Townsend described 50 cases of bleeding in newborns. Townsend was the first person to figure out that there was a connection between poor or insufficient breastfeeding and bleeding in newborns Shearer In , a Danish biochemist found that Vitamin K deficiency was the cause of unexpected bleeding in baby chicks Lippi and Franchini In , a definitive Swedish study was published including more than 13, infants who were given 0.
The researcher found that infants who received Vitamin K experienced a 5-fold reduction in the risk of bleeding to death during the first week of life. It was estimated that for every , full-term infants who were born, Vitamin K would save the lives of infants per year Lehmann Table 1: Newborn deaths due to bleeding before and after Vitamin K was introduced on September 1st, Lehmann, In , after nearly 2 decades of research had been published, the American Academy of Pediatrics recommended giving Vitamin K shots after birth.
This practice has been the standard of care in the U. The new name also reflects the fact that some infants begin bleeding later in infancy—after the four-week newborn period is over Shearer When infants do not receive any Vitamin K at birth , statistics from Europe show that 4. When infants receive mg of oral Vitamin K once at birth , anywhere from 1.
When infants receive 1 mg of oral Vitamin K at least three times during infancy typically at birth, one week, and four weeks , about 2. When infants receive 2 mg of oral Vitamin K at least three times during infancy at birth, 4 to 6 days, and 4 to 6 weeks or 2 mg of oral Vitamin K after birth and 1 mg of oral Vitamin K every week for three months , statistics from Germany, Switzerland, and Denmark show that somewhere between 0 to 0.
When infants receive the Vitamin K shot at birth , anywhere from 0 to 0. What are the potential consequences of late VKDB? Is that dangerous?
What is the treatment for Vitamin K deficiency bleeding? Why do breastfed babies not have enough Vitamin K? There are two main reasons why babies do not have enough Vitamin K in their system. The levels are low because: Very little Vitamin K1 transfers from the mother to the baby through the placenta Babies do not have enough bacteria in their intestines to make Vitamin K2.
Why are formula-fed babies protected from Vitamin K deficiency bleeding? How much Vitamin K is in the shot and how much might actually be needed to produce the desired result? Why do some parents refuse the shot? What are the ingredients in the shot? The ingredients in a shot with NO preservatives include: 1 mg of Vitamin K1, a fat-soluble vitamin derived from plants 10 mg of Polysorbate 80, which helps Vitamin K1 a fat-soluble Vitamin dissolve in liquid for the injection.
Polysorbate 80 is made from natural sorbitol and plant-based oleic acid, is used in a wide variety of foods, medicines, and vitamin supplements, and is included in the Handbook of Green Chemicals. Propylene glycol has been recognized as safe by the FDA for use in food products. Does circumcision increase the need for Vitamin K injection? Does eating a Vitamin K rich diet during pregnancy and nursing raise Vitamin K levels in newborns?
What is the take-away point on giving Vitamin K1 to the mother? Why is the Vitamin K1 injection the preferred method in the U. The shot is absorbed more easily than the oral version. The shot has a delayed release effect that protects against both classical and late bleeding.
When the shot is used, the chance of late VKDB is near zero does not completely eliminate the risk in cases of underlying liver or gallbladder disorders The 3-dose regimen of 2 mg oral Vitamin K1 also lowers the chance of VKDB to less than 1 in , births, but probably does not eliminate it as well as the shot Mihatsch et al.
Why do so many countries use different regimens? If all infants are born with low Vitamin K levels, is it really a deficiency or is this the natural design of human beings?
When infants are born, many of their systems are not fully developed yet. For example, their nervous system and immune system are immature. Maybe there is an unknown beneficial mechanism that is preventing some kind of environmental toxin from reaching the baby, and this mechanism also has the side effect of keeping Vitamin K from reaching baby in sufficient quantities through the placenta and breastmilk.
Are there any other risk factors for late VKDB, aside from breastfeeding? Do you need Vitamin K if you have a trauma-free birth? Do we perceive a need for Vitamin K simply because it was studied during years of operative vaginal births forceps, vacuum when babies were cord clamped immediately and taken away from their mothers with no breastfeeding at all? There is simply no evidence to support this theory. What is the exact number of lives saved with the Vitamin K shot?
Is there a risk of leukemia associated with injection? The short answer is no. The long answer is that this is a really interesting story: In , a British newspaper reported that researchers had found a link between Vitamin K injections and childhood leukemia Golding, Greenwood et al.
The two highest-quality studies on this issue were published in and In , researchers combined data from six major studies that looked at the potential relationship between Vitamin K and childhood cancer. There were 2, children with cancer and 6, children without cancer in these studies.
The researchers found no association between injectable Vitamin K and any type of childhood cancer Roman, Fear et al. In , researchers in Great Britain conducted the highest-quality study to date to determine whether there was a relationship between Vitamin K and childhood cancer.
In this study, there were 2, children with cancer half of whom had leukemia and 4, children without cancer. Is anyone keeping nationwide stats on how many infants get Vitamin K, and how many infants develop bleeds? Table 2 shows details on Rates of late Vitamin K deficiency bleeding in infants with no Vitamin K, different regimens of oral Vitamin K, and Vitamin K shots What is the evidence for the oral and injectable versions of Vitamin K? Are they effective? What treatments did the researchers study?
Seven studies compared one dose of oral Vitamin K to one dose of injectable Vitamin K. Doses ranged from mg and were given within 12 hours of birth. Four studies compared one dose of oral Vitamin K to nothing or placebo. Four studies compared one dose of injectable Vitamin K to nothing or placebo.
One study from the U. Is there any evidence that Vitamin K can prevent late Vitamin K deficiency bleeding? Why does oral Vitamin K sometimes fail to prevent bleeds? What about the daily and weekly oral regimens for Vitamin K? The Netherlands and Denmark had different protocols: In the Netherlands, until , all infants had 1 mg of oral Vitamin K1 after birth , and breastfed infants had 25 micrograms mcg daily by mouth from week 2 until week After , all infants had 1 mg Vitamin K shots at birth.
The results? Is it possible to buy oral Vitamin K for infants? What are the pros of the Vitamin K shot? Causes pain, which can be minimized by having the infant breastfeed while the shot is given Can cause bleeding or bruising at the injection site If the baby has undetected gallbladder or liver disease, the shot still may not protect them from VKDB What are the pros of oral Vitamin K?
Easy to give and not invasive pain-free The 3-dose regimen of 2 mg Vitamin K1 lowers the risk of classical and late VKDB to under 1 per ,, but is probably still not as effective as the injection, which has incidence rates even closer to zero. The weekly regimen seems to protect infants with undiagnosed gallbladder problems just as well as the shot does.
The 3-dose regimen of 2 mg Vitamin K1 has not been tested yet in this high-risk group. What are the cons of oral Vitamin K? Pucket and Offringa, Some babies may not be able to absorb it e. Requires that parents commit to giving at least three doses or weekly doses What are the current recommendations for giving Vitamin K?
References: American Academy of Pediatrics. Free full text. American Academy of Pediatrics Bolisetty, S. Gupta, et al. Click here. Busfield, A. Samuel, et al. Centers for Disease Control and Prevention Vitamin K Deficiency Bleeding. Accessed online April 9, Chuansumrit, A. Plueksacheeva, et al. Cornelissen, E. Kollee, et al. Cornelissen, M. Danielsson, N. Hoa, et al. De Winter et al. Ned Tijdschr Geneeskd.
Drugs and Lactation Database LactMed Fear, N. Roman, et al. Golding, J. Greenwood, et al. Greer, F. Marshall, et al. Greer et al. Improving the vitamin K status of breastfeeding infants with maternal vitamin K supplements. Pediatrics 99 1 : A new mixed micellar preparation for oral vitamin K prophylaxis: randomized controlled comparison with an intramuscular formulation in breastfed infants.
Arch Dis Child;79 4 Hanawa, Y. Maki, et al. Health Council of the Netherlands. Vitamin K for infants. The Hague: Health Council of the Netherlands, ; publication no. Ijland, M. Pereira, et al. Koklu et al. Lehmann, J. Lippi, G. Franchini Loughnan, P. McDougall A single vitamin K injection at birth is the most effective way of preventing this.
A single vitamin K injection at birth is the most effective way of preventing a serious bleeding disorder called vitamin K deficiency bleeding or VKDB.
Vitamin K is a substance in our bodies that helps our blood to clot and stops bleeding. Vitamin K is naturally present in the body and is made in the intestine from food. Vitamin K is made naturally in the intestine but as newborn babies have very little bacteria in their intestine, they do not make enough. As your baby grows they will start to make enough vitamin K.
VKDB is rare and the chance of babies developing it is small, even if they have not received extra vitamin K. But, if babies do develop VKDB, it can cause internal bleeding leading to death, or permanent damage to the brain and other organs. The most reliable way to give babies vitamin K is by one injection into the muscle in the leg intramuscular injection.
One injection just after birth will protect your baby for many months. All babies need vitamin K. This includes babies who are premature, very small or sick, as well as babies having surgery. Research and practice shows that giving Vitamin K by injection at birth is safe and effective. Research and practice shows that giving vitamin K by injection at birth is safe and effective. Babies in New Zealand, and in many other countries, have been given vitamin K injections for many years without problems.
Having the injection does not cause any health problems but some babies have a slight swelling or soreness at the site of the injection for a day or two. One study in the early s suggested that injections of vitamin K might be linked to one type of childhood cancer.
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. 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 safe and 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.
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 safer and more effective than by three sets of drops. Babies are born with very little vitamin K stored in their bodies. VKDB is a serious and potentially life-threatening cause of bleeding in infants up to 6 months of age. A: No, waiting to see if your baby needs a vitamin K shot may be too late. This can delay medical care and lead to serious and life-threatening consequences.
Breast milk contains only small amounts of vitamin K. That means that ALL newborns have low levels of vitamin K, so they need vitamin K from another source. A vitamin K shot is the best way to make sure all babies have enough vitamin K. Newborns who do not get a vitamin K shot are 81 times more likely to develop severe bleeding than those who get the shot. All four were over 6 weeks old when the bleeding started and they had been healthy and developing normally.
None of them had received a vitamin K shot at birth. Over the past two decades, many countries in Europe have started programs to provide vitamin K at birth — afterward, they all saw declines in the number of cases of VKDB to very low levels. In the early s in England, some hospitals started giving vitamin K only to newborns that were thought to be at higher risk for bleeding. They then noticed an increase in cases of VKDB. This tells us that giving vitamin K to prevent bleeding is what keeps VKDB a rare condition — when vitamin K is not given to newborns, cases of bleeding occur and VKDB stops being rare.
A: Babies without enough vitamin K cannot form clots to stop bleeding and they can bleed anywhere in their bodies. The bleeding can happen in their brains or other important organs and can happen quickly. Even though bleeding from low levels of vitamin K or VKDB does not occur often in the United States, it is devastating when it does occur.
One out of every five babies with VKDB dies. Of the infants who have late VKDB, about half of them have bleeding into their brains, which can lead to permanent brain damage.
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