Vitamin K
Vitamin K helps with blood clotting ability among other things. Vitamin K1 is obtained through the plants we eat and our gut makes vitamin K2. Babies are born with sterile guts that are not able to make vitamin K.
Babies receive small amounts of vit K through colostrum. Colostrum helps colonize the baby’s gut which, among other things, helps them start producing some vit K around 8 days old.
Why do we talk about vitamin K? Because some babies are born with a clotting disorder.
VKDB: Vitamin K Deficiency Bleed, is an uncommon but serious clotting disorder that can occur after birth. If a baby has this clotting disorder they need vit k.
Not receiving vitamin K doesn’t cause a clotting disorder. But, if the baby has VKDB then Vitamin K supplement is the remedy.
How often does VKDB occur?
The likelihood is approximately 1 in 11,000 babies. Most babies will recover with quick treatment - a small number will have long term damage and for a smaller number it will be fatal.
The actual chance of death from VKDB is low - if we give a prophylactic vit K supplement it’s even lower.
What causes VKDB?
We’re not exactly sure. Below goes through which babies are more likely to have VKDB.
Babies who are more likely to suffer from VKDB:
Received antibiotics either during labor or right before birth
Are born prematurely
Had their cord cut immediately:
This means the gut and liver were not perfused with blood properly
Cord blood contains stem cells that help heal the baby’s cells
Babies who are having latching issues - therefore not getting enough colostrum
Babies who are exclusively breastfeed - because formula has added vit k
Babies with infections such as syphilis
Decision making options:
Wait and Watch: No prophylactic vit k. If signs of VKDB are seen (listed below), go to the hospital and give Vit K injection. Note, there are not always easily visible signs for intestinal or brain bleeds.
Give Prophylactic Oral Vit K: Slightly less effective as injection, but close. This will not work for babies with gallbladder issues because it is suspended in sesame seed oil. 4 drops given the day of birth, then 2 drops once a week until baby is 13 weeks old. I only use Bio-K-Mulsion by Biotics Research.
Give Prophylactic IM Injection of Vit K: This is a one time intermuscular injection given the day of birth. Monitor injection site for infection. This injection does have some preservatives. As with any injection, monitor for signs of anaphylaxis.
If you see any of the below quickly seek guidance from your midwife or doctor:
Bleeding: in vomit, pee or poop. It may be a drop of blood in the poop or a ring of blood in pee diaper
Active bleeding: nose, mouth, gums or umbilical cord stump.
Baby bleeds more than expected after the heel prick or other intervention.
The soft spot on the head (fontanel) is bulging or tight.
Baby’s skin or gums are paler that the ought to be.
Baby has unexplained bruising.
Early Onset VKDB is seen in the first 24 hours to 8 days old
Typically some of the above signs are seen.
Late Onset VKDB is seen after 8 days old to 6 months old
Signs can be more ‘hidden’.
Resources for further learning and decision making:
Seven things every parent needs to know about vitamin k, by Dr Sara Wickham.
Evidence Based Birth article about vitamin k injection
Injection ingredient information sheet
