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Vitamin K

Update

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Your baby, Your decision

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What is Vitamin K

  • K for clotting—Koagulation (German)
  • Essential substance for the body thus termed a vitamin
  • Fat soluble, stored in the liver
  • Needed to prevent bleeding through formation of blood clots
  • Promotes good bone health
  • We cannot make it and we don’t store it well

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How does Vitamin K work

  • Platelets are broken down to form a network of protein fiber called fibrin
  • A number of other molecules, clotting factors, that are carried in the blood then fill in this network to form the clot.
  • Vitamin K is needed to manufacture these clotting factors.

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Source

  • Two naturally occurring forms
    • Vitamin K1 – 90%
      • Found in foods… leafy greens, cruciferous veggies, turnips, avocado, banana, kiwi, soybean oil.
    • Vitamin K2 – 10%
      • Converted from K1 by gut bacteria

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Pharmaceutical K

  • Contains oils into which K1 is dissolved
  • Helps long term release of the K
  • Depot of the drug is formed when it is injected into the muscle
  • This depot then releases slowly over several weeks

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HDN vs VKDB

  • Hemorrhagic disease of the newborn
  • Vitamin K deficiency bleed
  • Described in 1894 by Townsend
  • Swedish Doctor Jorgen Lehmann discovered that Vitamin K stopped HDN in 1944

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VKDB

  • Three types
    • Early onset VKDB
      • Within 24 hours of birth
        • Babies born to mothers taking drugs
          • Anticonvulsants, anticoagulants, antibiotics, TB meds
            • Vit K doesn’t work for these
    • Classical onset VKDB
      • 2nd to 7th day of baby’s life
        • Some say birth to 2 weeks
      • Under the skin, in the gut, from the nose or from a circumcision wound

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VKDB

  • Late onset VKDB
    • 8 days to 3 to 4 to 6 months (2-24 weeks)
      • Dangerous brain bleeds
        • Death or brain damage

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  • Secondary VKDB
    • Underlying disorder
      • Gallbladder disease, cystic fibrosis, or medication side effects

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Treatment

  • Vitamin K
  • Blood products
  • NICU
    • Up to 4 weeks depending on severity of bleed

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Intracranial Hemorrhage

  • Most severe complication – 30%
    • Some need brain surgery to relieve pressure
    • About 1/3 with VKDB have long term brain damage

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Studies

  • 1930 VKDB in chicks
  • 1944 13,000 babes in Sweden given .5

5 fold reduction. Saved lives of 160/100k from dying

  • 1961 AAP recommended Vit K shots
  • 1999 HDN changed to VKDB

Because it not just seen newborns

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Incidence and Dosage

  • No Vit K. Europe stats 4.4 to 7.2/100k will get VKDB
  • 1-3 mg oral once 1.4 to 6.4/100k will get VKDB
  • 1 mg oral 3x birth, 1 week, 4 weeks- 2.6/100k

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    • Two dosages same results
  • 2 mg oral 3x – birth, 4-6 days, 4-6 weeks – 0.9/100k
  • 2 mg oral birth, 1 mg oral every week for 3 months – 0.9

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  • Shot at birth – 0-0.4/100k

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At Birth

  • Babies born with low levels
    • Lowest at days 2-3
    • Adult levels by 6 months
  • K1 very little transfers through the placenta
  • Babies don’t have enough bacteria in gut to make K2
  • Breast milk has very little
  • All babies who have VKDB were breastfed

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Why some refuse the shot?

  • Vit K was unneccessary
  • Lack of knowledge on role of Vit K and VKDB
  • Concerns about preservatives
  • Clinicians don’t offer oral if refusal of shot
    • No licensed oral Vit K in US
    • Might encourage more refusals they think

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Don’t Need

  • Traumatic birth does not affect VKDB
  • Poor nursers more at risk
  • Delayed cord cutting
    • Little Vit K in cord blood
    • Does not pass across the placenta
    • Taking Vit K in pregnancy doesn’t help

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Risks of Shot

  • No leukemia risk
  • No risk of cancer

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Gallbladder disease

  • Have trouble absorbing fat and fat soluble vitamins
  • More at risk for VKDB

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Ingredients

  • Preservative free version
    • 1 mg Vit K1
    • 10 mg Polysorbate 80 (in Handbook of Green Chemicals)
    • 10.4 mg of Propylene glycol (safe by FDA)
      • .17 mg Sodium acetate anhydrous (salt, bicarbonate)
      • .00002 ml of glacial acetic acid – vinegar

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      • Allergic reactions only from IV form

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Oral Vit K

  • Fat soluble
    • Give after a feed
    • Repeat if spits up within an hour
    • Repeat doses are critical

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Bio-K-Mulsion

  • 500 mg per drop (4 drops = 2 mg)
  • Other ingredients
    • Water
    • Gum arabic
    • Sesame seed oil

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Low For A Reason

  • If all babies are born with a low Vit K count
    • There must be a Reason
    • There might be but no research has found it

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  • Nature is not flawed but the margin of safety is narrow!

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