The Truth About Prophylactic Vitamin K for Newborns: Debunking Myths and Misconceptions

Prophylactic vitamin K administration to newborns is often surrounded with misinformation and myth, despite its importance in preventing vitamin K deficiency bleeding (VKDB) in the newborn. This rare, but serious, condition affects approximately 0.25% to 1.7% of births per year (Ng & Loewy, 2024). Research shows that breastfed infants are five times more likely to develop VKDB unless given a vitamin K supplement (Ng & Loewy, 2024).

The three types of vitamin K deficiency bleeding are classified as:

• early-onset (occurs in the first 24 hours post-birth) (Shearer, 2009)

• classic (occurs from day 2 to day 7) (Shearer, 2009)

• late-onset (occurs most commonly from two to 12 weeks but can occur as late as six months) (Shearer, 2009)

Early VKDB is commonly associated with maternal medications that inhibit vitamin K activity, such as antiepileptics. Classic VKDB is associated with a low intake of vitamin K, and late VKDB with chronic malabsorption and low vitamin K intake (Shearer, 2009).

In Canada, prophylactic vitamin K can be given through two main methods:

• intramuscular injection

• oral supplementation

Administering one intramuscular (IM) dose of vitamin K (0.5 mg for infants weighing ≤1,500 g or 1.0 mg for infants weighing >1,500 g) routinely to all newborns within the first 6 hours post-birth is now the recommended best practice (Ng & Loewy, 2024). The incidence rate for late-onset VKDB, the most dangerous of the three types, is 0 to 0.4 infants per 100,000 with intramuscular injection (Shearer, 2009). So while not 100% infallible, most countries report zero or close to zero cases of VKDB yearly with IM injection. Intramuscular administration guarantees a fast and reliable boost in vitamin K levels.

The Canadian Pediatric Society advises that parents who choose not to administer the intramuscular (IM) injection of vitamin K should consider oral supplementation (Ng & Loewy, 2024). This involves a 2.0 mg dose given during the first feeding, followed by additional doses at 2 to 4 weeks and again at 6 to 8 weeks of age (Ng & Loewy, 2024). However, parents need to consult with their healthcare provider about this option before the baby is born, as oral vitamin K is not usually stocked in hospital pharmacies. Oral vitamin K will require a prescription beforehand and parents must bring the vitamin K drops to the place of birth at the time of delivery. When infants receive the full dosage schedule of 2 mg of oral Vitamin K, statistics show that the incidence rate of late-onset VKDB is 0 to 0.9 infants out of 100,000 (Mihatsch et al. 2016). However, oral vitamin K is not suitable for all infants. Factors like prematurity, malabsorption, or parents forgetting to administer doses, can limit its effectiveness (Ng & Loewy, 2024).

Statistics from Europe indicate that when infants do not receive any vitamin K at birth, between 4.4 and 7.2 out of every 100,000 infants will develop late Vitamin K Deficiency Bleeding (VKDB) (Shearer, 2009).

Unfortunately, this preventative practice has been met with controversy and misunderstandings that can hinder its acceptance among parents.

Intramuscular injection of Vitamin K at birth.

Understanding Prophylactic Vitamin K and Its Importance

Vitamin K1 is a fat-soluble vitamin and is necessary for blood coagulation while vitamin K2 benefits bone growth and cardiovascular health (Ng & Loewy, 2024). Vitamin K1 is primarily stored in the liver whereas vitamin K2 is produced by gut bacteria (Ng & Loewy, 2024). During pregnancy vitamin K, in either form, only crosses the placenta in minimal amounts and does not circulate freely in the bloodstream. Therefore an infant's cord blood does not provide any additional vitamin K to the newborn (Ng & Loewy, 2024). Iron and stem cells, yes. Vitamin K, no.

Colostrum and mature hindmilk only contain about 1 microgram of vitamin K per liter, although emerging research is showing that additional vitamin K supplementation by the mother during lactation can increase vitamin K levels in breastmilk (Shahrook et al., 2018). Whether this increase leads to a decrease in VKDB has not yet been studied. It has also not been studied if supplementing vitamin K2 is better than supplementing with vitamin K1, although it appears that vitamin K1 can be converted into vitamin K2 in breast tissue (Thijssen et al., 2007).

Debunking Common Myths About Vitamin K

Myth 1: Vitamin K Injections Are Unsafe

Many parents worry that vitamin K injections may harm their infants, stemming from the fear surrounding vaccinations. However, extensive research shows that vitamin K injections are both safe and effective. The World Health Organization and pediatricians around the globe recommend this injection at birth to prevent VKDB, emphasizing its safety.

Myth 2: Oral Vitamin K Is Just as Effective as the Injection

While some parents prefer oral vitamin K, studies reveal it is not as effective as the injection for immediate protection. Research indicates that about 30% of infants who receive oral vitamin K do not reach adequate levels (Ng & Loewy, 2024). The oral method involves multiple doses, which might be missed amid the busy early weeks and months of parenthood.

Myth 3: Vitamin K is A Vaccine

Vitamin K is sometimes mistakenly thought to be a vaccine. It is not. Unlike vaccines, vitamin K does not build antibodies. There is no herd immunity against VKDB. This supplement is a synthetic form of a vitamin that occurs naturally in certain plants and vegetables (Ng & Loewy, 2024). Aside from vitamin E, there is no difference between natural and synthetic vitamins. Did you know that 95% of vitamins on the market are synthetic?

Myth 4: Vitamin K Can Have Adverse Effects Later in Life

Some speculate that vitamin K could lead to negative health effects later, such as increased cancer risks. However, comprehensive studies have not supported these claims. Leading health organizations consistently affirm that the benefits of vitamin K injections in preventing VKDB far outweigh any potential long-term risks (Roman et al., 2002).

Myth 5: Parents Can't Discuss Vitamin K with Healthcare Providers

A misconception persists that parents cannot engage in conversations about vitamin K with healthcare providers. In truth, parents are encouraged to ask questions and share concerns regarding vitamin K administration. Healthcare providers value family involvement and are willing to explain the importance of vitamin K, while also addressing parental worries regarding procedural pain, preservatives, and anaphylactic reactions. This dialogue fosters a shared understanding of the critical role and benefits of vitamin K while also promoting informed decision-making.

Key Takeaways on Vitamin K Administration

The need for prophylactic vitamin K administration to newborns can safeguard their health. By understanding the facts and myths about VKDB, parents can take steps to protect their newborns. The choice between vitamin K intramuscular injection, oral supplementation, or declining all the options should be made with your healthcare provider.

Parent Resources:

Evidence Based Birth Podcast on Vitamin K for Newborns: The Latest Evidence

Nurse Tina Gives a Quick Breakdown on Vitamin K

References:

Mihatsch, W.A., Braegger, C., Bronsky, J., Campoy, C., Domellöf, M., Fewtrell, M., Mis, N.F., Hojsak, I., Hulst, J., Indrio, F., Lapillonne, A., Mlgaard, C., Embleton, N., van Goudoever, J. & ESPGHAN Committee on Nutrition. (2016). Prevention of vitamin K deficiency bleeding in newborn infants: A position paper by the ESPGHAN Committee on nutrition. Journal of Pediatric Gastroenterology and Nutrition, 63(1),123-9. https://onlinelibrary.wiley.com/doi/10.1097/MPG.0000000000001232

Ng, E., & Loewy, A. D. (2024). Guidelines for vitamin K prophylaxis in newborns. Paediatrics & Child Health, 23(6), 394-397. https://cps.ca/en/documents/position/vitamin-k-prophylaxis-in-newborns

Roman, E., Fear, N. T., Ansell, P., Bull, D., Draper, G., McKinney, P., Michaelis, J., Passmore, S. J., & von Kries, R. (2002). Vitamin K and childhood cancer: Analysis of individual patient data from six case-control studies. British Journal of Cancer, 86(1), 63-69. https://pmc.ncbi.nlm.nih.gov/articles/PMC2746550/pdf/86-6600007a.pdf

Shearer, M.J. (2009). Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Reviews, 23(2), 49-59. https://www.sciencedirect.com/science/article/abs/pii/S0268960X08000520?via%3Dihub

Shahrook, S., Ota, E., Hanada, N., Sawada, K., & Mori, R. (2018). Vitamin K supplementation during pregnancy for improving outcomes: A systematic review and meta-analysis. Scientific Reports, 8(1),1-11. https://pmc.ncbi.nlm.nih.gov/articles/PMC6065418/pdf/41598_2018_Article_29616.pdf

Thijssen, H. H., Drittij, M.J., Vermeer, C., & Schoffelen, E. (2007). Menaquinone-4 in breast milk is derived from dietary phylloquinone. British Journal of Nutrition, 87(3), 219-26. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/menaquinone4-in-breast-milk-is-derived-from-dietary-phylloquinone/E077FC14D9115A9C967794FD1068811E