Ask any mother or grandmother who was alive 1900, and they would tell you about a disorder that is rarely seen today, that of Vitamin K Deficiency Bleeding (VKDB) in a newborn baby. A simple single dose of vitamin K, given to almost all babies born in the U.S., made this disease just a bad memory… until recently. Parents today just don’t worry about this disease anymore but imagine you were a mother who had a perfectly normal pregnancy and delivery, had a healthy infant who was thriving at home, and suddenly at about 2 months of age, they had a devastating bleeding event in their brain with seizure and other devastating effects or began bleeding to death from a gastrointestinal hemorrhage. Unfortunately, in today’s hyper informed world, many parents have become more worried about theoretical risks of harm to their newborn from a simple dose of vitamin K that is recommended for newborns at birth, than the known risk of hemorrhagic disease in a newborn who don’t receive this therapy.
Why are newborns at risk of sudden catastrophic bleeding, you ask? Many infants are unable to form adequate blood clots because their store of vitamin K is low at birth and they are unable to manufacture or consume enough vitamin K to bring their blood levels up to healthy levels. To counteract this deficiency and prevent, bleeding a few weeks later, a shot of vitamin K is given to all newborns within hours of birth. This has been standard practice in the U.S. since 1961, unless parents refuse it. This administration boosts reserve levels of vitamin K, allowing a child to prevent bleeding. Babies who receive this treatment are 81 times less likely to develop late VKBD than babies who do not.
Recently in 2013, pediatricians and parents got a reminder of why we give that little vitamin k shot to newborns, when a cluster of four cases occurred among infants born in Nashville hospitals. After the Center for Disease Control investigated these cases, they discovered that in each case of bleeding, the infant’s parents had refused the vitamin K shot for their newborn after birth. Just like grandma had told us, the four babies who bled had thriving normally until they experienced sudden bleeding (mainly in their brain) at 6-15 weeks of age. These cases prompted and investigation to determine how many parents are refusing vitamin K in Tennessee. A random sample of birth records from three Nashville hospitals (3,080 infants) and four major Tennessee nonhospital birthing centers (218 infants) was undertaken. This analysis revealed that up to 3.8% babies born in Tennessee hospitals and 28% of babies born outside hospitals did not get vitamin K at birth. When the parents of the affected babies were asked why they refused vitamin K, they expressed concern about a now debunked association between childhood leukemia with vitamin K administration and a desire to minimize their newborn’s exposure to what they saw as an unnecessary foreign toxin.
As a parent of a new infant, if you perceive no risk to denying a recommended therapy such as a vaccine or vitamin supplement, and you perceive the therapy as toxic, of course you are going to refuse. But if that same parent has more information, I think they will be able to see that rather than a toxin, it might be a life saving vital nutrient that prevents serious disease or death in newborns. The numbers don’t lie. A simple dose of vitamin K at birth reduces a baby’s chance of hemorrhagic disease of the newborn by an amazing 81 fold. Rather than seeing this therapy as toxic, our opinion is that parents should see it for what it is, a miracle.
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- Notes from the Field: Late Vitamin K Deficiency Bleeding in Infants Whose Parents Declined Vitamin K Prophylaxis — Tennessee, 2013
November 15, 2013 / 62(45);901-902
Written collaboratively by Carson Blaylock and Paul Smolen M.D.