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Consequences of vitamin K refusal at birth devastating, irreversible

Lisa Irvin, MD

In the past few years, there has been an increase in parents refusing to have their children receive the vitamin K shot at birth. The result of this trend has been an increase in cases of vitamin K deficiency bleeding (VKDB).

Reasons usually cited for refusal are a fear of pain or stress for the baby due to the shot, or increased risk of leukemia. Many studies show there is no increased risk of leukemia, and the pain is minimal and brief.

Vitamin K is needed by our bodies for blood clotting. We’re born with blood-clotting factors, but vitamin K is needed for activation. Older kids and adults make vitamin K from the bacteria in their gut and from their diet.

Newborns, however, are born with little vitamin K, and fewer clotting factors than adults. Vitamin K doesn’t cross the placenta, and newborns don’t have bacteria in their gut yet to make it. Breast milk has low levels of vitamin K, so breastfed babies have low levels of the vitamin for a few weeks. Newborns are given vitamin K immediately following birth to activate these clotting factors and prevent hemorrhagic disease of the newborn, or VKDB. 

The 3 types VKDB 

  • The early type occurs in the first 24 hours and is uncommon. It usually is the result of the mother taking medication that interferes with vitamin K.
  • The classical type occurs between the second and seventh days of life, when vitamin K levels are the lowest in a newborn. Bleeding occurs most commonly in the intestines, umbilical cord, skin, nose, and circumcision site.
  • Late VKDB occurs when the infant is 3-8 weeks old and happens only in breastfed infants. These bleeds typically occur in the brain, intestines and skin. If bleeding occurs in the brain, the mortality rate can be as high as 20 percent.

The risks of VKDB are real and serious if vitamin K is declined at birth. Although it’s not a common event, the outcome can be devastating and irreversible. It’s preventable with one dose of intramuscular vitamin K at birth.

There are oral preparations of vitamin K that can be given, but because the absorption and compliance are variable, the recommendation for all infants is to receive the intramuscular dose.

Lisa Irvin, MD, is pediatrician at Partners in Pediatrics.

Lisa Irvin, MD, is pediatrician at Children’s Hospitals and Clinics of Minnesota.
Lisa Irvin, MD, is pediatrician at Children’s Hospitals and Clinics of Minnesota.