Newborn Vitamin K Injections

What is it?

In the United States, the practice of newborn vitamin k injections has become almost universal.  However, this routine newborn procedure is controversial in other nations.  It originated during the hospital age of routine separation of mothers from their babies, before rooming-in was an accepted practice.  

Why is this done?

The rationale for newborn vitamin K  injection at birth is that newborns are born with a "deficiency" of vitamin K. This perceived deficiency is based upon a comparison of newborn levels to normal adult values. Low levels of vitamin k can lead to decreased clotting ability of the blood, that can leave the newborn more susceptible to hemorrhage.  The risk is quite small, only about 1 in 200, but it does exist.  The following factors increase risk of hemorrhage in newborns:

Risk Factors for Cerebral Hemorrhage

• Precipitous Labor
• Prolonged Labor
• Significant Fetal Head Molding
• Birth Trauma
• Forceps Delivery
• Vacuum Extraction
• Variable Heart Decelerations in Late Labor
• Circumcision

Points to Ponder on Routine Injection

While newborn vitamin K  injection may sound like an acceptable intervention, there are several points to ponder, foremost of which is that all infants are born with a low level of vitamin k. Thus, it raises the question of whether the low newborn concentration of vitamin k should in fact be termed a deficiency. Additional concerns include:

• The amount of Vit K injected is 20,000 times the newborn level at birth. The dose size given is based upon normal adult values. Additionally, the injection may also contain preservatives which are known toxins to the infant.
• Large doses of Vit K are a cause of jaundice in the newborn.  A cure for one perceived ailment then becomes the cause of another.
• Colostrum, which precedes breastmilk, is rich in Vit K.  Thus, an infant who is breastfed immediately at birth will receive a natural source of Vit K, in most cases significantly raising the Vit K level.
• Vit K is absorbed by the gut from foods we eat.  However, the injection is an intramuscular one, which bypasses the gut and delivers the Vit K in a way the body wasn't designed to receive.
• Birth is an overwhelming sensory experience for the baby - it has never before been cold, hungry, been blinded by light, felt the touch of cloth or the pull of gravity.  Sticking a needle into its body and inflicting pain isn't a gentle way to allow the sensory system to gradually adjust to the outside world.
• Subconsciously, it sends the message that nature is inadequate, that medical interventions are are necessary to save us from ourselves.

Simple Solutions

1. Minimize interventions and the use of pain medications to reduce the risk of intercranial bleeding.

Interventions such as epidural anethesia, iv narcotics, internal fetal monitoring, induction, and operative delivery including forceps and vacuum extraction (ventouse) put the baby at greater risk of developing bruising and intercranial hemorrhage during or shortly after birth. Planning a low intervention birth limits risks to the baby and mother by reducing risks associated with these interventions.

1. Consider requesting an oral dose rather than an injection.

This eliminates the overdose and lessens the risk of hemorrhage and jaundice, as well as the pain of the injection and exposure to harmful preservatives.  Also, the Vit K is absorbed through the gut, as it was intended to be.  While this may seem like an easy solution, be sure to discuss this option first with your care provider.  Since hospitals are accustomed to standard operating procedure, it can be difficult for them to correctly determine the oral dosage for your infant.

Some hospital pharmacies may not stock oral Vitamin K. In this situation, you may wish to refuse the injection and administer the oral dose yourself. Oral vitamin K can be purchased online here and this is an oral dosing protocol you may wish to follow.

2. Nurse immediately after the birth with no supplementation given.

3. During the last few weeks of pregnancy, load your diet with foods rich in Vit K.

While this hasn't been shown to improve newborn vitamin  K levels, it has been shown to increase the amount of Vit K in breastmilk.

By following these simple solutions, you can receive the benefits of an accurate newborn vitamin K dose while avoiding all the negatives of an injection.

References

Puckett RM, Offringa M. Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002776. DOI: 10.1002/14651858.CD002776.

Hey, E. Vitamin K--what, why, and when.  Arch Dis Child Fetal Neonatal Ed. 2003 Mar;88(2):F80-3.

Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial haemorrhage in Shizuoka prefecture. Nishiguchi T, Saga K, Sumimoto K, Okada K, Terao T Br J Obstet Gynaecol 1996 Nov;103(11):1078-1084.

Plasma concentrations after oral or intramuscular vitamin K1 in neonates. McNinch AW, Upton C, Samuels M, Shearer MJ, McCarthy P, Tripp JH, L'E Orme R. Arch Dis Child. 1985 Sep;60(9):814-8.

[Effect of oral and intramuscular vitamin K on the factors II, VII, IX, X, and PIVKA II in the infant newborn under 60 days of age] [Article in Spanish] Arteaga-Vizcaino M, Espinoza Holguin M, Torres Guerra E, Diez-Ewald M, Quintero J, Vizcaino G, Estevez J, Fernandez N.  Rev Med Chil. 2001 Oct;129(10):1121-9.

Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Pediatrics. 2006 Apr;117(4):1235-42.

[Vitamin K 1 concentration and vitamin K-dependent clotting factors in newborn infants after intramuscular and oral administration of vitamin K 1] [Article in Hungarian] Goldschmidt B, Kisrakoi C, Teglas E, Verbenyi M, Kovacs I.  Orv Hetil. 1990 Jun 17;131(24):1297-300.

Vitamin K - An Alternative Perspective. Midwife Sara Wickham provides a much-needed update on vitamin K prophylaxis.  AIMS Journal, Summer 2001, Vol 13 No 2

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Page Last Modified by Catherine Beier, MS, CBE