Since the 1960s, the standard of care in U.S. hospitals is to give a baby a vitamin K shot at birth. But with growing suspicions associated with vaccines, many parents have shied away from all shots, including vitamin K.
The result is that more doctors are confronting a problem that’s hardly been seen for decades— intracranial hemorrhage, otherwise known as a bleeding brain.
In 2013, four otherwise healthy newborns from Nashville, Tennessee made headlines because they each suffered from brain bleeding between 6 and 15 weeks old. The common thread among these cases is that parents refused the K shot.
Dr. Karyn Kassis, an emergency medicine physician at Nationwide Children’s Hospital in Columbus, Ohio, witnessed a similar case. The 10-week-old baby she was treating was fussy, pale, and had a few flecks of blood in his diaper. But it wasn’t until she ran blood tests that Kassis realized her patient was suffering an intracranial hemorrhage.
“It’s one of these diseases that we thought had disappeared for the most part,” Kassis said. “A lot of us never saw a case of this and didn’t know to look for it. Unfortunately, things like child abuse are far more common and often much higher on our list of what this could be when we see babies with bleeding in the brain.”
Rare But Severe Consequences
Infant hemorrhage incidents are rare (about 1 in 10,000), but the presentation can be severe.
With some newborns, the consequences of vitamin K deficiency show up early. For example, boys may bleed excessively from their circumcision site.
Kassis said the more common and more dangerous presentation of vitamin K deficiency doesn’t emerge until several weeks after birth. For these late onset cases, over 50 percent of infants experience brain bleeding. The result can be seizures and coma, with a mortality rate of 20 percent. Survivors often suffer lasting neurological damage.
Because these late onset cases can be tricky to spot, Kassis wants health care providers to add a new screening question to their protocol—did your baby get a vitamin K shot at birth?
“It doesn’t cost any money, doesn’t expose the baby to any radiation and could really help you figure out what’s going on a lot faster than a lot of more expensive tests,” she said.
The Blood Clotting Vitamin
Vitamin K is required to make blood clot. It helps platelets stick together and adhere to surfaces so bleeding stops when tissue is damaged.
Newborn blood is similar to someone taking too much of the blood thinner drug, Coumadin. Coumadin works by reducing the amount of vitamin K in the blood to prevent clots from forming. The dose must be closely monitored, and patients taking the drug are often advised to limit their vitamin K intake so that levels stay consistent. The antidote to a Coumadin overdose is a vitamin K injection.
Vitamin K is abundant in green, leafy vegetables and a few fruits. Natural K supplements are often made from alfalfa.
However, even adults with poor diets rarely suffer a K deficiency. Bacteria in our colon store and synthesize an adequate reserve of vitamin K.
Babies, however, are born without a vitamin K reserve. Only a little of the vitamin crosses the placenta, and breast milk cannot deliver high enough levels to prevent hemorrhaging. Experts say infants who are exclusively breast fed are at greatest risk.
Some sources suggest that mothers-to-be can simply increase their intake of vitamin K before their due date. But according to the Centers for Disease Control, this strategy does not provide enough of the vitamin to remove the risk of injury. One study showed that even a mother who took large doses of K at the end of her term couldn’t transmit much of the surplus to her baby.
Without sufficient vitamin K, newborn bodies can bruise and bleed with little cause. Some suggest that nature has her reasons for keeping K levels low in the first days and weeks of a baby’s life. However, modern birthing methods require some concessions.
“In this very clean, very sterile environment that our babies are growing up in, we know that this is the way we have to do it,” Kassis said.
Scared of Shots
Shots are no fun for anyone, and vaccine wary parents are especially suspicious of needles near their children. But if it’s so important that babies get vitamin K, why not just administer it orally?
Several studies have considered an oral vitamin K, but a single oral dose has been found far less effective at preventing bleeding than the shot. The strategy of administering multiple doses presents other challenges.
“If you’ve ever had an infant, it’s hard to get them to take anything,” said Kassis.
There are valid protocols for oral dosing, but dedicated compliance is a must. The Cochrane Collaboration, a global independent network of doctors and researchers, reports that “very similar rates of protection against classical and late hemorrhagic disease can be achieved by giving repeated oral doses, either 1 milligram weekly or 25 micrograms daily. Undertaking this form of oral prophylaxis requires that parents accept responsibility for ensuring the course is completed.”
Oral dosing regimens can last about two months.
If infants spit up a dose, it must be repeated. For babies with absorption issues, oral dosing is not recommend. Researchers say another disadvantage of oral K is that it may not effectively prevent late onset bleeding in breast fed infants.
Talk to Your Doctor
Adding to the fears of needle-phobic parents is a 1990 study published in the British Medical Journal, which found an association between leukemia risk and babies who received a vitamin K injection. Two years later, the same author published a second study drawing a similar conclusion.
However, several subsequent studies from the United States and Europe and have since refuted the cancer link. The American Academy of Pediatrics recommends the injection for all newborns, and doctors from Canada and several European countries support a similar measure. The United Kingdom recommends the shot, but also supports an oral dose alternative.
If the shot sounds like the right choice for you, nothing special is required. It is the default option in U.S. hospitals.
But parents who tend toward a natural medicine approach can be difficult to convince. Even if the shot is approved by experts, the thought of injecting a newborn with a high dose of synthetic vitamins manufactured by a pharmaceutical company is hard to sell to the holistically minded.
Kassis said that if parents have any doubts or concerns about the vitamin K shot, they should discuss the risks and benefits with their doctor.
“It’s really, really important that families feel comfortable talking to their health care provider about their questions,” she said. “They should really think through their reasons for what saying no might be, and make sure they have a really educated discussion.”