What is Vitamin K?
Vitamin K is a fat-soluble nutrient that helps with blood clotting. Clotting is an important process in the body. Without it, bleeding would be life threatening. Older children and adults get Vitamin K from food such as green, leafy vegetables, meat, dairy, and eggs. The healthy bacteria in our intestines, which make up our microbiome, also produce some Vitamin K.
Why do babies need Vitamin K injections at birth?
Babies do not get enough Vitamin K from their mothers during pregnancy. Unlike other vitamins and nutrients, Vitamin K does not pass through via the placenta, nor does it pass to your baby when breastfeeding.
Vitamin K deficiency in newborns puts them at risk of a now rare, but potentially fatal, bleeding disorder called 'Vitamin K Deficiency Bleeding' (VKDB), also known as 'Haemorrhagic Disease of the Newborn' (HDN). VKDB can cause bleeding into the brain and may result in brain damage or even death. Fortunately, it is easy to prevent VKDB with a Vitamin K shot. The injection is given in your baby's thigh within 6 hours of birth.
How is Vitamin K given?
The easiest and most reliable way to give babies Vitamin K is by injection on the thigh. One injection just after birth will protect a baby for many months.
Vitamin K can also be given by mouth. Several oral doses are essential to give enough protection because Vitamin K is not absorbed as well when it is given by mouth, and the effect does not last as long. All babies born in public and private hospitals are given the Vitamin K injection at birth.
What is Vitamin K Deficiency Bleeding (VKDB)?
Newborns who do not get a Vitamin K injection at birth are at risk of Vitamin K Deficiency Bleeding (VKDB). This happens when a baby's blood cannot make clots, and their body cannot stop bleeding through the normal clotting cascade.
The bleeding can happen on the outside of the body. It can also happen inside the body where parents cannot see it. A baby could be bleeding into their intestines or brain before their parents know that anything is wrong. This is exceptionally dangerous. Brain bleeding happens in about half of all babies who develop VKDB, and it can lead to brain damage or death.
Infants who do not receive the Vitamin K shot at birth can develop VKDB at any time up until 6 months of age. There are three types of VKDB, based on the age of the baby when the bleeding problems start: early, classic, and late.
Early-onset:
This begins within the first 24 hours after birth. It usually happens when the mother is taking certain medications that interfere with Vitamin K.
Classic:
This happens between 2 days and 1 week after birth. Doctors do not know exactly what causes most of these cases. Early-onset and classic VKDB occur in 1 in 60 to 1 in 250 newborns.
Late-onset:
This happens between 1 week and 6 months after birth. Studies have shown that it is rarer than early-onset or classical VKDB, occurring in 1 in 14,000 to 1 in 25,000 babies. Infants who did not get a Vitamin K shot at birth are 81 times more likely to develop late-onset VKDB than babies who do get the shot. This highlights the importance of the Vitamin K injection.
What are the signs of Vitamin K Deficiency Bleeding?
Commonly, there are no warning signs to alert parents that something serious—and possibly life-threatening—is happening. However, some subtle, but nonspecific, signs include:
Bleeding from the umbilical cord or nose
Paler skin or pale gums
Bruising easily, especially around the face and head
Bloody stool or black, dark, sticky stool
Vomiting blood
A yellow tint to the white parts of the eyes 3 weeks or more after birth
Seizures, irritability, excessive vomiting, or sleeping too much
Take home Message
Babies, have very little Vitamin K in their bodies at birth. This puts them at risk for bleeding. Fortunately, it is easy to prevent VKDB with a Vitamin K shot. The injection is given in your baby's thigh within 6 hours of birth.
This article is written by Dr. Itumeleng Buti (MBChB)
References
1. Zipursky A. Prevention of vitamin K deficiency bleeding in newborns. British journal of haematology. 1999 Mar 1;104(3):430-7.
2. Ivan L. Hand. Why Your Newborn Needs a Vitamin K Shot. [Internet] Healthy Children.Org:[ Updated 2022 March 9; Cited 2022 May 11] Available from: https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Where-We-Stand-Administration-of-Vitamin-K.aspx.
3. Pregnancybirth&baby. Vitamin K at birth. [Internet] Pregnancy Birth and Baby. [ updated 2020 July; Cited 2022 July] Available from: https://www.pregnancybirthbaby.org.au/vitamin-k-at-birth
4. Shearer MJ. Vitamin K deficiency bleeding (VKDB) in early infancy. Blood reviews. 2009 Mar 1;23(2):49-59.
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