Oral Vitamin K

[S.Elise]

Hi all,

For those of you who are pro-vitamin K, has anyone looked into the differing effectiveness between the shot and the oral version? We decided on the shot last time, but this time (since I am homebirthing in NY) its going to be a hassle to get the shot. Do we think the oral version is OK? To get the shot, I will have to take the baby to the hospital the day or so after it is born, and with swine flu and all, I'm not super into that option.

Thanks in advance,

Lauren

[at_the_hip]

We did the oral vit K...my midwives offer it as an option and I felt perfectly fine with it. I believe it has to be given 3 times? I'm sure you will get more advice but I was happy not having the additives that are in the shot!

[MamaMonica]

Moved to Homebirth.

[jljeppson]

All studies seem to show that while a single dose of oral Vit K is effective at preventing classic VKDB, it does NOT prevent late onset hemorrhagic disease. Repeated doses of oral vit k does appear to be just as effective as the IM Vit K. The recommended dosage is as follows;
4mgs of vit k with a dose of 1 drop at birth, 1 drop at 1 wk, and 1 drop at 1 mth

[nashvillemidwife]

Originally Posted by jljeppson

All studies seem to show that while a single dose of oral Vit K is effective at preventing classic VKDB, it does NOT prevent late onset hemorrhagic disease.

Are you sure? My research is that the 3-dose protocol is as efficient as effective for preventing classic onset, but there is no protocol of equal efficacy to the shot for late onset. There is little or no evidence to support a single dose at all. But I could be mistaken, in which case I'd very much like to know.

[rachel65655]

I am not against Vit K...just the injectable version...Vit K is absorbed through the stomach lining.

I would read this website: http://www.givingbirthnaturally.com/...vitamin-k.html

And read this -

Injectable Vit K Manufacturers Warning:

GENERIC NAME: VITAMIN K - INJECTION
BRAND NAME(S): Aqua-Mephyton, Vitamin K

Warning | Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage | Medical Alert

WARNING: The injectable form of this medication must be used only when the oral form cannot be used. Injectable vitamin K can cause rare, possibly fatal allergic reactions, even during the first injection. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness or trouble breathing.

USES: Vitamin K is a fat soluble vitamin which plays an important role in blood clotting. This medication is used to prevent and treat hypoprothrombinemia (low blood clot factor levels) caused by vitamin K deficiency.

HOW TO USE: This medication is given by injection by a health care professional under the skin (SC, SQ), or if no alternative, into a large muscle (IM) or intravenously (IV), though very serious side effects may occur with the IV or IM route. Follow dosing instructions. Do not increase your dose, take this more often or stop taking this without first consulting your doctor.

SIDE EFFECTS: This medication is generally well tolerated. You may notice pain, swelling and tenderness at the injection site for a few days. Notify your doctor if you experience any of the following while taking this drug: chest pain, flushing, strange movements, rapid pulse, tightness of the chest, cramps. In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor if you have: blood disorders, allergies. A preservative (benzyl alcohol) which may be found in this product or in the liquid used to mix this product (diluent) can infrequently cause serious problems (sometimes death) if given by injection to an infant during the first months of life (neonatal period). The risk is greater with lower birth weight infants and is greater with increased amounts of benzyl alcohol. Symptoms include sudden gasping, low blood pressure, or a very slow heartbeat. Report these symptoms to the doctor immediately should they occur. If possible, a preservative-free product should be used when treating neonates. This medication should be used as directed during pregnancy or while breast-feeding. Consult your doctor about the risks and benefits.

Typically newborns are injected with it into a deep muscle, like the thigh, without any regards for the manufacturers recommendations on how and when this should be used.

If the oral is available, I will allow it even though it is really not necessary with an uncomplicated easy birth and I BF immediately. I will absolutely not allow the injection. Since we are having the twins at home, I probably won't worry about it at all anyway. The hospital we have used in the past doesn't even have the oral version so they haven't gotten it anyway.

[emnic77]

I promise I'm not trying to hijack the thread, but how on earth is something as routine as the vit K shot not only being given to newborns but is required in most hospitals with those sort of warnings right on the freaking package? Is the oral dose really not available in hospitals anywhere?
What am I missing here?

head + brick wall

[fiikske]

We're living in Belgium, and as far as I know, the vit. K is only administered oraly.

KR,
Fiikske

[jljeppson]

My apologies, I didn't mean to make it seem like I was endorsing the single dose. Combined with breastfeeding, a single dose will HELP deal with classic VKDB, but it doesn't have the long term effectiveness that repeated doses have and certainly doesn't match the effectiveness of the IM Vit K. Interesting to note is a study that I have quoted below

In 1998, Greer and colleagues compared 2 mg doses of Konakion MM® given at birth and repeated at 7 and 30 days of life in 79 infants with standard IM dosing (a single 1 mg injection at birth) in 77 infants at two Wisconsin hospitals.[21] At three months, patients receiving the oral preparation had significantly higher serum vitamin K concentrations than the patients receiving the IM dose. No patients in either group experienced late VKDB. There were no significant differences in prothrombin times (INR values) between the groups. Uncarboxylated prothrombin (PIVKA II) values were elevated in three of the 77 IM patients at 56 days, but none of the 79 infants given the new oral product. The authors concluded that the mixed micellar preparation is a safe and effective alternative to traditional IM vitamin K administration.

The problem is that there are now studies showing that in countries that primarily used oral Vit K there has been a rise in cases of late onset hemorraghic disease. Some, for instance Australia, have switched back to the IM Vit K despite the possibilities of cancer. There's no new data yet to show whether this has had any effect on their numbers. Some countries are now using the oral, but doing a dose at birth and then a weekly dose for the next two months and have had good results with it. For me, everything I've read has led me to be comfortable with the oral dosing, as long as there are 3 doses provided. But in most cases, I don't even use Vit K unless there has been some birth trauma that prompts me to use it.

[nashvillemidwife]

So since nearly every baby born in the U.S. along with many other countries get a vitamin K shot at birth, where are all the damaged babies?

[lovebug]

Based on my research most other counties us ORAL VIT K in 3 doses… the USA is one of the only counties that still uses the shot...

[S.Elise]

Thanks, everyone, this is helpful. I didn't realize that oral was the international consensus. I had my first baby in the UK and had all three options - nothing, oral or shot, and I chose shot because the info I had did not mention any of these warnings. So I guess oral is OK then...which makes my life a lot easier! I will check out these resources more carefully now...many thanks.

[rachel65655]

Originally Posted by nashvillemidwife

So since nearly every baby born in the U.S. along with many other countries get a vitamin K shot at birth, where are all the damaged babies?

There are some studies that think that neonatal jaundice is due mostly to the overdose of Vit K in their system. We all think that newborns are just supposed to be jaundice and it's normal. My youngest DD is the only one who had not gotten the Vit K injection and the only baby that I have had with no jaundice....I don't think that it is a coincidence.

[emnic77]

Originally Posted by nashvillemidwife

So since nearly every baby born in the U.S. along with many other countries get a vitamin K shot at birth, where are all the damaged babies?

a five second search for "vitamin k injection harming neonates" in the Scholar search for google turned up a bunch of stuff I'm not inclined to go slogging through, because I have no plans of doing the Vit K injection anyway, but this was the first thing on the list:

http://www.bmj.com/cgi/content/abstract/316/7126/178

Case-control studies of relation between childhood cancer and neonatal vitamin K administration

BMJ 1998;316:178-184 (17 January)
Papers
Case-control studies of relation between childhood cancer and neonatal vitamin K administration

Objective: To investigate the possible link between neonatal administration of intramuscular vitamin K and childhood cancer.
Design: Matched case-control study.
Setting: Selected large maternity units in England and Wales.
Subjects: Children with cancer born 1968-85, diagnosed 1969-86; controls matched for sex, month of birth, and hospital of birth.
Main exposure measures: Neonatal administration of vitamin K, length of gestation, birth weight, type of delivery, admission to special care baby unit.
Results: After exclusion of cases with missing notes or unknown hospital vitamin K policy, 597 cases and matched controls were studied. Written records on the use of vitamin K were available for only about 40% of these, and to avoid possible bias from selective recording it was assumed that the stated hospital policy was followed. The association between cancer generally and intramuscular vitamin K was of borderline significance (odds ratio 1.44, P=0.05); the association was strongest for leukaemia. There was, however, also an effect of abnormal delivery, which could explain some of the findings.
Conclusions: The lack of consistency between the various studies so far published, including this one, and the low relative risks found in most of them suggest that the risk, if any, attributable to the use of vitamin K cannot be large, but the possibility that there is some risk cannot be excluded. A comparison of the predicted consequences of various policies shows that even a 10% increase would imply that prophylaxis using the commonly recommended 1 mg intramuscular dose should be restricted to babies at particularly high risk of vitamin K deficiency bleeding; alternatively a lower dose might be given to a larger proportion of those at risk.

[sunfish21]

Originally Posted by rachel65655

There are some studies that think that neonatal jaundice is due mostly to the overdose of Vit K in their system. We all think that newborns are just supposed to be jaundice and it's normal. My youngest DD is the only one who had not gotten the Vit K injection and the only baby that I have had with no jaundice....I don't think that it is a coincidence.

Not to hijack....but my dd received no vit K and was jaundice. These things are always difficult to figure out, as reliable info seems to be buried or not available.

[flapjack]

Originally Posted by rachel65655

There are some studies that think that neonatal jaundice is due mostly to the overdose of Vit K in their system. We all think that newborns are just supposed to be jaundice and it's normal. My youngest DD is the only one who had not gotten the Vit K injection and the only baby that I have had with no jaundice....I don't think that it is a coincidence.

All three of my winter babies had some jaundice, none requiring treatment but the child that had delayed cord clamping (but cut before the placenta was born) and oral vitamin K was by far the most yellow and was a very sleepy newborn. I think it's fair to say that there is a need for more testing.

Oh, and oral vitamin K has only been standard practice, where it is standard practice, for a decade or so.

[nikirj]

The vit K/ leukemia link has been pretty thoroughly debunked.

Several studies have shown oral vit K to be just as effective as injected; you need to do multiple doses, though. Watch the concentration; it's hard to get the same vit K in the US that is used routinely elsewhere, and there is more vit K per drop in the solutions typically available in the US (so the dose might need to be adjusted). There are also several different schedules, and there isn't any one clearly "right" way to do it, but what is clear is that just one dose doesn't do the trick.

[Zangua]

As far as I know all of the homebirth midwives in NYC have access to the injectible version. Your midwife should be able to get you either.

[S.Elise]

Originally Posted by Zangua

As far as I know all of the homebirth midwives in NYC have access to the injectible version. Your midwife should be able to get you either.

OK, she did say something about "getting me a prescription", but then after I spoke to the ped I got the impression this was a prescription to go into the hospital and get it. I'll have to clarify this with her. Thanks for this.

[jljeppson]

You can get the injectible online at Birthwithlove, so if you don't want to go in just order it yourself.