Lately, parents who refuse the Vitamin K shot have come under heavy criticism from doctors, public health personnel, and the news media. Because of the increased attention, it is becoming more important than ever for parents to understand what the Vitamin K injection is supposed to do.
The medical explanation for administering the Vitamin K injection is that all newborns are Vitamin K deficient and that this puts them at a special risk for intracranial hemorrhage (bleeding inside the skull). Currently, the condition of newborn hemorrhage is called Vitamin K Deficient Bleeding (VKDB). However, it used to be called Hemorrhagic Disease of the Newborn. It was first observed during the 1890’s in relation to babies with non-classical hemophilia, but it wasn’t until the 1960’s that doctors began administering routine prophylactic Vitamin K injections. The injections are said to be more effective than oral drops, which have to be administered repeatedly over the first 12 weeks of life to be effective.
There are three types of VKDB: early onset (occurring within 24 hours of birth), classical onset (occurring within 1-7 days of birth), and late onset (occurring within 2-12 weeks of birth). Breastfeeding is said to be a risk factor because breastmilk is not fortified with Vitamin K.
Newborns and Vitamin K
The first problem with the current model of VKDB is the idea that all newborns are Vitamin K deficient because their levels of Vitamin K are lower than those of adults. It really should not seem unreasonable to consider that lower levels of Vitamin K are normal for newborns since all newborns are born with these “low” levels of Vitamin K.
From a biological and evolutionary perspective, newborns don’t ordinarily need to have high levels of clotting factor because they don’t do much that could cause a lot of injury. Unlike most other animals, human infants are completely helpless when they are born and can’t move about much on their own. Their bodies have not been equipped to deal with physical trauma outside of being pushed out in a squatting position at birth and then being snuggled and carried around for several months. Babies only develop adult levels of clotting factor around six months, about the time when they start to become more mobile and get ready to start crawling. For a newborn, adult levels of vitamin K are probably abnormal.
The other problem with the current idea of VKDB is the assumption that because high doses of Vitamin K can treat the bleeding, that the bleeding must be caused by a deficiency of Vitamin K. Just because a condition is treated with a certain substance doesn’t meant that the patient is deficient in it. Severe bleeding is a condition that can be caused by Vitamin K deficiency and treated with high doses of Vitamin K, but can have many other causes such as physical trauma and infection.
Classic VKDB
Routine Vitamin K injections were first instituted during the “Twilight Sleep Era”, one of the most brutal periods in Western obstetrics. Women were given a hallucinogenic drug called scopolamine which made them forget the experience of birth, but also made them lose control of their minds and become violent. They were tied to their beds flat on their backs and being unable to effectively participate in the birth, their babies were often dragged out with forceps.
This type of trauma is obviously beyond what the human infant’s body has evolved to have the capacity to deal with. In fact, Classic Hemorrhagic Disease of the Newborn is associated with physical trauma from the use of forceps and vacuum extraction as well as from surgical sites (like circumcision), and the umbilicus.
Even before the use of Vitamin K prophylaxis, evidence that newborn hemorrhage can be caused by the use of instrumentation during birth existed. A 1911 study from the New England Journal of Medicine found that in a study of 51 cases of HDN, 9 were forceps deliveries. So there is a long correlation between birth injury and newborn hemorrhage.
The current theory of VKDB assumes that the methods used to deliver babies are safe and that the problem lies in an imperfection in the body. A more logical hypothesis for Classical Hemorrhagic Disease of the Newborn/ VKDB might be that many of the cases of HDN were caused by injuries from the use of excessive force and instrumentation during birth and that high doses of Vitamin K were used to treat the condition. The methods of doctors, not the body, are then the problem.
Early Onset VKDB
Early Onset VKDB is often caused by prenatal conditions, such as the mother taking certain seizure medications. Giving extra doses of Vitamin K to the mother 2-4 weeks before delivery is actually the favored protocol for preventing these types of newborn hemorrhage cases.
Late Onset VKDB
These are cases of hemorrhage that occur between two and twelve weeks and even as long as six months after birth. Late Onset VKDB is an extremely interesting phenomenon. Its symptoms differ from the two other types of VKDB. Intracranial hemorrhage (bleeding inside the skull) is rare in both other types of VKDB, but is present in over 50% of Late Onset cases. Babies with this type of VKDB also have sleep apnea and seizures.
Most of the sensationalist news articles about babies developing VKDB because parents refused the Vitamin K shot deal with Late Onset VKDB. The diagnosis of VKDB is not as exact a science as most doctors and reporters would like us to think.
To start with, one of the listed causes of VKDB is being breastfed and not receiving the Vitamin K shot, so not having the treatment/prophylaxis is deemed to be the cause of the condition. This means that when a baby comes into the hospital with intracranial hemorrhaging and is found to be solely breastfed and not have received the Vitamin K shot, the doctor is very likely to diagnose VKDB despite the fact that there are other causes of true Vitamin K deficiency in infants.
Conditions such as celiac disease, cystic fibrosis or vaccine reactions can all cause the characteristic intracranial bleeding associated with late-onset VKDB. Intracranial bleeding can also be caused by forceps delivery . Intracerebral bleeding can also be caused by infections of the central nervous system such as encephalitis resulting from (among other causes) vaccine reactions.
It is very possible that some of the so-called Vitamin K Deficient Bleeding cases reported in the media are babies who didn’t receive a Vitamin K shot, but were vaccinated and developed encephalitis. But because of the persistent belief that babies are born with a Vitamin K deficiency, doctors are more likely to gloss over the possibility of vaccine induced encephalitis when a baby with a brain bleed and no Vitamin K shot comes into the emergency room.
Side Effects?
According to medical literature, Vitamin K is well tolerated in high doses except for those with pre-existing liver conditions or who take certain medications. There are claims that the shot increases the risk for childhood leukemia, but the medical community says there is no definitive link.
For babies who will have to suffer from out-of-the-ordinary physical trauma soon after birth, such as surgery to correct a congenital abnormality, Vitamin K prophylaxis could be a good idea, though no research exists about whether this is necessary. My husband and I had initially planned on refusing the Vitamin K shot, but consented to it when we found out that our first son would need surgery 36 hours after birth. We refused it for our second son since he was born healthy and without trauma.
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