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Oral vitamin K - which protocol?

4513 Views 9 Replies 8 Participants Last post by  mwherbs
I'd love to talk about the various oral vitamin K protocols. Here are my disjointed thoughts on vitamin K.

Part of me wonders if we should routinely give vitamin K to newborns. If it doesn't cross the placenta well and it is found in only small amounts in breastmilk, perhaps there is a reason God created it to be this way. Should we be messing with newborn systems we don't fully understand?

On the other hand, there is no known risk to giving oral vitamin K (is there?) Yet there is a known and rare but very serious risk of NOT giving oral vitamin K. So it seems prudent to give the oral doses, no?

What I'm trying to determine is the best regimen to use. After doing tons of research, I'm wondering which of these is best.

Option 1: 2mg at birth, 2 mg at 4-7 days, 2mg at one month (some add 2mg at 6 or 8 weeks)

This seems to be the standard recommendation and is pretty effective, although not quite as effective as the shot or other oral regimen I talk about below. However, it is easy, just three drops, you're done after just a month, and the baby only receives 6mg total of vitamin K

Option 2: 2mg at birth, 1mg/wk for 12 weeks
This is the most effective oral route, and works well even in infants with biliary atresia/cholestasis. However, you have to do it for 3 months and the infant receives quite a bit of vitamin K, 14mg. Could there potentially be a risk to giving this much vitamin K to babies, almost all of whom don't need it? I know there is the worry over the proposed cancer/leukemia link of the shot. There was no link found with the oral drops, although I believe they only looked at 3x1mg regimens so the babies were only getting 3mg total (I'm not positive about that but it's what I remember in my research.) Could we be possibly increasing cancer/leukemia risk with large total oral doses of vitamin K like this regimen? Thoughts?

Option 3: Supplementing the nursing mother to increase levels in breastmilk
If moms take a supplement of 5mg/day, the levels in their breastmilk have about as much vitamin K as formula does, and VKDB is virtually unheard of in formula fed babies. I read one source that suggested the protection afforded to formula fed babies has more to do with their differing gut flora which produces vitamin K more effectively rather than the higher levels of vitamin K in the formula. ?? They cited that formula fed babies get 25-50ug/day of vitamin K (most other sources say it's about 50ug/day) and virtually never get VKDB but breastfed babies who get 25ug/day are not nearly as well protected. Would breastfed babies who got 50ug/day be as well protected? No studies on this as far as I know. Some suggest that if moms are going to do this, their babies still need the initial doses at birth and 1 week but do not need the subsequent doses.

Thoughts on all this? VKDB, especially late VKDB is so rare but it does happen so do you think we should supplement all babies and if so, how? Just go for what we know works in all babies (3 month regimen) even though it's more total mgs given and takes 3 months? Go for what's easy and sufficient for the vast majority of babies (3x2mg)? Or go for a more natural route of supplementing nursing moms, even though we're not quite sure how effective this is? Or something else entirely?
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I'm also wondering if there are any concerns with introducing anything other than breastmilk to the newborn's virgin gut. Do you think that is a concern with the oral vitamin K? Do you think there are risks to the oral vitamin K that we are not aware of? Or do you think it's silly *not* to give the oral vitamin K when we know it can prevent something horrible?
there are studies on newborn gut flora in the Netherlands or one of the countries that uses the oral dosing for vitamin K- and they are the ones saying best gut flora with home births, vaginal births and then lastly c-sections-

the thing about the schedule you propose option#3 is even the formula fed babies in the studies start off with a shot or the oral schedule in addition to the formula 50 micrograms daily

I really recommend doing some searches on pub med
We gave Dd the oral vitamin K at birth. She went on to have pretty bad jaundice (5 days of the bili blanket at home) and severe multiple food intolerances.

So, in my reading this time around, I find that the vitamin K (in either form) can actually increase the risk of jaundice, and the oral form of course has implications against a virgin gut.

Weighing the risk of vitamin K deficiency bleeding (about 1 in 10,000) against our KNOWN genetic risks of jaundice and gut issues, it became a no-brainer to me to waive the vitamin K entirely. The only case in which I might be persuaded to use it is if there is birth trauma and evidence of bruising.

I also think there's something to the idea that perhaps the lower levels of vitamin K in newborns is not actually a "deficiency" that needs to be combatted with heavy-duty injections. I wish I could find more information on why it might be beneficial to have lower vitamin K levels at birth...

Originally Posted by Becken View Post
We gave Dd the oral vitamin K at birth. She went on to have pretty bad jaundice (5 days of the bili blanket at home) and severe multiple food intolerances.

So, in my reading this time around, I find that the vitamin K (in either form) can actually increase the risk of jaundice, and the oral form of course has implications against a virgin gut.
Can you point me to the sources about this?
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I haven't made these decisions for myself because I don't have a baby yet, but I'm a scientist and a student so these studies really interest me. I think this is an excellent review- you've really covered the available research. Personally, I would be concerned about introducing anything except breastmilk to a newborn gut. So that makes option 3 very appealing. But as you point out, there isn't sufficient evidence that it will be effective.

I think Option 2 is probably the most solidly evidence-based, and a risk of leukemia has never really been linked to any of the oral regimens.

Alternatively, what about combining Option 1 with some kind of maternal supplement (i.e. Option 3)? The babe would end up with blood levels of vit k somewhere between Option 1 and Option 2. I would feel a little better about administering the "less-effective" regimen if I were also supplementing.

Good luck with your decision!
I'm wondering why you're skipping over the injection option, I thought any possible link with leukemia was now disproven. My take on it is that if you are going to supplement then do it in the most efficient, reliable way, which is injection. I don't know the volume of liquid for each mg of vit K supplementation, but even 1ml is actually quite a lot to reliably get into a newborn and get them to keep it down, which brings me back to if I'm going to do it, why not give them the injection.

We only heard about this even being done a few days before our first was born (not sure how we missed it, I'd read a fair bit), so we just let him have it. With our other two, we skipped it, but would have got it had there been any sign of trauma, or a forceps or ventouse delivery.
in the Netherlands they give quite an extensive oral vitamin K protocol- 1mg at birth followed by 25 micrograms /day for 13 weeks- the study that looks at newborn to 1 month flora is also from the Netherlands - that is the one showing that place of delivery and type of delivery have the most impact--

you can read the full text articles
Oral vitamin K Netherlands

---- pretty large newborn flora study---

everything has a degree of impact- if you wash/don't wash, what you bathe with if you use deodorant , what is your oral flora do you have cavities do you chew gum, what do you wash your dishes with, do you have other kids...

as for causing jaundice, quoting Dr. Klaus -All newborns have jaundice, it is a matter of degree. the bigger concerns about jaundice have to do with is there any ongoing distruction of red blood cells ? Rh factor(s) being of greatest concern, then ABO incompatability, there are other things like cholestasis and mild cholestasis associated with unconjugated hyperbilirubinemia in some infants with prolonged jaundice- which is an indicator for injectable vitamin K instead of oral dosing
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