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Vitamin K for your baby at birth?


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It's fairly standard practice for the hospital to give your baby Vitamin K either in injection or liquid form soon after it is born. Often they will do this without discussing it with you.

See Vitamin Kas it's a slightly contraversial issue anyway, and it's worth knowing your options.

My query / concern is whether a baby born to a mother (or father) with PSD should be given this Vitamin K at birth. Our babies have a 50% chance of inheriting PSD and if they have inherited it, could the Vitamin K shot/liquid cause clotting problems in our newborns?

Is it worth, perhaps, avoiding it given that it's a fairly rare disorder that it will prevent, that there are risks associated with it, and chances are our baby will have the opposite problem?

FYI: My son was given the oral version of Vitamin K at birth, and I wasn't consulted beforehand. I don't yet know if he has inherited PSD because he's too young to be tested, but he didn't have any clotting issues. I would like to know if this was luck or whether it's irrelevant to the PSD issue. Do any of you have any information or thoughts about this subject?

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The typical risk period for Protein S Deficiency is late teens onwards. If you are taking warfarin you are advised to avoid foods high in Vitamin K because they will disrupt your INR. However, if we were all taking a different drug (say Exanta) they we might not be concerned with our Vitamin K intake at all.

The issue of Vitamin K supplement for newborns really serves to highlight how we get our normal Vitamin K intake... most of which is from bacteria in the gut, and some from our diet. Babies have very little vitamin K in their bodies at birth. Vitamin K does not cross the placenta to the developing baby, and the gut does not have any bacteria to make vitamin K before birth. After birth, there is little vitamin K in breast milk and breastfed babies can be low in vitamin K for several weeks until the normal gut bacteria start making it. Infant formula has added vitamin K, but even formula-fed babies have very low levels of vitamin K for several days.

With low levels of vitamin K, some babies can have very severe bleeding - sometimes into the brain, causing significant brain damage. This bleeding is called haemorrhagic disease of the newborn (HDN). The injection/drops of vitamin k are given to prevent HDN, to give the baby a headstart on getting their vitamin k up to a safer level.

I think that this issue is unrelated to PSD (though I can't offer any evidence to say so) but it does raise the important point of informed consent for the 'routine' injection/drops given at birth.

I've read the article you mentioned but think it might be a little on the scary side. I think that this article is a litle more balanced... http://www.betterhealth.vic.gov.au/bhcv2/b...es?OpenDocument

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Thanks for the info James (although that URL doesn't respond?)

When I was pregnant with my first child, the ante-natal class teacher handed out leaflets printed by the local health authorities (London, UK) which highlighted the possible risks, and they informed us that our local hospitals would give our babies an oral dose unless we requested otherwise. Because I had a rather rushed c-section we basically forgot about it until it was too late and they had already administered it to him, but we weren't particularly concerned.

The 'scary' URL contains the same information as the local health authorities in London had printed and distributed, I guess Australia has a slightly different approach to the Brits! There are differences in alot of baby related stuff worldwide and the approach each countrys health system has. For example, here in Canada most mothers I've met take their babies for their 'needles' in the first few years of life, and if you ask them what the needle is for, they have no idea. Also, without the MMR vaccine your child is not allowed to attend school (despite any misgivings you may have about it). I think we Brits tend to be given more (granted, sometimes confusing) information, and and therefore perhaps question things a little more.

I guess I'm only concerned about it (Vitamin K) now because of the PSD. I'm personally satisfied with the safety of the oral dose of Vitamin K for babies, I'm less happy with the vaccine version, and I just want to be certain that there wouldn't be any kind of issue for a baby born with PSD, perhaps being a bad idea to give it any extra help with clotting. I guess the answer is that it's probably not an issue...

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Thanks for the info James (although that URL doesn't respond?)

Darn, the URL doesn't work for me either! I guess their server is down. Here is Google's cache of the page in case we don't get to see it again...

http://www.betterhealth.vic.gov.au/bhcv2/b...es?OpenDocument

http://66.102.11.104/search?q=cache:uJVBhu...&hl=en&ie=UTF-8

Vitamin K and newborn babies

?

Vitamin K is needed by humans for blood clotting. Older children and adults get most of their vitamin K from bacteria in the gut, and some from their diet. Without enough vitamin K, small cuts can go on bleeding for a very long time and big bruises can happen from small injuries. Bleeding can also occur in other parts of the body, such as the brain (causing one type of stroke).

Babies have very little vitamin K in their bodies at birth. Vitamin K does not cross the placenta to the developing baby, and the gut does not have any bacteria to make vitamin K before birth. After birth, there is little vitamin K in breast milk and breastfed babies can be low in vitamin K for several weeks until the normal gut bacteria start making it. Infant formula has added vitamin K, but even formula-fed babies have very low levels of vitamin K for several days.

With low levels of vitamin K, some babies can have very severe bleeding - sometimes into the brain, causing significant brain damage. This bleeding is called haemorrhagic disease of the newborn (HDN).

Informed consent

For more than 20 years, all newborn babies have been given vitamin K at birth, by injection. This has been found to be very safe, and HDN was not seen in Australian babies. However, although the program was in place to give the injections, most parents did not get any information about the injection and why it was given. When some concern about its safety was published in an international journal, there was a considerable outcry - not so much about its safety (it was quickly shown to be both extremely safe and extremely effective), but about the fact that parents were not given information about the need for the injection, or given the opportunity to make an informed decision about an injection given to their baby.

Injections or drops

For a short time, when concerns were first raised about the safety of vitamin K injections, parents were given information to make an informed decision and they were offered the opportunity to have their babies given vitamin K by drops, rather than injection. Two doses of drops were needed for all babies (one at birth and one 3 to 5 days later), and another in the fourth week, if the baby was breastfed.

During the time that many babies were getting vitamin K by drops, several babies in Australia had severe episodes of bleeding, which were probably due to HDN. It seemed very clear that getting vitamin K by one injection is far safer and more effective than by three sets of drops.

It's your choice

Parents do not have to allow their baby to have a vitamin K injection, but it is very strongly recommended that they do give permission for it. Vitamin K injections have been routinely given in Australia for over 20 years, with no ill effects at the time of the injection, or later. Some babies have a slight soreness for a day or so at the injection site. Vitamin K injections remain the best preventive measure for reducing the risk of haemorrhagic disease of the newborn.

Child Health Record

When a baby is given vitamin K by injection or oral dose, this needs to be recorded in the child's Health Record. The Victorian Child Health Record is given free of charge to parents after the birth of their baby.

Where to get help

* Your doctor

* Maternity hospital

* Maternal and Child Health nurse.

Things to remember

* Vitamin K is needed for blood clotting.

* Newborn babies are given vitamin K injections to prevent a serious disease called haemorrhagic disease of the newborn (HDN).

* Vitamin K can be given by mouth if preferred, but oral doses aren't as effective. ?

?

Related articles:

Vitamins and mineral supplements.

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Article publication date: 26/04/2001

Last reviewed: April 2003

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This article, like all articles on the Better Health Channel, has passed through a rigorous and exhaustive approval process. It is also regularly updated. For more information see our quality assurance page.

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When my third child was due I was also worried about Vit K so spoke to the thrombophilia team. I put to them the same thoughts that you have expressed and they talked me through what James has posted.

Their advice was that all babies regardless of maternal clotting tendency should be given Vitamin K as the risk of bleeding being fatal was significant. Then they said that I should weigh this up against all the other issues surrounding Vit K (drops v injection etc) but that they would still advise accepting it.

She had the drops and to be honest I haven't thought about it since.

Sometimes there are too many decisions aren't there? And you are right; there is a lot on information here in the UK, which I believe to be no bad thing.

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Thanks for the information, orangefoot and James both!

It is good to have all the information easily accessible to us, Brits seem to be exposed to more than perhaps citizens of other countries, I think. Sometimes there is bliss in ignorance though! I know that there's little, if any, criticism of the MMR vaccine or Vitamin K, or those other slightly controversial issues on this continent (N. America). I remember being very torn by the MMR issue when my son was of age whereas here they look at you as if you're insane if you voice any doubt about it! Sometimes I wish I didn't have some information, it would make life a whole lot less stressful :rolleyes:

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  • 3 years later...

It has concerned me that giving the Vitamin K injection to a newborn when you've got a clotting disorder might not be the best course of action. Our PSD children have a 50% chance of having the disorder and I am not too sure that giving them a clotting agent is wise. I had no medical backup for my theory but I just came across this on a website so I thought I would C&P it. Obviously it refers to FVL but maybe PSD would have similar concerns.

Midwifery Today E-News (Vol 2 Issue 19) is a special on Factor V Leiden (FVL) - a genetic condition which increases the chances of blood clots developing. Depending on the area, between 3% and 10% of caucasian people carry the FVL gene; no stats are given for people from other ethnic groups, and it is implied that it is a caucasian anomaly. The baby of someone carrying FVL has a 50% chance of carrying it too, and the author speculates that routine vitamin K administration could be dangerous for these babies. Interesting thought - and how many areas routinely test women for the condition? If they don't, routine vitamin K adminitration could be putting their babies at risk.

I've copied an excerpt below:

o=o=o=o=o=o=o MIDWIFERY TODAY E-NEWS :a publication of Midwifery Today, Inc. (www.midwiferytoday.com)

Volume 2 Issue 19 May 12, 2000

Factor V Leiden Code 940

o=o=o=o=o=o=o

All the following information on Factor V Leiden has been prepared by Jennifer Rosenberg, CD (DONA).

Pregnancy, Clotting, and Factor V Leiden: An Overview

The past 10 years have brought new understanding of and explanations why some women clot on birth control pills and during pregnancy. Research into genetic origins of disease has uncovered many coagulopathies, some of them surprisingly common. The most common is Factor V Leiden, also known as Activated Protein C Resistance, which carries a 3-10 times greater risk of clot when someone has one copy of the gene and 30-140 times greater risk of clotting for someone with two copies.

Between 3% and 10% of Caucasian people are heterozygous for Factor V Leiden, and a much smaller percentage are homozygous. In Sweden the rate of heterozygous mutation may be as high as 15% in some areas, while in other parts of the world and among other races only a fraction of a percent of the population may have it. It is thought that the original mutation occurred as much as 20,000-30,000 years ago in a single individual.

Women with Factor V Leiden (FVL) have a substantially increased risk of clotting in pregnancy (and on estrogen containing birth control pills or hormone replacement) in the form of DVT (deep vein thrombosis, sometimes known as "milk leg") and pulmonary embolism. They also have an increased risk of preeclampsia, as well as miscarriage and stillbirth due to clotting in the placenta, umbilical cord, or the fetus (fetal clotting may depend on whether the baby has inherited the gene). Note that many, many of these women go through one or more pregnancies with no difficulties, while others may miscarry over and over again, and still others may develop clots within weeks of becoming pregnant.

... Remember that approximately one in twenty of the women you serve will have FVL. Approximately one in a hundred of women with FVL (estimates vary radically from a 1% thrombosis rate (4) to a 25% thrombosis rate (my hemotologist) will have a serious DVT during pregnancy...

FVL is inherited. This means that for every pregnant woman who has FVL, the child she carries has at least a 50% chance of inheriting the disease (more if the father also has it). ..

Vitamin K encourages clotting, and thus there is some concern among parents with FVL about giving their newborns the prophylactic vitamin K bolus. At the very least such treatment should NOT occur immediately after birth, when hormone levels are still up, in my opinion as a parent. And it may be advisable (though research has not been done!) to do the quick screening test for FVL (not the genetic test; this test simply checks to see how resistant clots are to activated protein C) prior to giving the infant vitamin K later. Perhaps testing cord blood for APC resistance immediately after birth and only giving negative babies vitamin K would be reasonable. Another approach would be to delay the vitamin K shot for 6-12 hours if not longer, to allow hormone levels to drop. I am aware of one family that feels their baby's death was caused by the vitamin K shot. Although the story is completely anecdotal, it echoes fears I had with my own daughter.

(End of excerpt from Midwifery Today E-news. Please visit the Midwifery Today website at www.midwiferytoday.com.)

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http://www.betterhealth.vic.gov.au/bhcv2/b...es?OpenDocument

http://66.102.11.104/search?q=cache:uJVBhu...en&ie=UTF-8

Vitamin K and newborn babies

Vitamin K is needed by humans for blood clotting. Older children and adults get most of their vitamin K from bacteria in the gut, and some from their diet. Without enough vitamin K, small cuts can go on bleeding for a very long time and big bruises can happen from small injuries. Bleeding can also occur in other parts of the body, such as the brain (causing one type of stroke).

Babies have very little vitamin K in their bodies at birth. Vitamin K does not cross the placenta to the developing baby, and the gut does not have any bacteria to make vitamin K before birth. After birth, there is little vitamin K in breast milk and breastfed babies can be low in vitamin K for several weeks until the normal gut bacteria start making it. Infant formula has added vitamin K, but even formula-fed babies have very low levels of vitamin K for several days.

With low levels of vitamin K, some babies can have very severe bleeding - sometimes into the brain, causing significant brain damage. This bleeding is called haemorrhagic disease of the newborn (HDN).

There is probably an issue with informed consent and awareness of the purposes of the injection but Vitamin K is not our enemy. We are told by doctors to be careful with our Vitamin K intake if we are taking warfarin but this is a drug related problem, not a Protein S related problem. An injection of Vitamin K is also used to reverse heparin in an emergency.

Left to our own devices, without the injection at birth, we will develop the ability to create Vitamin K in our gut anyway. The injection just gives us a little boost whilst we are waiting for the digestive system to get going.

The article you have referred to seems to suggest that by giving the injection the balance between getting a clot or not is somehow tipped into a dangerous state. Therefore, in a few weeks time, when the newborn's body starts producing Vitamin K (naturally, whether we like it or not) would it shift the blood clotting cascade into a perilous state? I don't think so. It is also probably worth remembering that for the majority of people that are unlucky enough to have inherited the genetic disposition to PSD the likely period for onset of thrombosis is late teens onwards.

There are babies that have severe problems with PSD, so it might be a good idea for them to investigate this issue further, however I can't see how the doctor could conceivably balance the Vitamin K levels in the baby against the Protein S deficiency, especially if the baby is going to naturally produce the Vitamin K in due course. It is very difficult to regulate one deficiency with another.

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I went around and around about this again when expecting Frida - just as you are now I expect. I have read Jennifer Rosenberg's articles for Midwifery today before and have not always agreed with her analysis of thrombophilia. She has FVL herself which is why she writes on it.

There is a lot of anti VitK feeling among midwives here (http://www.radmid.demon.co.uk/archive.htm) even the oral version which I think comes partly from the logical thought that babies are generally born with what they need. Levels of a variety of things in little people's bodies are less than in adults and that must be for a reason - as pregnant women have lower protein s for example. Breastmilk is only considered to have lower levels of vitamin K because it is compared to formula. Formula contains many ingredients but the exact composition of breastmilk is not known and may vary from mother to mother so who is to say that there is not some other component of breastmilk having x or y effect?

The other thought is that it is important to treat the intestinal tract of a newborn very carefully and that even drops are an odd thing to introduce into the system at an age where the gut is not yet sealed and absorbtion of any substance is very fast due to the open state of the gut. Which is co-incidentally the reason why the introduction of solids has been moved to 6 months in order to reduce the possibility of reactions to wheat etc which are readily absorbed by the body before this age and are thought to contribute to food sensitivities in later life.

Thinking about the role of vitK as described here

Vitamin K is a cofactor needed for the synthesis (in the liver) of

factors 2 (prothrombin), 7, 9, and 10

proteins C and S

So a deficiency of Vitamin K predisposes to bleeding

It looks as though the lack of prothrombin and other factors is what prevents clots forming because we already know that low Protein S or Protein C predisposes to clotting. What a tangle.

Konakion solution can be administered either orally with a dropper or intramuscularly (sp?) so I am not sure why it is administered orally here but the US seems to prefer injection.

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There are probably three schools of thought:

1/ have the injection, it will help to kickstart Vitamin K levels

2/ don't have the injection, the baby doesn't need it

3/ don't have the injection, it could cause thrombosis

Personally I'd be happy for my child to have the injection. And I would respect anyone that felt the second option was more appropriate. However I don't subscribe to the third point of view. Vitamin K is important to the normal blood clotting process, as an adult it isn't something you would take as a supplement, and our wariness to it only seems to stem from problems with the way in which some anticoagulant drugs work. We don't need to stigmatise Vitamin K.

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Thanks guys - am amused by my pregnant brain forgetting I started this debate last pregnancy too!

Couple of points.

Oral Vit K - wasn't this trend started during the vit k injection = leukemia scare (now debunked) ? I know St Thomas's hospital in London offered it as standard for a while, because of this.

Newborn Haemorrhagic Disease - somethign like 1 in 10,000 babies? Very rare.

I think I generally subscribe to James #2 point but given that it is State Law here in Washington to have Vit K given at birth, and refusal to do so means you are reported to Child Services (yes really), I am hoping that I can make a case for a pause for thought given the PSD situation.

My general feeling is that babies probably don't need Vitamin K and it's one of those things that's been accepted into widespread medicine without much justification other than a very rare disorder which most doctors have never seen. It's a little like the policy (again, law) of putting antibiotic cream into the eyes of a newborn to treat infections that the baby may have got coming through the birth canal. This is regardless of whether the mother has any infections. Or whether she has a c/section thus not exposing the baby anyway. Poor Harry had this done to him at birth and it clogged up his eyes and tear ducts for days, he could barely open them. I would rather not have them done this time, esp. as I'll be having a c/section, but again I have no choice.

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  • 2 months later...
Guest natalieb

Hi - sorry to come late into this debate. My 3 children all have factor v leiden (from my husband) and my middle son has protein s deficiency and a raised factor viii level.

When we were expecting our youngest son, we went through the vit k injections/ drops issue and felt very strongly that he should have the drops. Being in the uk, the hospital agreed and ordered in the drops.

However, 2 weeks before the due date, I developed obstectric choleostatis - where I itched and itched and itched! It is caused by a build up of bile salts under the skin when the liver starts to function properly.

We discovered that it put our son at risk of haemorragic disease of the newborn. He had the injection as soon as he was born.

Risks change, and advice changes.

Best wishes with your decision, Natalie.

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  • 2 weeks later...

I just had an interesting chat with my perinatologist about this issue.

He was intrigued by it, and is going to research, discuss with hospital pediatricians, and call me back.

One thing he did say was that the risk of haemorrhagic disease is X and the risk of clotting is Y, and in the case of potential inherited clotting disorders the clotting risk (Y) is going to be higher, and he would be interested to find out which wins out in the risk/benefit ratio but that the concern of giving it made alot of sense to him.

NB: The amount of Vit K given to a newborn is 9000 times the amount of a normal adult. Just re-reading over the thread and there was mention of the potential risks with whether when the bodies normal system kicked it wouldn't that put you over the edge anyway... I'm thinking not, given that the normal level of a baby is considerably lower than this.

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It is interesting to have different perspectives on this from a clotting point of view.

The oral form is the only form offered in our area and I expect all over the UK. As soon as she had had the drops Frida brought up milk and the vitK and our health visitor said that sometimes she wasn't sure that the babies actually held the liquid (0.2ml) down at all. This may be an advantage or disadvantage depending on which side of the fence you are on.

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Something has just occured to me about the Vit K issue.... having decided not to go ahead with it. I apologise if I've ever posted this before, I have pregnancy brain and can't remember but would appreciate any input.

Breastfeeding while on Lovenox..... tiny amounts may pass into the breastmilk, correct? Ergo, will I be putting my baby at increased risk for clotting and therefore should I do the Vit K after all?

Yours confusedly.

K x

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AFAIK the whole reason that LMWH is ok when breastfeeding is because is molecules are too large to pass from blood to milk

However, one recently published abstract deserves mention because it contains information regarding lack of transfer of LMWH into breast milk. Blood and milk samples were obtained from 15 breastfeeding women on days 3-5 after cesarean section.[54] At 3-4 hours after injection of dalteparin (Low Liquemin; Roche, Nutley, NJ) 2500 or 5000 U, anti-Xa activity ranged between 0.074 and 0.308 U/ml in maternal plasma and between less than 0.005 and 0.037 U/ml in breast milk. No significant correlation between plasma and milk anti-factor Xa activity was noted. Low milk levels are considered of little clinical relevance.[54]

http://www.medscape.com/viewarticle/418033_10

As you know misinformation and lack of support for breastfeeding is one of my bugbears. Googling just now to find you an answer I found links to my own posts here and elsewhere :blink:

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