57442154What is vitamin K?

Vitamin K is a substance that is naturally present in our body and plays an important role in helping our blood to clot. At birth, a baby is born with very low stores of this vitamin; these are then quickly used up over the first few days of life. This can leave a baby vulnerable to severe bleeding (called ‘haemorrhage’) and they can also develop a rare but very serious condition called ‘vitamin K deficiency bleeding’ (VKDB). A baby who develops VKDB might have excessive bleeding from their umbilical cord, nosebleeds, or unexpected bruises. Some babies may also have jaundice (a yellow tinge to their skin) which lasts for much longer than usual and their urine may be dark brown, while their stools (poo) are pale, clay or chalk-coloured. VKDB is most common in the first week after birth, but can occur within the first 24 hours, or not until much later, when the baby is six or eight months old.


Which babies are more at risk of VKDB?

Babies thought to be more at risk of developing VKDB include those who are born early (prematurely), babies who have an assisted birth – are delivered by forceps or ventouse (vacuum extraction) and babies whose mothers have taken specific medicines, especially those used to treat epilepsy.


How to make a decision about whether your baby should have vitamin K

Since 1998 the Department of Health has recommended that vitamin K is given to all newborn babies as soon after birth as possible. This can be as an injection in your baby’s leg, or as liquid medicine drops into their mouth (oral). The oral drops are usually given in three doses, two within the first week (the first, very soon after they have been born) and then a third dose when the baby is one month old.


How do you decide whether your baby receives vitamin K as an injection or oral drops?

Much of the controversy that has surrounded the use of vitamin K is because of research that suggested a link between giving babies vitamin K as an injection and an increased risk of their developing childhood cancers. Recent research has shown this to be very unlikely; however, if you still feel concerned, please talk to your midwife or GP who should be able to give you up-to-date and balanced information.


Breastfeeding versus formula feeding

Infant formula milks for newborn babies have vitamin K added to them, which increases the levels of vitamin K in babies fed on this type of milk. This poses a dilemma for women who wish to breastfeed because, apart from the added vitamin K in formula milk, there is an increased digestive activity in formula fed babies which aids absorption of the vitamin and stimulates the baby’s own production of vitamin K more quickly. By comparison, levels of vitamin K that can be obtained from breast milk are at their lowest when the most common form of VKDB can occur. However, levels of vitamin K will gradually rise, even in those babies who receive only breast milk, as feeding becomes established and the baby begins to take a more varied diet. Therefore, the naturally occurring low levels of vitamin K needs to be put into context alongside the many health benefits that breastfeeding offers to both mothers and babies.


It’s your choice

Although the Department of Health has made this recommendation, you have a choice as to whether or not your baby receives vitamin K. Your midwife or doctor will give you information to read about vitamin K, which will include why it is being offered to your baby, and how it can be given. They will be able to answer any questions you might have.

A consensus statement: vitamin K prophylaxis in the newborn (2003). New Zealand College of Midwives Journal 23:January:33-34.

Adame N, Carpenter SL (2009). Closing the loophole: midwives and the administration of vitamin K in neonates. Journal of Pediatrics 154(5):769-771.

Ansell P, Roman E, Fear NT et al (2004). Vitamin K update: survey of paediatricians in the UK. British Journal of Midwifery 12(1):38-41.

Enoch JH (2000). Babies and vitamin K. Midwifery Today (56):42-45, 64.

Harrington DJ, Clarke P, Card DJ et al (2011). Urinary excretion of vitamin K metabolites in term and preterm infants: relationship to vitamin K status and prophylaxis. Pediatric Research 68(6):508-512.

Puckett RM, Offringa M (2000). Prophylactic vitamin K for vitamin K deficiency bleeding in neonates (Cochrane Review). (Date of most recent substantive update: 6 August 2000). The Cochrane Database of Systematic Reviews issue 4.

Robertson NRC (2000). A manual of normal neonatal care 2nd ed. London: Arnold. 350 pages.

Stine S D (2000). Vitamin K deficiency: the waterbirth and hospitalization of Amanda. Midwifery Today (56):December:35-37.

Strehle EM, Howey C, Jones R (2010). Evaluation of the acceptability of a new oral vitamin K prophylaxis for breastfed infants. Acta Paediatrica 99(3):379-383.