NY Times: Vitamin K for Newborns is a No-Brainer

One of the most difficult clinical situations I helped manage involved a newborn who had a devastating intracranial hemorrhage after the parents had refused the routine  administration of vitamin K.  At that time, I did not ask the parents what they were thinking.  I presumed that they were well-intentioned.  Nevertheless, they allowed their child to suffer permanent neurologic injury.

A recent editorial highlights this growing problem: NY Times: Vitamin K for Newborns is a No-Brainer Here’s an except:

Parents are increasingly questioning, and declining, vitamin K, which protects newborns from serious bleeding…

Accounts of healthy babies developing serious, even fatal bleeding in the days and weeks following birth can be found going back centuries

Since the early 1960s, it has been standard-of-care for newborns to receive an intramuscular injection of vitamin K shortly after delivery. Nearly six decades’ worth of data demonstrate that this intervention virtually eliminates vitamin K deficiency bleeding and carries no compelling risk of serious side effects…

Many of the reasons my patients’ parents decline vitamin K are similar to the reasons they decline vaccines: They worry about interventions they perceive as “unnatural” or unnecessary, about whether the doses and ingredients are “toxic” and whether there may be serious complications that doctors are not aware of or that are even being purposefully obscured by doctors, public health officials and pharmaceutical companies…

Parents continue to ask me whether vitamin K might cause childhood cancer, though this suggested association has been debunked….Others simply prefer to spare their newborn the pain of an injection…

Each year in the United States, if no vitamin K were administered, more than 70,000 infants would most likely be affected…

The seeds of mistrust — along with skepticism of science and intellectualism, the allure of the “natural” and the development of social-media-fueled communities founded on these values — run deep, and they’re threatening the health of our youngest and most vulnerable.

My take: Just like seat belts, the approach to this problem should be policy-based.  In my view, if an infant suffers from vitamin K-refusal bleeding, reports should be made public health departments.

Related blog post: Educated or Misinformed –Leading to Hemorrhagic Disease of the Newborn

Educated or Misinformed –Leading to Hemorrhagic Disease of the Newborn

“Hemorrhagic Disease of the Newborn,” now termed “Vitamin K Deficient Bleeding,” has reemerged as a problem. Many well-intentioned parents are refusing vitamin K to keep things more ‘natural’ for their infants.  This phenomenon is likely encouraged by some alternative health websites and other parents; babies who are breastfed are at increased risk of vitamin K deficiency (without prophylaxis).  Unfortunately, they are playing Russian roulette with their infant’s safety. In addition, many practitioners will not readily recognize this disorder because of the effectiveness of Vitamin K prophylaxis that has been provided since 1961.

An excerpt from the St. Louis Dispatch provides more information: Four babies hemorrhage after parents refuse vitamin K shot, a practice on the rise

Maternity care providers here and nationwide are on high alert for life-threatening vitamin K deficiencies in newborns, at the same time they are seeing more parents refusing a routine preventive injection.

The Centers for Disease Control and Prevention released a report last month about four babies in Nashville, Tenn., who hemorrhaged after their parents refused vitamin K injections at birth. The babies were diagnosed with life-threatening vitamin K deficiency bleeding between February and September. Three had bleeding in the brain, and one had gastrointestinal bleeding. They survived, but the infants with brain hemorrhages could have long-term neurological problems.

“Not giving vitamin K at birth is an emerging trend that can have devastating outcomes for infants and their families,” CDC director Dr. Tom Frieden stated in the report. “Ensuring that every newborn receives a vitamin K injection at birth is critical to protect infants.”

The vitamin is necessary for normal blood clotting, but because vitamin K does not transfer well across the placenta, most babies are born with low levels. The deficiency can lead to a rare, sudden bleeding disorder up to 6 months of age.

The CDC investigation found that parents refused the injection for several reasons, including a concern about an increased risk for cancer from the injection, an impression that it was unnecessary and a desire to minimize exposure to “toxins.” A 1992 study associated vitamin K and childhood leukemia, but the findings have been debunked by subsequent studies…

The number of parents refusing is more alarming at birth centers, which provide care led by midwives who support natural birth. Among the most recent 75 births at the Birth and Wellness Center in O’Fallon, Mo., 23 percent refused the injection, and 14 percent opted for the oral dose, said Jessica Henman, the center’s certified nurse midwife.

The CDC studied a random sample of births this year in the Nashville, Tenn., area and found that parents of 3.4 percent of 3,080 newborns discharged from hospitals had refused the vitamin K injection, while parents of 28 percent of 218 born at birth centers had refused…

A newborn not getting the injection is 81 times more likely to get the late form of the disorder than a baby who gets the shot, according to the CDC. [my emphasis in bold]

Related link from Stanford:  Guidelines for Vitamin K Prophylaxis – Newborn Nursery at LPCH

Bottomline: When seeing an infant with bleeding, ask about vitamin K prophylaxis after birth.

If a parent caused intracranial hemorrhage in an infant by shaking the infant, they would probably be jailed.  What should be done in these cases?

Related blog post:

Bleeding due to vitamin K deficiency | gutsandgrowth