Why Newborns Need Vitamin K

In 1894, Charles Townsend put to words a disturbing trend. He examined the cases of 50 infants with severe bleeding less than a week after birth. To describe this, he coined the term hemorrhagic disease of the newborn (HDN). Since Townsend’s research, our understanding of vitamin K deficiency bleeding (VKDB) has improved substantially.

It took several other major discoveries to uncover that the solution to this condition was pretty simple. A single dose of vitamin K. Recently, a cloud of misinformation has caused new parents a lot of anxiety about a choice that should be simple.

UVA Health Pediatrician Ann Kellams, MD, is unequivocal. “Vitamin K injection at birth for babies saves lives. We do not have a way to predict which babies will develop hemorrhagic disease of the newborn until it is too late and there have been often devastating or fatal consequences.” 

Fast Facts About the Vitamin K Shot

• It has been the standard of care since 1961
• Before the vitamin K shot, 1 in 60 babies developed bleeding related to vitamin K deficiency (VKDB)
• Babies begin producing their own vitamin K at 6 months
• The dose of vitamin K needed is extraordinarily small, only 0.5 ml to protect for 6 months

What Is Vitamin K?

Vitamin K is a fat-soluble vitamin. It helps your body form blood clots. Adults get vitamin K through green leafy veggies, soybeans, and canola oil. They also get vitamin K from their “gut flora.” Which basically just means that one of the benefits the bacteria in a mature gut provide is vitamin K.

Almost all adults have adequate amounts of vitamin K.

Newborns are all vitamin K deficient. There are a few reasons for this, but what it boils down to is:

• Vitamin K doesn’t cross the placenta
• Newborns don’t have active gut flora of their own
• Breastmilk doesn’t provide enough vitamin K

When Do Babies Develop VKDB?

There are 3 time periods that are associated with VKDB.

Early VKDB

This type of bleeding happens in the first 24 hours after birth. Unlike other types, this type does have some known risk factors, like exposure to certain medications taken during pregnancy.

Classic VKDB

This type of bleeding happens within the first week of birth and occurs in about 2% of infants.

Late VKDB

This occurs in babies between 1 week and 6 months of age.  But between 2 weeks and 2 months is the most common time period. 1 out of every 5 babies who has late VKDB will die from it. And more than half will have brain injuries that will affect them for the rest of their life.

What Are the Symptoms of VKDB?

Early and classic VKDB is most often caught when newborns are still at the hospital. Sometimes it’s an umbilical stump that keeps bleeding, or a heel prick that bleeds too much.

But there’s a reason that late VKDB has the highest mortality. For around half of these infants, they’ll develop bleeding in their brain, where it can go unseen until it causes severe symptoms.

One parent shared her story about how her son developed 2 brain bleeds at 5 weeks old due to VKDB. In the course of a day he went through symptoms that seemed like a stomach bug. When he became lethargic, his parents decided to take him to the hospital, but before they could even get in the car, the seizures started. With neurosurgery, he lived, but it shows how quickly symptoms come on, and how even attentive parents can feel blind-sided by the onset. 

How Do We Prevent VKDB?

The good news about VKDB? In the United States right now, the risk of VKDB is very low. That’s because, since 1961, most parents have opted for a single vitamin K injection given at birth.

This has been so effective that almost every other nation has followed our example. Rarely, a small area will experiment with not offering it, only to see that excessive bleeding still occurs in 1 out of every 60 infants, due to either classic or late VKDB.

How We Give Vitamin K

Vitamin K is given immediately after birth. Kellams shares her suggestion for helping your baby be comfortable:  

“For parents concerned about the pain of an injection, it has been shown that getting the shot while skin-to-skin and especially while breastfeeding reduces any distress in the babies—so make sure to let the team know that you prefer to hold and feed that baby during the injection,” she shares.

To reduce the risk of vitamin K deficiency bleeding, we also will not perform any elective procedures for infants who haven’t been given vitamin K, including circumcision and tongue-tie revision.

FAQ for Vitamin K

Can’t I Give Vitamin K Later if My Baby Needs It?

Symptoms can come on suddenly, and seemingly at random. If a baby develops a brain bleed shortly before bedtime, they may have severe symptoms by the time they’re noticed.

But I’m Healthy, Won’t My Baby Be as Well?

Most babies with VKDB have no underlying medical condition, and if given vitamin K, have no ongoing medical issues. They are perfectly healthy.

VKDB isn’t usually an ongoing health concern. It’s the equivalent of a random car accident, and it can occur even if you’re being careful and are healthy beforehand. Vitamin K is like a seatbelt. We can't predict who may be hurt in a car accident. Most people would probably be fine without a seatbelt. But by encouraging everyone to buckle up, we ensure more people arrive home safely.

Is the Shot Risky?

No. There have been very, very few reactions to the shot. And since it’s been given to almost every single infant since the 1960s, we have decades of safety data. 

Can Delayed Cord Clamping Improve Vitamin K Levels?

Delayed cord clamping is another great practice that is standard of care. It improves hemoglobin and iron levels. But vitamin K doesn’t cross the placenta, meaning it’s not coming through the umbilical cord at all.

We absolutely recommend delayed cord clamping. We also recommend vitamin K.

What About Oral Vitamin K?

“Oral preparations for vitamin K are often difficult to obtain, and research shows that they are not absorbed as well or as consistently.  As much as I try to avoid causing any pain to babies whatsoever, this one little micro-second poke may save a baby’s life, and to me, there is no question that that is worth doing,” Kellams shares.

Does Vitamin K Have a Black Box Warning?

Black box warnings are often used as a scare tactic. These warnings are often for specific patient groups or specific use cases. Some antibiotics, for example, shouldn't be used in pregnancy. That doesn't mean they aren't lifesaving for the patients who need them, and who aren't part of the group at risk. For vitamin K, the black box warning refers to large doses, which are sometimes used for adults.

In infants, only 1 severe allergic response was ever recorded over many decades of use. Compared to the hundreds of infants that would have died from vitamin K deficiency, it’s a pretty straightforward risk assessment.

Kellams agrees, “There are many things that are recommended for newborns, some of which, with careful risk analysis on a case-by-case basis, may be ok to skip for a particular baby or situation. In my view, vitamin K is not one of them.”

Parenting is Full of Hard Choices. This Isn’t One

Parenting is an important job. Exploring and researching choices and options is part of doing the job right. On this choice, the numbers are clear. Vitamin K might save your child’s life. And it certainly won’t hurt.