Vitamin K is essential for blood clotting, as it allows blood platelet cells to become "sticky" and coagulate together, which prevents internal bleeding and allows external injuries to heal. Some newborns experience vitamin K deficiency bleeding, either at the time of birth or shortly thereafter, which is life threatening. It has become common practice in the United States and Europe to inject newborns with vitamin K, although this routine procedure carries some risk and has become controversial.
Role of Vitamin K
Vitamin K represents a group of five fat-soluble compounds that are essential for the process of blood clotting. Vitamins K-1 and K-2 subtypes are derived from plant and animal sources, respectively, while the other types are synthetic versions found in fortified foods. Vitamin K is absorbed in the intestines and required for glutamic acid to catalyze into gamma-carboxyglutamic acid, which is needed for the coagulation cascade to work. Deficiency leads to uncontrollable bleeding. Anticoagulants block the actions of vitamin K.
Newborn Deficiency
According to "Professional Guide to Diseases," severe vitamin K deficiency occurs in about 1 in 10,000 newborns, although lesser deficiency that could lead to excessive bleeding might occur in 1 in 200. Vitamin K deficiency can leave the newborn more susceptible to hemorrhage in response to birthing trauma, especially due to breech or forceps delivery, or once at home due to minor trauma or circumcision. Bleeding into the brain and causing permanent brain damage is the biggest concern. These risks are almost completely preventable by giving extra vitamin K immediately after birth, which is why injections have been standard protocol in the U.S. and Europe since the 1960s.
Causes of Newborn Deficiency
Newborns can be vitamin K deficient due to a deficiency in their mothers, or they can develop the deficiency shortly after birth due to a liver disease, malabsorption problem or malnutrition. Bottle-fed babies very rarely develop vitamin K deficiency because most formulas are fortified. Mothers primarily at risk of deficiency include those who take anticoagulant or anticonvulsant drugs, those with liver conditions or those with fat absorption problems, as cited in "Human Biochemistry and Disease." In practical terms, mothers suffering from alcoholism, cystic fibrosis and bulimia are also at risk.
Controversy of Vitamin K Injections
According to "Cochrane Database of Systematic Reviews," concerns about the safety of vitamin K injections arose in the early 1990s when two studies were published that suggested a link between vitamin K injection and childhood leukemia. The studies indicated an increased risk of leukemia by a factor of about 1.8 in those newborns who received the injections. Further studies were conducted, but none confirmed the association between cancer and vitamin K injections. The American Academy of Pediatrics states that vitamin K injection prevents a life-threatening disease and the risks of cancer are unproven and unlikely. They recommend a single injection for all newborns. Despite this, oral doses of vitamin K were developed and are available in Europe and the U.S. Critics of the injection method argue that the amount of vitamin K injected is 20,000 times the newborn levels at birth and may contain preservatives that are toxic, as cited in a 2003 edition of "Archives of Disease in Childhood." Further, vitamin K is meant to be absorbed in the gut not injected into muscles, which is why the oral route is preferred. Finally, colostrum, which precedes regular breast milk, is rich in vitamin K and can act as a natural source if a newborn is immediately nursed.
References
- "Professional Guide to Diseases: Ninth Edition"; Springhouse Publishing; 2009
- "Human Biochemistry and Disease"; Gerald Litwack; 2008
- "Cochrane Database of Systematic Reviews"; Prophylactic vitamin K for vitamin K deficiency bleeding in neonates; R. Puckett et al.; Issue 4, 2000
- American Academy of Paediatrics: Vitamin K Injection Policy Statement
- "Archives of Disease in Childhood - Fetal Neonatal Edition"; Vitamin K--what, why, and when; E. Hay; March 2003
Member Comments