Vitamin K for newborns

 

Part I:   Vitamin K: General Information

[Note: I wrote Part I with help from:  http://www.vitamin-insight.com/   Click on ‘vitamins’ tab.  Then see sidebar on left, with links to each vitamin.  This site also has basic info on minerals, herbs, etc.  Information also came from:  http://www.vaughns-1-pagers.com/   On sitemap click ‘foods’.  Scroll down to ‘Vitamin K Foods Summary’ for list.  This site has much brief information, not just nutrition.]

Vitamin K is a group of compounds – it is referred to as phytonadione (a plant form), menaquinone (made in the intestines with help of gut flora) or menadiol (a synthetic form). It is ‘the anti-hemorrhage vitamin’. It is also an ‘oil soluble vitamin’, only formed and absorbed in the presence of fats, and stored in the body’s fat cells rather than excess being excreted in the urine (as with ‘water soluble vitamins’).  Recommended daily allowance is measured in micrograms, (mcg: millionth parts of grams) as opposed to milligrams (mg: thousandth of grams) as with most nutrients:  Women need about 60-65 mcg  Vitamin K daily.

Main Functions
Vitamin K regulates normal blood clotting and protein formation, and promotes healthy bone development. Newborns are usually given vitamin K to prevent hemorrhage disorders.

Deficiency Symptoms
Prolonged bleeding or poor clotting is the main symptom: excessive nosebleeds, easily bruising, stomach bleeding, blood in urine, osteoporosis. Vitamin K deficiency is rare, but if you use excessive antibiotics, have intestinal problems or liver disease, you are at risk. 

 

 

Part II:   Why Vitamin K is Recommended for Newborn Babies to Prevent HDN

This Q & A is taken from an exchange with Gail Hart, LM (Oregon), highly-experienced CPM, researcher, author and speaker on homebirth health and safety.

Note: HDN is “Hemorrhagic Disease of Newborn”; VKDB is “Vitamin K Deficiency Bleeding”; these terms are interchangeable and other acronyms also exist.  This disorder can be early-onset, occurring soon after birth, or late-onset, occurring up to 12 weeks following birth for 4-7 per 100,000 babies and more in some regions.

 General Overview 

QDo you believe every baby ‘should’ be given Vitamin K after birth?

A.  I think it is wisest to assure baby has enough vitamin K.  The baby needs to be inoculated with beneficial bacteria in order to form vitamin k [in the gut] (human bodies can’t make it—we need help). Breastfed babies have healthy digestive systems [but] sometimes they don’t grow a sufficient quantity of this bacteria compared to formula fed babies. Breastfed babies are at higher risk of Vitamin K deficiency HDN and of more severe response due to deficiencies of other clotting factors.

We can help protect them by trying to make sure they are quickly inoculated after birth. Skin-to- skin contact with mom is probably the best step. Using germicides on the perineal area inhibits inoculation, so avoiding germicides (especially betadine) is probably another good step.

We don’t know what else to do.  HDN is rare but it DOES happen and it can be devastating.  In most babies, there is no warning. The first sign of problems is often cerebral hemorrhage, and then it’s too late.  So — I personally think it IS a good idea to supplement every baby with vitamin K.

I think there are some possible risks of harm from IM (intramuscular) vitamin K.  But I see no possible harm from ORAL supplements of vitamin K.  I recommend it, even though I don’t insist on it.  It’s easy to do.  It’s a cheap and harmless protection; the non-prescription form is easy to obtain, it tastes good, and buys peace of mind.

I give my clients absolute power to make their own decisions. Many want to use oral vitamin K but some don’t. For those who don’t, I ask the moms to continue to take alfalfa for the next two months in an effort to assure there are high levels of vitamin K in the breastmilk.  In older days, babies used to be given a small weekly dose of cod liver oil.  Maybe we should revive that??? [note: there are many food sources of Vitamin K; see ‘Vitamin K Natural Food Sources’ handout]

Some Further Details 

Q. Does oral Vitamin K work as well as IM Vitamin K, in preventing early onset HDN?  [also ‘parenteral administration’: IM, IV, and subcutaneous—under skin—routes for anything put into the body; parenteral refers to all ‘non-oral’ routes]

A. According to my studies, including reports from Europe and Asia, oral administration of vitamin K has been shown to have efficacy similar to that of parenteral administration in the prevention of early VKDB.

Q. Does oral Vitamin K work as well in preventing late onset VKDB, as the IM dose does?

A. The rate of late onset VKDB, which often manifests as a sudden central nervous system hemorrhage, ranges from 4.4 to 7.2 per 100,000 births when there is no form of prophylactic Vitamin K administered.  With a single oral dose of Vitamin K, the rate decreases to 1.4 to 6.4 cases per 100,000. I submit it would be very difficult to compare such low numbers—in fact, almost impossible to rule out ‘random chance’.  The only factual thing to report is that the already low range decreases even more, [with a single oral dose]. Also, newborns receiving incomplete oral prophylaxis tended to have a higher risk of developing late-onset VKDB, with rates of approximately 2 to 4 per 100 000 [3 oral doses, administered over baby’s first month, is the standard recommendation]. 

But [single-dose] parenteral vitamin K prophylaxis prevents the development of late VKDB in infants, with the rare exception of those with severe malabsorption syndromes.  Most of these malabsorption babies have some other symptoms of problems –such as prolonged jaundice.

[Note: the above information on rates of VKDB, and comparing routes of Vitamin K administration, came from the journal PEDIATRICS; Vol. 112 No. 1, July 2003, pp. 191-192
’Controversies Concerning Vitamin K and the Newborn Committee on Fetus and Newborn’.  However, different studies of HDN in different regions have found a higher incidence of HDN than found by the Pediatrics Journal; the reasons for this difference are not known.  Maybe environmental and socio-economic factors play a part in the frequency of HDN: for instance, food grown in more or less healthy soil has already been shown to influence the amount of nutrients in that food–which effects the health of those eating it; also, people with less education and less financial security— using the same hospitals where a ‘research group’ might be drawn from—are also generally known to suffer from many health problems relating to poor nutrition and the other stresses of poverty]

Gail’s Conclusion 

I think this is a good issue for parents to decide.  I think there is good data that one dose of oral vitamin k is equivalent to IM vitamin K — at least for the first few weeks. After that, there is still a very low risk of HDN developing. The parents will have to be the ones to decide if that risk concerns them enough to chose IM over oral—or to choose repeated doses of the oral form.

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WomynWise Comment:  Normally, babies are born having no gut flora yet, to help them digest food and make vital nutrients; during normal birth, though, babies receive their mamas’ normal flora.  This is how babies are ‘innoculated with beneficial flora’: they get a healthy contact with beneficial, ‘normal germs’ from their mothers during birth and following–this gives babies the flora they need for digestion and creation of Vitamin K.  For healthy women who eat plenty of foods containing Vitamin K, and also have plenty of beneficial flora to pass to their babies at birth, the risk of VKDB is extremely low.  As with anything in life, though, ‘random chance’ can play a part. 

Any newborn with known risk factors, or who is in generally poor health, might be best protected by receiving supplemental Vitamin K.  If a mother received antibiotics during pregnancy or labor, or baby received antibiotics following birth, then the risk for Vitamin K deficiency may be elevated: antibiotics often kill the beneficials along with the pathogens, so Vitamin K cannot be formed in the gut.  Even without antibiotics, either or both may show signs of deficiency of healthy flora leading to Vitamin K deficiency, such as yeast infections/thrush, urinary tract infections, other. 

In such cases, parents may want to consider either giving the baby a Vitamin K supplement, or, starting a 1-month (minimum) course of probiotics for both mother and baby (see GBS handout re: probiotics).  Probiotics are made from colonies of beneficial flora, pills or formulas that we take to increase that flora in our bodies–they can be used safely by mothers and babies (in the right prepararations for each).  This helps ensure that both are able to form Vitamin K in the gut, preventing a deficiency from occurring.  Taking probiotics also supports healthy digestion, and the making of some other ‘gut-flora-dependent’ nutrients that we need for good health.   

 

For families choosing to give their baby Vitamin K, WomynWise prefers the idea of 3 doses of oral Vit K during first month.  Receiving Vitamin K by injection is painful to babies, and a needle stick carries the risk of infection; oral dosing is painfree and non-invasive–and each route can protect the baby just as well. 

 

 

Part III:   Vitamin K Food Sources

General rules for obtaining the most Vitamin K from these foods:  All of these foods will supply Vitamin K, whether eaten cooked or raw.  However, some foods are able supply the highest levels of bio-available Vit K when cooked first, aiding breakdown of cell walls and ‘liberating’ the vitamin; others supply the most when eaten raw. 

Dark Green Leafies, cooked: Alfalfa, Kale, collards, and all dark green leafy vegetables, seaweeds.  These greens contain the highest available amounts of Vit K

Vegetables, cooked: asparagus, broccoli, Brussels sprouts, cabbage and Chinese cabbage, sauerkraut, asparagus, snow peas (edible pod), rhubarb, celery, okra

Vegetables, raw: green leaf lettuce, iceberg lettuce, savoy cabbage, scallions (‘spring onions’, bulb and stalk), cucumber w/peel, endive, parsley

Other sources: cheddar cheese, egg yolk, liver, cowpeas, vegetable oils, stewed prunes (no sugar added)

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