That seems a shame to give a brand new baby a shot right after he is born. Or is it?

 

I was finishing a busy day in the office when a nurse from the hospital labor and delivery gave me a call. She informed me that a patient of mine who was in labor was refusing to let her new baby receive the Vitamin K shot at birth. Would I talk to the mom after I finished seeing my patients? This was an unusual and uncommon request. I thought I would review the literature about Vitamin K before speaking with the mom.

 

Vitamin K Deficiency Bleeding (VKDB) occurs as a result of impaired production of clotting factors in the newborn. The consequences may be bleeding from the umbilicus, mucus membranes (nose and mouth), intestinal tract, circumcision site and more seriously within the brain.

 

Newborns are susceptible to having low Vitamin K levels for a number of reasons. They are born with very low stores of Vitamin K. It is poorly passed through the placenta from the mother. Breast milk contains very little Vitamin K and the gut flora of the newborn has not yet been established. Vitamin K is produced by certain bacteria that we have in our intestinal tract. It takes time for the newborn gut to become colonized with this bacteria.

 

There are three main types of VKDB:

• Early Onset VKDB

  This usually occurs within the first 24 hours of life. It often is seen in moms that are taking certain medications such as anti-seizure meds, anti-TB meds such as isoniazid, blood thinners like Coumadin and some types of antibiotics, especially the cephalosporins.

• Classic VKDB

  This occurs after the first 24 hours of life and may not become evident until up to a week of life. The incidence of this in babies NOT given Vitamin K after birth is .25 – l.7 out of 100 births.

• Late Onset VKDB

  This presents itself within 2 – 12 weeks of life but may occur up to 6 months in some cases. The incidence of an intra-cranial hemorrhage, or bleeding within the brain, in late onset VKDB is well over 50%.

 

VKDB has been well understood for over a century. In 1961 the American Academy of Pediatrics made its recommendations that all newborns receive one dose of Vitamin K intramuscularly to prevent VKDB. This has been the standard of care ever since.

 

Some other countries have adopted a policy of giving newborns oral Vitamin K. But these countries have seen a resurgence of VKDB and are having to re-think this policy. A paper from 1994 looked at four countries that used oral Vitamin K. They reported a failure rate of 1.2 – 1.8/100,000 births compared to NONE who received intramuscular Vitamin K. There is no oral preparation of Vitamin K available in this country.

 

There was a paper published in England in the 1990s that suggested a possible link between Vitamin K and childhood cancers. A large cohort study and a retrospective analysis of this failed to confirm the suggestion. With new genetic testing we are finding that many of these childhood cancers had an actual genetic cause, thus proving a prenatal origin of the cancer.

 

After conducting my review I was ready to talk with the mom, to make my case for recommending her baby receive Vitamin K after birth. I spoke with the same nurse who was experienced in labor and delivery for over 25 years. She laughed and said, “No need to bother, doctor. I had a good LONG talk with mom and dad. Now they are fully on board with getting the shot!” I thanked her. There is nothing like an experienced nurse.