Joseph R. Anticaglia, MD
Medical Advisory Board
Currently, there are about six million live births in the United States every year. And according to American Academy of Pediatrics, every one of these newborn infants needs to receive an intramuscular injection of vitamin K within hours after birth, to prevent harm from internal or external bleeding. After the mother gives birth, the Obstetrician hands the baby to the Pediatrician, or nurse in the delivery room.
While the Obstetrician is attending to the mother, the Pediatrician and her/his team are busy suctioning mucus from the baby’s nose, listening to the infant’s heart, and lungs, weighing and measuring the newborn as well as injecting the newborn’s thigh with Vitamin K.
The American Academy of Pediatrics in 1961 recommended the “intramuscular administration of vitamin K for the prevention of vitamin K deficiency bleeding (VKDB). This has been the standard of care since that recommendation.
What is Vitamin K?
Vitamin K, also known as phylloquinone, is a fat-soluble vitamin that dissolve in fats and oils, and is stored in the body’s liver and fatty tissues. It is vital for blood to clot., and plays an important role in strengthening bones, and heart health.
Low levels of Vitamin K in newborns has led to catastrophic, uncontrollable bleeding into the brain, intestine, and other regions of the body. A single, intramuscular injection of vitamin K
into the thigh of the newborn shortly after birth protects the infant from such a potential lethal event.
Classification of VKDB
This classification is adapted from the CDC which listed “three types, based on the age of the baby when the bleeding problems start: early, classical and late.”
Early
Early-onset within the first 24 hours after birth. A severe form of the condition. The risk is much higher for those infants whose mothers used certain medications during pregnancy.
Classical
It occurs between two to seven days after birth. It is characterized by bruising, and bleeding from the umbilical cord.
Late onset
It happens between one week to six months after birth, most often two to eight weeks after birth. A significant number of newborns (30-60%) have bleeding within the brain. It tends to occur in breastfed only babies who have not received the vitamin K shot.
What Are the Signs of Vitamin K Deficiency Bleeding (VKDB)
Signs can vary from child to child.
- Bleeding can occur from nose, or umbilical cord.
- Blood in the stool makes it appear black
- Child bruises easily
- Skin appears paler than usual; in dark-skinned babies, pale gums
- White parts of the eyes have a yellow tinge to them — after baby is three weeks old
- A lot of vomiting, or blood in the vomit
- Excessive sleepiness, irritability, or seizures
Parental Refusal
The AAP reports that despite the success of preventing VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. The frequency of refusal of intramuscular vitamin K by parents ranged from 0% to 3.2% in U. S. hospitals, up to 14.5% in home births, and up to 31.0% in birthing centers.
Extrapolating a refusal rate of 3.2% to 6,000,000 live births in the United States up to 192,000 newborns could be at risk for VKDB. About half of all babies who develop Vitamin K deficiency bleed into their brains, according to the CDC.
Vitamin K deficiency places your baby at risk for life-threatening bleeding. Since 1961, the AAP has recommended the one time intramuscular administration of vitamin K to prevent vitamin K deficiency bleeding in newborn infants. Parents should be made aware of the benefits of Vitamin K to newborns.
Glossary
Vitamin deficiency happens when a person doesn’t have enough of a vitamin stored in the body. Charles Wendel Townsend in 1894 described 50 cases of a bleeding disorder in newborn. The Nobel Prize were awarded to Henrik C. P. Dam, and Edward A. Doisy for their work in identifying Vitamin K.
References
- American Academy of Pediatrics| Policy Statement|; Vitamin K and the Newborn Infant; Ivan Hand, MD, Lawrence Noble, MD, Steven Abrams, MD; February 22, 2022
- Jaspreet Loyal, MD , Eugene D Shapiro, MD, Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review; Hosp Pediatr, March 10, 2020
- CDC; Protect Your Baby From Bleeds — Vitamin K Deficiency Bleeding (VKDB).
- CDC; About Vitamin K Deficiency Bleeding
- Donna Freeborn PhD et al; Vitamin K Deficiency of the Newborn; University of Rochester Medical Center previous song
- Obladen M. Innocent blood: a history of hemorrhagic disease of the newborn. Neonatology. 2015;107(3):206—212
- Raju TN. The Nobel chronicles. 1943: Henrik Carl Peter Dam (1895-1976); and Edward Adelbert Doisy (1893-1986). Lancet. 1999;353(9154):761
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.