Vitamin K for the Newborn
This page gives you some information to help you make a decision about whether to give your baby Vitamin K. As parents you have a choice of whether to give Vitamin K to your baby or not and whether you should give Vitamin K as an injection or orally. It is important that you have full information about the benefit and risks of giving Vitamin K as well as understand the potential risk in choosing not to give Vitamin K to your baby. Ask your LMC before your baby is born about the use of Vitamin K in preventing haemorrhagic disease of the newborn and for any written information about Vitamin K.
The Women's Health Action Trust produce a pamphlet "Vitamin K - does my new baby need it? which highlights the benefits, the possible risks and the available evidence on the topic. Ask your LMC or to visit their website to order one: Click Here
Vitamin K is essential for normal blood clotting. It is contained in some foods and is also produced in the gut by the action of bacteria. Newborn babies have low level of Vitamin K in their blood at birth and it takes them several weeks to start producing their own supply.
Why give Vitamin K to baby?
Vitamin K given at birth can prevent haemorrhagic disease of the newborn (HDN). This condition is also known as Vitamin K Deficiency Bleeding (VKDB). Some uncertainty still exists on whether low levels of Vitamin K directly causes bleeding as some cases of bleeding have been due to the problem with the baby's liver. However it is clear that giving Vitamin K to the baby will prevent almost all cases of VKDB.
The classic HDN is bleeding that occurs in the first seven days of the baby's life. It is serious in about 1 case in 10,000 births. The late HDN is bleeding that occurs between one week and about six months of baby's life. It occurs in between 4-8 cases in 100,000 births in which about half the cases are classed as serious. Serious bleeding is meant as bleeding that causes brain damage or death.
Which babies are at risk of Vitamin K Deficiency Bleeding?
It is not known exactly which babies will develop Vitamin K Deficiency Bleeding. Most babies are at very low risk but the following babies may be at higher risk:
- Premature babies and sick babies.
- Babies whose mothers have been on some sort of medications during the pregnancy, such as antibiotics, anticoagulants (drugs that thin the blood), anti TB drugs and anticonvulsants (drugs that prevent seizures or fits).
- Babies born following a long "pushing stage".
- Babies born by forceps, ventouse or caesarean section.
- Low birth-weight babies.
- Babies with liver disease or problems absorbing food.
If you had decided not to give Vitamin K to your baby then you would be asked to review the decison if any of the above applies for your baby. If you are taking any medications that may affect Vitamin K levels in you then talk to your LMC as you may need to take oral Vitamin K for 2 weeks before your baby is due.
How is Vitamin K given to the baby and what dose is given?
Vitamin K can be given by an intramuscular injection into the baby's leg or orally by mouth. Both these methods increase Vitamin K levels in the baby. The oral Vitamin K is slightly less effective than an intramuscular injection in preventing VKDB. The risk of VKDB per 100,000 babies is 1.42 if oral Vitamin K is used to 0.11 if Vitamin K injection is given (BMJ, 1991; 303:1105-1109). If the baby is at greater risk of VKDB or HND it is recommended that they have the intramuscular injection.
If you choose to give your baby the injection then one dose of Konakion MM 0.5-1mg is given into the muscle of the baby's thigh at birth.
If you choose to give your baby oral Vitamin K then repeat doses of Konakion MM 0.5-1mg are needed. Various countries use different number and timing of doses. In New Zealand the Ministry of Health recommends three separate oral doses. These are as follows:
- first dose soon after birth
- second dose is given when the baby is between 3-5 days of age
- third dose is given when the baby is between four to six weeks of age
If the baby vomits within the hour of being given the dose then the oral dose is repeated. The drops are given by the LMC or by yourself.
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Is Vitamin K safe for the baby?
Two British studies in the early 1990's suggested the use of Vitamin K injection at birth caused childhood cancer. Five other studies from Europe and North America found no risk or a small risk than the first two studies. Four further British studies have been published in 1998. Two showed no increased risk, one showed a possible slightly increased risk, and the other showed a significant increase in the risk of childhood leukaemia. The health professionals in New Zealand think that the link between Vitamin K injection and childhood cancer is unlikely. From the research it is not clear that Vitamin K injection leads to a risk of childhood cancer. There has been no links shown between childhood cancer and oral Vitamin K.
What about Vitamin K in Breast Milk and Infant Milk Formula?
Breast milk contains very low levels of vitamins, including Vitamin K so there is a decline of Vitamin K in breastfed babies over the first few days following birth.However Vitamin K is especially concentrated in colostrum and hind milk. Therefore mothers who are breastfeeding and choose not to give Vitamin K to their baby should be advised to breast feed the baby as soon as possible after birth, breast feed freely and often so the baby gets higher levels of Vitamin K in colostrum and after the first few days let the baby feed on the breast for as long as possible so the baby gets the milk that comes later in the feed (hind milk). Vitamin K levels in breast milk can be increased by the mother eating foods rich in Vitamin K such as green and yellow vegtables, dairy products, egg yolk, fresh fruit, fish liver oils and whole grain cereals.
Infant Milk formula has Vitamin K added to it so babies that are given formula feed have higher levels of Vitamin K than breast fed babies. However breast feeding has many important benefits for both mother and babies. These are that breast fed babies get fewer colds, fewer tummy bugs, chest infection and allergies and help baby and mother form a close bond.
How do I know if my baby has VKDB or HND?
Your baby may have VKDB or HND if the following signs are present:
- unusual bruising on the skin
- blood oozing from the tummy button area, from the nose or blood on a nappy
- black bowel motion or stools after day 1-2
- red blood shot eyes after the first few days of life
- any other sign of bleeding
If you notice any of the above signs contact striaght away your LMC, family doctor or take the baby to an Accident and emergency Department. It is important to tell them whether your baby had been given Vitamin K and how this was given.
Recommendation in New Zealand is that all babies should receive Vitamin K. This agreement by New Zealand Health Professionals was reached in August 2000.
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