Updated: Feb 4
Vitamin K is a fat-soluble vitamin needed for blood clotting. We cannot make Vitamin K ourselves, and we don’t store it very well in our body. We get Vitamin K1 (also known as phylloquinone) from:
Leafy green vegetables, such as spinach, kale, swiss chard, and collards, Broccoli, Cabbage, Cauliflower, Turnips, Brussels sprouts, Avocado, Banana, Kiwi, Soybean oil
For the most part, our bodies can continue to clot with low Vitamin K levels. However, as the levels keep getting low, we can suddenly get so low where our bodies stop clotting and start spontaneously bleeding.
Why is this an issue for newborns?
Newborns are not born with adequate Vitamin K. It takes a baby until about 6 months of age to build up enough Vitamin K to clot on their own. Without enough Vitamin K newborns are susceptible to VKDB (Vitamin K deficiency bleeding). This is spontaneous bleeding that occurs in the brain, intestines, or GI tract.
VKDB is classified into 3 categories based on when it occurs:
1. early (24 hrs from birth)
2. classical (2-7 days old)
3. late (3-8 weeks old) - the mortality rate for late VKDB is approximately 20%
The main prevention for VKDB is to give the infant 1 mg of Vitamin K via an intramuscular injection at birth. By giving newborns a vitamin K shot at birth we are covering them for their vitamin K needs for those first 6 months until their body catches up.
Many people may be wondering if delayed cord clamping or breastfeeding could supply the infant the extra iron they need for the first 6 months, sadly no...
Delayed cord clamping raises iron levels because cord blood is rich in iron. However cord blood has extremely low levels of Vitamin K. Very little Vitamin K1 transfers from the mother to the baby through the placenta and babies do not have enough bacteria in their intestines to make Vitamin K.
Secondly, breast milk has very tiny amounts of Vitamin K, formula actually has more Vitamin K because it is fortified with it. There is also no evidence supporting increasing maternal Vitamin K intake during pregnancy or while breastfeeding has an effect on infant levels.
About formula. Technically, another way to prevent VKDB is through formula feeding (I would never recommend you to formula feed over breast just for the Vitamin K benefits, your breast milk has many many more benefits when compared to formula even though it lacks in Vitamin K).
There are virtually no reports of VKDB occurring in infants who are formula fed. Formula has high levels of Vitamin K at around 55 micrograms per liter (Shearer, 2009).
Babies who are formula fed have around 100 times more Vitamin K1 than babies who are breastfed. Although bottle feeding due to this solely is STILL NOT BETTER than breast.
In 2013, six infants were admitted to Vanderbilt Children’s Hospital in Nashville, Tennessee, with life-threatening bleeding. The infants were diagnosed with late Vitamin K deficiency bleeding (VKDB)—four had bleeding in the brain, two had bleeding in the intestines. Two required emergency brain surgery, one has severe brain damage (a stroke with right-sided paralysis and severe cognitive delays), and two have mild to moderate brain injuries (Wilemon, 2013).
"The infants ranged in age from seven weeks to five months old; three were male and three were female. Three of the infants were born in hospitals, two were born at home, and one was born in a birth center. They all had normal, vaginal births (no Cesareans, no forceps, no vacuum deliveries). Both the babies and their mothers had not been taking any antibiotics, they had not been sick, the mothers were not on restrictive diets, and the babies had no head trauma.
All of the infants were exclusively breastfed, and they all had critically low levels of Vitamin K in their blood. Most importantly, what these infants had in common was that all of their parents had declined Vitamin K shots at birth" (Dekker, 2020).
A Swedish study from 1944 that included over 13,000 infants who were given 1 mg of Vitamin K at delivery proved that infants who received Vitamin K had a 5-fold reduction in the risk of bleeding leading to death. They estimated that for every 100,000 infants, Vitamin K could save 160 infants lives per year (Lehmann 1944).
When infants do not receive any Vitamin K at birth, 4.4 to 7.2 infants out of 100,000 will develop late VKDB.
When infants receive the Vitamin K shot at birth, anywhere from 0 to 0.4 infants per 100,000 get late VKDB.
WHY do people refuse Vitamin K?
1. They believe Vitamin K is unnecessary AKA they lack the knowledge about the role of Vitamin K in preventing bleeding from VKDB.
3. They have concerns about preservatives that are in infant injections. You can ask your hospital or provider if they have the preservative-free version of Vitamin K.
The ingredients in a shot with NO preservatives include:
1 mg of Vitamin K1- a fat-soluble vitamin derived from plants.
10 mg of Polysorbate 80- helps Vitamin K1 dissolve in liquid for the injection. Made from natural sorbitol and plant-based oleic acid and is used in a wide variety of foods, medicines, and vitamin supplements.
10.4 mg of Propylene glycol- helps absorb extra water and maintain moisture in certain medicines. Recognized as safe by the FDA.
0.17 mg of Sodium acetate anhydrous- a mixture of salt and bicarbonate, used to adjust the pH of the injection.
0.00002 mL of Glacial acetic acid- AKA vinegar, used to adjust the pH of the injection (Dekker, 2020).
4. They heard Vitamin K is linked with causing Leukemia. There are a total of 12 studies examining this link. Out of these 12 studies, two small studies (one being the original study) found a small link. The other 10 studies found no relationship between Vitamin K and childhood cancer.
ALSO IMPORTANT TO NOTE: many hospitals will NOT do circumcisions if your infant has not received Vitamin K due to the bleeding risk. Many providers will recommend you wait until 6 months to circumcise the infant because by then they will be making their own Vitamin K.
Alternatives? Oral Vitamin K?
Research and providers mat say that oral Vitamin K1 is not available in the U.S. because there is not an FDA-approved oral version for sale.
However, there is a Vitamin K1 supplement that you can buy in the U.S. called BIO-K-MULSION®. It contains 500 micrograms of Vitamin K1 (as K1-phytonadione) per drop (4 drops = 2 mg), water, gum arabic, and sesame seed oil. It is sold as a supplement without FDA approval. The amount of Vitamin K could vary between vials since it is not FDA approved.
What are the cons of the Vitamin K shot?
Can cause infant pain at injection site, this is temporary.
Can cause bleeding or bruising at the injection site, also temporary and will happen with an injection.
Most will have a preservative called benzyl alcohol. Preservative has caused respiratory distress in premature newborns however this is INSANELY RARE and providers believe the benefits outweigh this very small and rare risk.
Dekker, R. (2020, February 03). Evidence on: The Vitamin K Shot in Newborns. from https://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/
Lehmann J. (1944) Vitamin K as a prophylactic in 13,000 babies. Lancet from CABI
Shearer M. J. (2009). Vitamin K deficiency bleeding (VKDB) in early infancy.Blood reviews,23(2), 49–59. https://doi.org/10.1016/j.blre.2008.06.001
Wilmon, Tom (2013). Babies hemorrhage after parents refuse vitamin K shots. USA Today.