Vitamin K at birth: to inject or not to inject?

Reprinted from International Chiropractic Pediatric Association Newsletter
September/October 2002 Issue

by Linda Folden Palmer, DC

UPDATE to below article: A very large 2003 study in the British Journal of Cancer (Fear et al.) has suggested that there is no link between bolus vitamin K provision at birth and leukemia or other cancers. (The study eliminated 2% of cancer cases in their study group that were diagnosed prior to 3 months of age. They additionally did not count Down's syndrome babies and some others.) I'm inclined to believe that the risk is slight if it exists. Still, the conflicts in findings lead me to want to see an analysis of premature babies only, as any effect will be enhanced in this set and may provide a more definitive answer for older babies --- not to question provision in preemies as the benefits of vitamin K administration are more important in premature infants.

Newborn infants routinely receive a vitamin K shot after birth in order to prevent (or slow) a rare problem of bleeding into the brain weeks after birth. Vitamin K promotes blood clotting. The fetus has low levels of vitamin K as well as other factors needed in clotting. The body maintains these levels very precisely.¹ Supplementation of vitamin K to the pregnant mother does not change the K status of the fetus, confirming the importance of its specific levels.

Toward the end of gestation, the fetus begins developing some of the other clotting factors, developing two key factors just before term birth.² It has recently been shown that Vitamin K is involved in regulating the rate of cell division in the fetus. It's possible that abnormally high levels of vitamin K can allow cell division to get out of hand, leading to cancer.

What's the Concern?

The problem of bleeding into the brain occurs mainly from 3 to 7 weeks after birth in just over 5 out of 100,000 births (without vitamin K injections); 90% of those cases are breastfed infants,³ because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.

The cause of this bleeding trauma is generally liver disease that has not been detected until the bleeding occurs. Several liver problems can reduce the liver's ability to make blood-clotting factors out of vitamin K; therefore extra K helps this situation. Infants exposed to drugs or alcohol through any means are especially at risk, and those from mothers on anti-epileptic medications are at very high risk and need special attention.

Such complications reduce the effectiveness of vitamin K, and in these cases, a higher level of available K could prevent the tragic intracranial bleeding. This rare bleeding disorder has been found to be highly preventable by a large-dose injection of vitamin K at birth.

The downside of this practice however is a possibly 80% increased risk of developing childhood leukemia. While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely.^4,5 A more recent analysis of six different studies suggests it may be a 10 or 20% increased risk. This is still a significant number of avoidable cancers.⁶

Apparently the cell division that continues to be quite rapid after birth continues to depend on precise amounts of vitamin K to proceed at the proper rate. Introduction of levels that are 20,000 times the newborn level, the amount usually injected, can have devastating consequences.

The Newborn's Diet

Nursing raises the infant's vitamin K levels very gradually after birth so that no disregulation occurs that would encourage leukemia development. Additionally, the clotting system of the healthy newborn is well planned, and healthy breastfed infants do not suffer bleeding complications, even without any supplementation.⁷

While breastfed infants demonstrate lower blood levels of vitamin K than the "recommended" amount, they show no signs of vitamin K deficiency (leading one to wonder where the "recommended" level for infants came from). But with vitamin K injections at birth, harmful consequences of some rare disorders can be averted.

Infant formulas are supplemented with high levels of vitamin K, generally sufficient to prevent intracranial bleeding in the case of a liver disorder and in some other rare bleeding disorders. Although formula feeding is seen to increase overall childhood cancer rates by 80%, this is likely not related to the added vitamin K.

The Numbers

Extracting data from available literature reveals that there are 1.5 extra cases of leukemia per 100,000 children due to vitamin K injections, and 1.8 more permanent injuries or deaths per 100,000 due to brain bleeding without injections. Adding the risk of infection or damage from the injections, including a local skin disease called "scleroderma" that is seen rarely with K injections,⁸ and even adding the possibility of healthy survival from leukemia, the scales remain tipped toward breastfed infants receiving a prophylactic vitamin K supplementation. However, there are better options than the .5 or 1 milligram injections typically given to newborns.

A Better Solution
The breastfed infant can be supplemented with several low oral doses of liquid vitamin K⁹ (possibly 200 micrograms per week for 5 weeks, totaling 1 milligram, even more gradual introduction may be better). Alternatively, the nursing mother can take vitamin K supplements daily or twice weekly for 10 weeks. (Supplementation of the pregnant mother does not alter fetal levels but supplementation of the nursing mother does increase breastmilk and infant levels.)

Either of these provides a much safer rate of vitamin K supplementation. Maternal supplementation of 2.5 mg per day, recommended by one author, provides a higher level of vitamin K through breastmilk than does formula,¹⁰ and may be much more than necessary.

Formula provides 10 times the U.S. recommended daily allowance," and this RDA is about 2 times the level in unsupplemented human milk. One milligram per day for 10 weeks for mother provides a cumulative extra 1 milligram to her infant over the important period and seems reasonable. Neither mother nor infant require supplementation if the infant is injected at birth.¹¹

The Bottom Line
There is no overwhelming reason to discontinue this routine prophylactic injection for breastfed infants. Providing information about alternatives to allow informed parents to refuse would be reasonable. These parents may then decide to provide some gradual supplementation, or, for an entirely healthy term infant, they may simply provide diligent watchfulness for any signs of jaundice (yellowing of eyes or skin) or easy bleeding.

There appears to be no harm in supplementing this vitamin in a gradual manner however. Currently, injections are provided to infants intended for formula feeding as well, although there appears to be no need as formula provides good gradual supplementation. Discontinuing routine injections for this group alone could reduce cases of leukemia.

One more curious look at childhood leukemia is the finding that when any nation lowers its rate of infant deaths, their rate of childhood leukemia increases.¹² Vitamin K injections may be responsible for some part of this number, but other factors are surely involved, about which we can only speculate.

Source: http://babyreference.com/VitaminKinjectORnot.htm

Nowadays with biotechnology advancing faster than research of consequenses, we are at risk of more mistake option than non. I think I'll most probably go for the oral option which feels to be the safer method.

Update:

Spoke to Dr.Sudha about the vitamin K injection. Seems this is the standard practice in malaysia for quite some time now. Was included in my ceasarian package too. I brought up about vitamin K alarming 20,000X over dose and the possibility of raising the chances of leukimia, and the alternative of oral dosage instead. She told me she will check with her pediatrician.

I was thinking to opt for oral dosage if its anyway possible.

Another note from Dr. Sudha, she says vitamin K is very crucial and must be given no matter in which form as without the boost there are risk when they cut the cord or when giving any injection and the bleeding wont stop.