Society states on its website that there is “no link between cancer and vitamin K injections.”
- What about oral vitamin K for my baby instead?
Oral regimens are less effective in preventing late-onset VKDB. The rate of late-onset VKDB bleeding was 1.2-1.8 per 100,000 births for the oral dosing versus zero reported cases for the injection. It also requires multiple doses in the first two months, and the absorption is still not comparable to that of the single injection.