Why is Vitamin K given?

Vitamin K is necessary for the blood clotting process and deficiency can increase the risk of haemorrhagic disease of the newborn (HDN). Early disease is most likely to occur within 7 days of life. Some babies can develop a late and more severe form of this disease after the first week and up to 26 weeks (about 6 months) of life (1.2). Intracranial bleeding may result and of those affected, 30-50% will die or suffer severe brain damage (2).

At The Simpson it is recommended that newborn babies routinely received INTRAMUSCULAR Vitamin K to prevent the development of HDN.

Babies born to the following women are at higher risk of developing HDN:-

• those receiving anticonvulsant therapy or antituberculous agents
• those who have poor absorption due to hepatic disease or biliary obstruction (2)
• women who have undergone surgical procedures during delivery, have experience prolonged labour or are suffering from albuminuria
• babies who are birth asphyxiated (3).

These parents should be informed that we strongly advise the administration of IM vitamin K to their baby.

Vitamin K can be administered orally to babies. To those parents who request more information on the oral route, it is essential to discuss the advantages and disadvantages of oral versus IM vitamin K. This will enable these parents to make an informed decision.

The use of vitamin K must be discussed with the prospective parents in the antenatal period

Concerns about Vitamin K

Use of intramuscular Vitamin K in neonates was previously associated with an increased risk of certain childhood cancers (6). It was unclear whether this supposed causal link was due to the total dose given, route, use of a bolus dose or certain components of the parenteral formulations. As a result, an oral form of Vitamin K is now licensed for use in term babies > 36 weeks (4). The association of Vitamin K with childhood cancers has now been strongly refuted (7,8). There are now concerns that sub-optimal doses of oral Vitamin K may increase the incidence of late onset HDN (9). It is therefore essential to stress to parents who have requested oral Vitamin K that they must ensure that babies receive all the recommended doses (1,2,3). 

References

1. McNinch AW, Tripp JH. Haemorrhagic disease of newborn in the British Isles; two year prospective study BMJ 1991; 303: 1105-8.
2. The Scottish Office, Home and Health Department, Prophylaxis against vitamin K deficiency bleeding in infants. SOHHD/CAMO (92) 16 (1992).
3. Slattery JM. Why we need a clinical trial of vitamin K. BMJ 1994; 308: 908-10.
4. Konakion MMā Data Sheet. Roche Products Ltd. ABPI Data Sheet Compendium and Summary of Product characteristics 1996/97.
5. Stoeckel K, Joubert PH; Gruter J. Elimination half-life of vitamin K1 in neonates is longer than is generally assumed: implication for the prophylaxis of haemorrhagic disease of the newborn. Eur J Clin Pharmacol 1996; 49: 421-423.
6. Golding J, Greenwood R, Birmingham K, Mott M. Childhood cancer, intramuscular vitamin K and pethidine given during labour BMJ 1992; 305: 341-6.
7. Von Kries R, Gobel U, Hachmeister A, Kaletsch U, Michaelis J, Vitamin K in childhood cancer; a population based case-control study in Lower Saxony, Germany. BMJ 1996, 313: 199-203.
8. Ansell P, Bull D, Roman E. Childhood Leukaemia and intramuscular vitamin K; findings from a case control study. BMJ 1996: 313; 204-5.
9. Croucher C, Azzopardi D. Compliance with recommendations for giving vitamin K to newborn infants. BMJ 1994; 308: 894-5.
10. The Royal College of Midwives (1996). The Midwife’s role in the administration of vitamin K. Position Paper 13, RCM, London.

Further reading

Slattery J. Treating all babies with Vitamin K: an "unnatural policy?" British Journal of Obstetrics and Gynaecology Vol 103 no 5 May, 1996 pp 400 - 401

Greer FR, Marshall SP, Foley AL et al. Improving the vitamin K status of breastfeeding infants with maternal vitamin K supplements. Pediatrics Vol 99 no 1, Jan, 1997 pp 88-91

Ruby C. Vitamin K Prophylaxis: a historical perspective. MIDIRS vol 7, no 3 Sept 1997 p 362-364.