Newborn Vitamin K Informed Choice

Vitamin K is a natural coagulant that helps a person’s body clot blood. Infants are born with lower levels of Vitamin K until around day 8 postpartum at which time it begins to be created/synthesized in the gut. Very rarely (1 in 20,000) an infant experiences internal bruising / bleeding because this process is interrupted for unknown reasons. In thinking about the prevention of this potentially health threatening situation, parents will need to make a decision regarding the administration of Vitamin K to their newborns.

There are four possible approaches to the Vitamin K decision: 

1. Newborn Injected Vitamin K: The current standard of care in the US is to administer a Vitamin K injection to newborns in the first few hours after birth.

2. Newborn Oral Vitamin K: Another approach (and current standard of care in some parts of the world) is to supplement newborns with regimented oral Vitamin K drops. The parents give the baby a weekly dose of oral Vitamin K for 12 weeks.

3. No Newborn Vitamin K Supplementation: Some parents choose to not supplement their newborns with prepared Vitamin K.

4. Maternal Vitamin K Supplementation: Maternal supplementation of Vitamin K (either oral drops or food-based) transfers into breast milk. Independent of parental choice regarding newborn Vitamin K supplementation, nursing mothers can impact the Vitamin K levels of their newborns via breastmilk by supplementing themselves. Note that this approach can be combined with one of the three approaches above. 

As is the case with any controversial decision, professional advice varies, feelings are strong, and “The Science” is mixed. Moreover, research on Vitamin K administration is often interpreted in opposing ways because it is far from fully explored or settled. This is a charged subject. Because all of the approaches above involve some small level of real risk, I encourage you to study each option, read original source research, evaluate the risks, and come to a decision compatible with your views.

Below are two opposing research based links to springboard your reading followed by a summarization of some global thoughts on each approach. As your advocate, you have my support in whichever route you choose. 

Pro-Newborn Injected:
http://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/ 

Pro-Newborn Oral, Pro-Maternal Supplementation:
http://www.mommypotamus.com/newborn-vitamin-k-shot/

Newborn Injected Vitamin K

Pros: When the shot is given, the chance of an excessive bleed in the infant is close to zero. Vitamin K is believed to store in the muscle and release over time, so it is protective for 6 months and there is no need for further Vitamin K supplementation.

Cons: There are minimal risks (severe reactions, toxicity, and rarely fatality) associated with the injection. Some parents are concerned about toxic ingredients - at least one brand (Hospira) contains aluminum. There is a preservative free brand that parents can request or purchase. Also, it is unknown whether such high levels of Vitamin K might cause other unintended harm. Infants may have pain, soreness, or redness at the injection site - nursing during the shot helps to comfort babies. 

Newborn Oral Vitamin K

Pros: Several countries (including Denmark and the Netherlands) have oral Vitamin K regimens that studies indicate are as protective as injected Vitamin K in preventing bleeding episodes. Oral Vitamin K is noninvasive and easy to administer. 

Cons: Drops need to be paired with feedings so that they are properly absorbed. Infants may spit up a portion of the drops or have underlying health issues that compromise absorption. Parents must remember to give the drops on multiple occasions. 

No Newborn Vitamin K Supplementation

Pros: Though not explored by research, some parents believe that Nature has a plan and infants are born with low Vitamin K for a reason. Others believe practices such as the administration of medicines and antibiotics, immediate cord cutting, and delayed or infrequent nursing in the first hours interfere with initial absorption amount and also compromise the infant’s gut flora, where Vitamin K is eventually produced. An overlapping theory is that maternal diets are lower in Vitamin K than those of primitive cultures, and available Vitamin K in breast milk is therefore less than it was historically. 

Cons: The above are speculations, not facts. We do not know why infants have low levels of Vitamin K. The large majority of babies will be fine without intervention, however, without a bolstering of Vitamin K levels in some way, some babies will experience brain injury or death from excessive bleeding. 

Maternal Vitamin K Supplementation 

Pros: Mothers can significantly increase the Vitamin K content of their colostrum and milk by taking oral drops and/or consistently eating high Vitamin K diets in the weeks before and following the births of their babies. Research supports that oral Vitamin K drops taken by the mother increases the Vitamin K content of her milk to sufficient levels and drastically lowers the risk of infant bleeding. Maternal supplementation (oral drops or food-based) can be done in addition to infant supplementation. 

Cons: While a maternal diet high in Vitamin K does translate to more Vitamin K in colostrum and milk, the levels of Vitamin K are much lower than levels available to infants through injected or oral supplementation. However, it is not known whether Vitamin K in milk may be absorbed differently than synthetic Vitamin K. 

This decision is not easy. All options involve risk. Independent of the route you choose, adding any of the following to your plan will support your infant: avoid medications and antibiotics for yourself and baby, eat a diet consistently high in Vitamin K, delay cord cutting, and breastfeed soon after birth and on demand. 

Ordering Information for Newborn Vitamin K Injection: I will have this on hand at your birth. The cost is $65. I will Venmo you a request for payment.

Oral drops: In His Hands Birth Supply - Bio-K-Mulsion Oral Vitamin K by Biotics Research Corporations

Newborn Oral Vitamin K Protocol in Denmark and the Netherlands 

Denmark (Hansen, Minousis, & Ebbesen, 2003): Give 2 mg at birth, followed by weekly 1 mg doses until 3 months of age 

The Netherlands (Cornelissen, von Kries, Loughnan, & Schubiger, 1996): Give 1 mg on the first day, followed by a low daily dose of 25 mcg starting at 1 week through 13 weeks