Articles:

https://publications.aap.org/pediatrics/article/149/3/e2021056036/184866/Vitamin-K-and-the-Newborn-Infant

https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Where-We-Stand-Administration-of-Vitamin-K.aspx

Key Takeaways

Vitamin K deficiency bleeding (VKDB) can occur in three time periods: early (1-2 days), classic (2-7 days), and late (2-12 weeks), with late VKDB being particularly dangerous and often presenting as catastrophic bleeding

Injectable vitamin K is superior to oral formulations because babies' immature guts don't absorb it well, there's no FDA-approved oral formulation in the US, and injectable vitamin K provides both immediate protection and stores vitamin K in the liver for months

Common myths about vitamin K include confusion with vaccines, concerns about the boxed warning (which applies only to IV formulations, not the newborn IM injection), leukemia risk (thoroughly debunked), and assumptions that it causes jaundice (not with current formulations)

Breastfed babies are at highest risk for VKDB because breast milk contains minimal vitamin K regardless of maternal diet or supplementation, while formula-fed babies receive vitamin K supplementation in their formula

Healthcare providers should approach each conversation about vitamin K with openness and adequate time, identifying the family's specific concern and providing evidence-based responses while offering strategies to minimize infant discomfort during administration

The rate of vitamin K refusal has increased significantly from 2.9% in 2017 to 5.18% recently, mirroring broader trends in medical distrust and requiring healthcare providers to be prepared for these conversations

While vitamin K quickly corrects laboratory abnormalities in babies with VKDB, the damage from intracranial hemorrhage or other serious bleeding often results in long-term complications or death, making prevention critical

Quotable Moments

"Vitamin K is one of your coagulation factors. It was actually discovered by two scientists back in the early 20th century who received the Nobel Prize for medicine for their discovery. And the K is because the word coagulation in German has a K in it."

"Babies are born with very low levels of it. Vitamin K doesn't cross the placenta well from mom into babies."

"Babies can have early vitamin K deficient bleeding, which is really within the first day or two of life, which is more related to mom being on certain medications"

"These babies can have kind of long-term impacts related to their bleeding complications."

"I've never seen early, that's the one I've never seen, but I've seen classic and I've seen late. It's really a, a tragedy when those things happen."

"The babies aren't very good at absorbing vitamin K just related to some of their gut immaturity. And then also because we don't have a standard uh, formulation of oral vitamin K in the United States."

"We've had several that have come in over the past year that have had bleeding into their brain with intercranial hemorrhage."

"If you're already having significant bleeding into your brain or into another kind of enclosed space in your body, that can cause significant problems that even if you fix the bleeding, you might still have complications related to that."

"I never had a family refuse or decline their vitamin K until maybe 10, 15 years ago. And it really seems to have mirrored some of the distrust in medicine in general."

"It gets lumped in I think with other kind of vaccines, but it's certainly not a vaccine in any way. It's a, it's a vitamin that the babies just aren't able, able to make at that time in their life"

"I think sometimes it's really hard for parents to kind of wrap their heads around doing something that they know is going to hurt their own child."

"it's been several generations now. And so, the ability for families to kind of know someone who they've had this happen to is, is pretty rare"

"There are a lot of things we do to support an infant when they're first born, right?"

"Infant mortality rates are in the 19 hundreds or 165 per thousand. So, you know, we've gone down dramatically since then."

"The boxed warning on the IV form for the benzoyl alcohol, correct me if I'm wrong, I think is for more of kind of allergic type reactions, which we don't have that kind of preservative in the intramuscular form"

"I sometimes hear is we're giving babies antifreeze and, and that of course is incorrect."

"We do not consider babies to have kind of normal vitamin K levels, normal coagulation pathways until they're a little bit closer to six months."

"Jaundice is so ubiquitous in this newborn population, but if you look back at the original forms of vitamin K that were given, there were higher reports of jaundice."

"It's got to last for some months. Right."

"Maternal milk does not contain very high amounts of vitamin K regardless of kind of how much you eat or how much you supplement or those sorts of things."

"The levels that mom has to take to get detectable levels in the breast milk are like not available like in any way in the store or anything like that."

"We do not have a kind of, um, approved version of oral vitamin K that's given in the United States."

"In Denmark they moved to oral and then went back to injectable because of the increased rates of vitamin K deficiency bleeding."

"This is where I think it's really helpful to talk to your pediatrician or to talk to another medical provider that you trust"

"I'm a parent and I've had these, you know, thoughts, uh, when my daughter was born and it's very hard to kind of recommend, uh, getting something that may or may not be an issue."

"It's the first time for that family, right? And so approaching that conversation with the same level of openness and time commitment that you would on your first time versus your 30th time"

"I think it's hard when something's been recommended and in use since 1961 to really grasp on kind of a population level of like what happens if you don't do it because most people haven't seen that"

Show Notes by Barevalue.

No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC’s Podcasts in determining the best practices for any particular patient. Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular Podcast. It is the responsibility of the treating physician or health care professional, relying on independent experience and knowledge of the patient, to determine appropriate treatment.