Who is at Risk for Vitamin K Deficiency Bleeding?
To download the free Vitamin K handout, click here or on the image below!
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Links and resources:
Learn more by reading the Evidence Based Birth® Signature article on Vitamin K.
References:
- Mihatsch et al. (2016). “Prevention of Vitamin K Deficiency Bleeding in Newborn Infants: A Position Paper by the ESPGHAN Committee on Nutrition. JPGN Vol.
63(1). - Puckett and Offringa. (2000). “Prophylactic vitamin K for vitamin K deficiency bleeding in neonates.” Cochrane Database Syst Rev (4): CD002776.
- Shearer (2009). “Vitamin K deficiency bleeding in early infancy.” Blood Reviews 23(2): 49-59.
- Van Hasselt et al. (2008). “Prevention of Vitamin K deficiency bleeding in infants.” Pediatrics 121(4): e857
Transcript
Hi everyone, and welcome to the free video series about vitamin K. My name is Rebecca Dekker, and I’m a nurse with my PhD, and the founder of Evidence Based Birth. So, in 2014, I spent a year researching and working on an article for the public, all about the vitamin K shot for newborns.
This article was so popular and it had so many people reading it, the website kept crashing, and it took us a while to get the website back online to be able to handle the traffic. The article that we released was covered by multiple journalists, and even referenced by the Centers for Disease Control on their webpage about vitamin K.
So, why was this vitamin K articles so popular? Because it was so controversial, which seems kind of funny when you think about it, that a vitamin could be controversial. But I was blown away by the number of people who were upset by the research evidence on vitamin K. I had no idea how much misinformation there was out there about the vitamin K shot for newborns.
So, in these free videos, we’re going to talk a little bit about the misinformation that’s out there, and we’ll talk about the research evidence, the facts. So, let’s start with the why. Why are babies all around the world given vitamin K shortly after birth?
Well, vitamin K has been given to most babies since the 1960s. Because in the 1940s and the 1950s, researchers discovered that by giving vitamin K to babies shortly after birth, they could prevent cases of severe bleeding among those newborns and death due to bleeding.
Vitamin K is an essential part of preventing bleeding, and for some unknown reason, it exists in very low levels in newborns and in mother’s breast milk. Before you routinely gave vitamin K shots to all newborns after birth, in Europe, about four to seven babies per 100,000 had what we call a late vitamin K deficiency bleed.
With the onset of the shot, the rate is closer to zero babies per 100,000. Now, rates of vitamin K deficiency bleeding were even higher in Asia. For example, in Thailand, it used to be that 80 babies out of every 100,000 had a late vitamin K deficiency bleed, and that dropped down to about six babies per 100,000 after introduction of vitamin K supplements for newborns, either through a shot or through oral doses.
Many parents ask us, “How do I know if my baby is one of those few babies who will be at risk for bleeding?” And they’ll say to me, “If I knew my baby was going to have a bleed, potentially in their brain, then I would definitely have them get the shot. But what if my baby is one of those many who won’t develop bleeding in the brain? Then, I’d be giving them something unnecessary that could cause side effects, right?”
Well, here’s the tricky part. Bleeding due to vitamin K deficiency is rare, but the results are potentially catastrophic. This type of bleeding happened suddenly without warning, and the bleeding in the brain that happens with a vitamin K deficiency is not related to getting a knock on the head or something like that.
It’s simply happens spontaneously without warning and without reason other than the vitamin K deficiency. The only reason a baby starts bleeding with vitamin K deficiency is because they don’t have enough vitamin K to keep their blood clotting appropriately. And we cannot predict with any certainty which babies will have this type of bleeding and which will not.
The only thing that we do know about risk factors is that the two main risk factors for this type of bleed are not being supplemented with vitamin K after birth and exclusively breastfeeding. So, if you’re exclusively breastfeeding your baby and you chose not to supplement with vitamin K after the birth, your baby is one of the ones at higher risk.
Now, wait, you might be saying, “You just said breastfeeding? Isn’t breast mill nature’s perfect food?” Well, the truth is, breast milk is amazing, and it has so many, many beneficial qualities. However, it does contain very limited amounts of vitamin K, no matter how much the mother is taking in her diet.
Also, as I said earlier, babies are born with very small amounts of vitamin K in their body, because it doesn’t pass through the placenta well from the mother to the baby. So, it’s not stored in the cord blood. So, delayed cord clamping doesn’t help with that.
And so, babies are born with limited amounts of vitamin K in their body and they get very tiny amounts from breast milk. This means they’re going to have very low levels of vitamin K until they reach about six months of age and they start eating solid foods.
This is because vitamin K primarily comes from plants. About 90% of the vitamin K in your body comes from plant-based foods. So, during this six month period, before babies eat solid foods, they’re at risk for both experiencing bleeding in the brain and bleeding in the intestinal track due to not having enough vitamin K.
Wait. So, you might be asking, “So, that’s it? Really? Those are the two things that put a baby at risk for bleeding, breastfeeding and not receiving vitamin K?” Yep, that’s it. Remember, this is a rare but catastrophic problem, so researchers have not been able to figure out why some babies bleed with vitamin K deficiency and others might not.
A great example is a set of twins that were born in Tennessee and were covered by the news media and also in a research article. The parents declined the vitamin K shot at birth, and a couple months later, one of the twins developed a severe bleed in the brain.
Both of the twins had severe vitamin K deficiency, but only one of them started bleeding and the other had not yet started bleeding. So, it just goes to show you we can’t predict which babies are going to bleed with lower levels, or at which point the vitamin K gets low enough that they start bleeding.
One other risk factor that I haven’t mentioned yet is undiagnosed gallbladder or liver problems in the baby. But this problem is rare. It only happens in about one out of 20,000 newborns. Also, people don’t typically know that their baby has a gallbladder or a liver problem until the baby starts bleeding.
And just so you know, these types of gallbladder or liver problems are not related to adult gallbladder or liver problems. So, having a family history of gallbladder or liver disease has nothing to do with babies developing gallbladder or liver disease.
Now, a lot of people email us and they really get stuck on the breast milk factor. They all say things like, “But breast milk is nature’s perfect food. How could nature design something that’s so wrong?” Or, they’ll say things like, “How could mother nature or God or evolution designed something that’s faulty?”
Well, I go into more detail on this on some of the courses we teach inside our Evidence Based Birth professional membership. But basically, we don’t know why this is, why vitamin K levels are so low in breast milk. What we do know is that babies received very limited amounts of breast milk, and most infants will be okay with that.
But if you will experience severe vitamin K deficiency and severe bleedings that are bad enough to cause brain damage or death and we don’t know ahead of time which infants will experience that. Another thing that people get stuck on is they’re worried that there might be preservatives or toxins in the shot.
If you visit evidencebasedbirth.com/vitamink, you’ll see our big long signature article with all the research information on this topic. And we list all the ingredients in both the regular shot and the preservative free shot. If parents are really concerned, they can ask for the preservative free version of the shot.
Also, in that article, we go over the side effects, which are all minor side effects such as redness, swelling and pain at the injection site. This is definitely a controversial issue, and I’m totally aware and sensitive to the fact that there are a lot of rumors, myths, and misinformation floating around on the internet.
The focus on these myths has led a lot of parents to decline or refuse the vitamin K shot. We just actually had the first study published on vitamin K refusal in the United States. The study was conducted through the BORN network, which includes newborn nurseries in 34 states.
More than half of the respondents reported an increase in parents refusing vitamin K shots in the last five years. The most common reasons for refusing the shot were: the perception from parents that the shot is unnecessary, parents not understanding the role of vitamin K in preventing bleeding and concerns about preservatives in the shot.
So, in summary, vitamin K deficiency can cause severe bleeding in infants, and infants are at higher risk if they’re exclusively breastfed and they did not receive any supplemental vitamin K after birth. There are a lot of myths and rumors floating around, and there’s been an increase in parents refusing vitamin K for their newborns.
I think one thing that we need to do is to look at the facts and talk about the actual research on vitamin K, and you can do that by visiting evidencebasedbirth.com/vitamink. Another possible solution is to offer parents an oral solution of vitamin K rather than the shot. Oral vitamin K drops for babies are common in countries such as Canada or the United Kingdom, the Netherlands, Germany and Switzerland.
But it’s a little complicated in the United States because there is no FDA approved oral vitamin K drops for infants. We’re going to talk more about the option of oral vitamin K in your next video. That’s it for this video. Thanks for watching.
Please make sure to download the free handout that goes along with this video. I’ll put the link to that here on the screen. And stay tuned for the next video, where we’ll talk about the option of using an oral dosage of vitamin K instead of the shot. Thanks everyone. Bye.