Vitamin K is a valuable food component, and is also a key part of the blood coagulation system. The needs of the body in this component, as a rule, are compensated with those foods that people consume daily. In addition, the synthesis of vitamin K occurs inside the body, which is a kind of security from its deficiency.
In the neonatal period, the level of this biologically active substance in the baby’s body is reduced compared with adults. When a baby is born, its immature organism is not yet capable of producing the proper amount of this component. In order to avoid a deficiency of this element, medical professionals perform an injection of a drug that contains natural vitamin K.
Vitamin K deficiency in the newborn
Often parents do not realize the importance of the presence of vitamin K in the child’s body. When a newborn baby faces a deficiency of this element, its blood coagulation system ceases to function properly. A similar condition is fraught with the appearance of internal bleeding.
The most serious complication of vitamin deficiency is hemorrhagic disease of the newborn, which is characterized by regular internal bleeding. In severe cases, the disease risks turning into a hemorrhage into the brain of the infant.
The main factors for the occurrence of hemorrhagic disease of newborns include:
- Birth of a baby through cesarean section. In this case, children are born with sterile intestinal microflora, so the synthesis of vitamin K is carried out in insufficient quantities,
- Low birth weight, as well as premature birth
- A delivery that was performed using obstetric forceps,
- Pathologies of the hepatobiliary system, as well as an increased load on the liver after administration of the hepatitis B vaccine,
- Situations in which a pregnant woman was forced to take anticoagulants, antibacterial agents and anticonvulsants. This is especially true for pregnant women in the first trimester of carrying a baby,
- Prolonged delivery, especially at the stage of expulsion of the fetus.
Serve as a factor for the occurrence of hemorrhagic disease of newborns can as one of these points, and their combination. After analyzing this information, parents should not have questions about the need for injection of this substance in the walls of the hospital.
How and when do injections
A simple way to deliver vitamin K is by injecting intramuscular administration of the corresponding drug. An injection of vitamin K is performed in the anterior surface of the thigh. Injecting the drug is carried out for several weeks or until such time as the body of a newborn baby matures for the independent production of a biologically active component.
If some parents do not want to load the child with injections, then they are offered to inject the drug orally. From the point of view of efficiency, this method is not preferred. In addition, in clinical practice there have been cases in which oral use of vitamin K caused vomiting in a newborn. The standard injection plan for this substance is as follows:
- The first injection is performed immediately after birth.
- The second injection is done in one week,
- 3 injection is performed 1 month after the birth of the baby.
Important! Both parents and doctors should not forget that the oral use of vitamin K supplements is absolutely contraindicated in children born earlier than expected. A similar ban applies to babies who have congenital diseases.
For injection to a newborn baby, vitamin K analogues are used - Vikasol and Kanavit. Single side effects that occur in newborns with the introduction of these medicines are associated with those preservatives that are used in the manufacture of medicines.
Vitamin K to newborns: what threatens its lack?
This vitamin, like all others, the baby receives through the placenta of the mother during pregnancy. For an already born baby, the way of vitamin K is different: through nutrition, that is, mother's milk or a special mixture. However, in the first hours of life the baby may lack nutrition, and the risk of internal hemorrhages immediately after birth is 0.4%. In addition, a shortage of vitamin K to newborns can cause hemorrhagic diseases in the future.
When to give an injection to a newborn: is there a risk group?
Yes, some babies are really more susceptible to a lack of vitamin K. These include newborns:
- whose birth is breastfed, not artificial,
- which came to light earlier than planned, or by caesarean section (the problem is that their flora remains sterile),
- moms who during pregnancy drank medicine for convulsions or sedatives,
- lack of a pregnant woman’s diet, and then nursing mothers of green vegetables,
- small weight crumbs at birth.
Whether to inject K in the maternity hospital: the risks of an injection for a newborn
To avoid all these complications can be the introduction of a synthetic analogue of vitamin K in the form of injection or drops. The main rule that doctors advise to remember is simply stated.
With obvious symptoms of vitamin K deficiency, injection is indicated.
If vitamin K newborns need in the form of prevention, then you need to choose a drop.
Do whether the injection of K in the hospital, doctors will say. But they will definitely recommend injection to kids with streaks of blood in meconium, with bruises under the skin and a bluish skin tone.
When to make an injection? Immediately, on the first day of the baby's life. The dosage of the drug is minimal, 1 mg, but it can save the life and health of the newborn.
Vitamin K newborns in the form of drops: are there any risks?
Oral administration of vitamin K occurs in three stages:
- immediately after the birth of the crumbs,
- on the third or fourth day after birth (usually before discharge from the hospital),
- when the baby is one month old.
This method is absolutely painless. His only minus, because of which doctors do not always give him preference - portability. Some newborns do not tolerate the drug very well and may even burp. Again, oral administration is more intended for prophylaxis. The dose in this case is 2 mg of the drug.
Should I inject vitamin K in the maternity hospital? Simple and painless alternative to injection
I just can not stay away from the heated debate on the Internet concerning an important question for future parents: should the newborn have a painful injection of vitamin K while still in the hospital? Is it worth it to expose the child to such a test? Is there a more human alternative? After all, the further happy childhood of the baby depends on their correct decision. There is a lot of information on the Internet and all of it is contradictory. I will try to touch on all aspects regarding vitamin K and offer a very loyal solution, not traumatic for the child.
Why is vitamin K given immediately after birth?
Vitamin K is necessary for normal blood clotting in children and adults. Some children (more and more of them recently) are born with a low level of this vitamin, due to the immaturity of the liver and the gastrointestinal tract, where vitamin K is synthesized. In utero, the baby cannot receive vitamin K because it is not absorbed through the placenta. It is very low in breast milk.
This condition can cause bleeding - hemorrhagic disease of the newborn (HDN). Internal bleeding in the brain and other organs can cause serious damage, sometimes even death.
Despite the fact that this disease is rare (the reasons and what percentage are indicated below), vitamin K is administered as a prophylaxis to all polls intramuscularly, the basis is Protocol No. 152 of 04/04/2005 of a medical examination for a healthy newborn child (http://sop.com .ua / regulations / 2340/2592/2593/420061 /), changes since 2010, 10 p.
Three forms of vitamin K
There is a large group of forms of vitamin K close in its chemical composition and action on the body (from vitamin K1 to K7). Of the greatest interest among them are the two main forms that exist in nature: vitamin K1 and K2.
Vitamin K1 (phylloquinone and its isomers: phytomenadione, phytonadione) - found naturally in plants, especially in green leafy vegetables, which are the main pharmaceutical raw materials for the production of isomers.
Only the natural form of vitamin K is completely SAFE for newborns and does not cause toxicity even in large dosages!
How it works: Affects the liver, is involved in the production of proteins that regulate blood clotting and blood clots.
Vitamin K2 (Menaquinone) - a substance that is synthesized in the human body by microorganisms (saprophytic bacteria) in the small intestine.
How it works: affects more on the walls of blood vessels and bones than on liver tissue. Its main task is the proper distribution of calcium in the body.
Vitamin K3 (menadione, menadione) - It is a synthetic form that is clearly toxic, interferes with the function of glutathione, a natural antioxidant in the body, which leads to damage to the cell membranes, especially over time. Menadione also causes toxic reactions in the liver cells, weakens the immune system, causes an abnormal red blood disorder, and also leads to cytotoxicity (cell death).
It is important to note that babies injected with this synthetic vitamin K3 had toxicity. It is widely used in the food industry, animal husbandry.
Early HDN occurs within 24 hours after birth.
This is almost exclusively for mothers who take drugs that inhibit vitamin K, such as anticonvulsants (carbamazepine, phenytoin and barbiturates), anti-tuberculosis drugs (isoniazid, rifampicin), some antibiotics (cephalosporins), and vitamin K antagonists (coumarin, warfarin).
The clinical picture is heavy: hematoma of the head, intracranial and intra-abdominal hemorrhage. Frequency in newborns without added vitamin K, varies from 6% to 12%.
Classic HDN occurs between the 1st and 7th days of life.
Associated with a delay or inadequate nutrition.
Clinical manifestations are mild: skin bruises, bleeding in the mucosal tissue (mouth, nose, throat, gut, uterus, urethra), umbilical cord bleeding or the place of circumcision. However, blood loss can be significant, and intracranial bleeding, although rare, does occur.
Frequency vary from 0.25% to 1.5% in older reviews 19 and 0-0,44% in later.
Late HDN occurs between 2 and 12 weeks.
Most cases occur between the ages of 3 and 8 weeks. Associated exclusively with breastfeeding.
The clinical picture is heavy: mortality is 20%, and intracranial bleeding - 50%. Survivors have permanent neurological damage.
Frequency in full breastfed babies who did not receive vitamin K at birth, 1/15000 to 1/20000. Children with cholestasis syndrome are at particular risk.
Any item is enough for the risk of bleeding in an infant:
- premature babies, low birth weight
- delivery with forceps or vacuum extraction
- cesarean section (microflora of the child remains sterile after such birth)
- very fast or long labor, especially in the second stage of labor (expulsion of the fetus)
- mother taking antibiotics, anticoagulants, anticonvulsants during pregnancy, especially in the first trimester
- undetected liver disease, liver strain after hepatitis B vaccination
- the introduction of drugs to the newborn for any reason
The data is taken from an article by Dr. Joseph Mercol, USA - http://1796web.com/vaccines/opinions/vitamin_k.htm, but most of the information is outdated by now.
I want to make some addition, based on the new facts about the risk factors for late HDN: Bleeding due to vitamin K deficiency can happen to any child, be it early or long-term, trauma or lack of injury. The researchers were unable to pinpoint which children are most at risk. That is why doses of vitamin K are prescribed to all newborns or those whose mothers intend to exclusively breastfeed.
In fact, there is no fresh evidence to support the theory that babies born with forceps or caesarean are at a higher risk of bleeding.
In one of the largest 2013 studies on this topic in Southeast Asia monitored Thai women during pregnancy and after birth and studied the risk factors for vitamin K deficiency. Researchers noted infants as “high risk” for vitamin K deficiency if they were small for gestational age, born prematurely, or were born by caesarean section or vacuum delivery. The researchers found no difference in the percentage of infants with vitamin K deficiency between infants with low and high risks.
With regard to insufficient breastfeeding in the first hours of life, there is a link between the insufficient amount of breast milk in the first few days of life and classic HDN. And it is theoretically possible that a traumatic experience at birth will cause a child to bleed more often during the first week of life if they have a low level of vitamin K. But the study (see above) did not confirm the theory that traumatic supplies are directly related to vitamin K deficiencies.
Therefore, the most important The risk factors for HDN are exclusive breastfeeding and non-vitamin K. The evidence does not support the theory that the trauma at birth has anything to do with HDN.
There are four main areas of risk associated with this injection:
- Study published in 2004, showed that very early pains or stressful experiences have long-term adverse effects on the newborn, including changes in the central nervous system and changes in the sensitivity of the neuroendocrine and immune systems to maturity. The defenseless and innocent kid will have to overcome emotional trauma to achieve health.
- The amount of vitamin K given to newborns is much higher than the recommended daily intake for adults. In recent years, the situation has begun to change for the better, in any case, you should consult with your pediatrician about the dose that is suitable for your child.
- An injection for a weak and immature immune system of a baby creates an additional risk of introducing infection from the environment in which dangerous pathogens are found. As well as irritation of the injection site or damage to the nerves and muscles, since the injection is done deep into the muscle. This is a rare complication, but still.
- The injection solution contains preservatives that are toxic to the baby’s immature immune system. Currently, 2 forms of vitamin K are used for injection:
Kanavit, Konakion (K1 as phytomenadione) and cheaper option - Vikasol (K3 as menadione, menadione). Both synthetic forms, the latter is even more active and stronger.
Vikasol gives a lot of side effects, even if you do not consider the preservatives in the composition: facial flushing, itching, bronchospasm, hemolytic anemia, cytotoxicity in the liver cells leading to jaundice, tachycardia. Our official medicine does not confirm this. For information, for these reasons, the US has banned the use of synthetic K3 for the treatment of vitamin K deficiency.
Canave, Konakion was developed and approved for use solely on the grounds that it appears to cause less hemolysis. It is a synthetic petrochemical product obtained from 2-methyl-1,4-naphtaquinone in a polyethoxylated castor oil base or polysorbate-80.
Although these drugs are more easily tolerated, we see the following side reactions in annotations: skin rash, burning pain and inflammation at the injection site, cardiovascular collapse, bronchospasm, problems with the gastrointestinal tract.
And also reported case of anaphylactic shock in 2014 due to the intramuscular administration of vitamin K1 in the newborn.
Poor mother has to make a choice and purchase one or another drug. As far as I know in Russia it is difficult to get Kanavit or Konakion, it is not produced or imported.
A simple solution that replaces the injection of vitamin K
According to the world's best vitamin K expert, associate professor at the Department of Biochemistry, University of Maastricht (Netherlands), Dr. S. Wermeer, there are safer and non-invasive (without disturbing natural integument) ways to replenish the vitamin K level in a newborn with no dangerous consequences. Речь идет об оральном приеме природного витамина К, который исключает передозировку и уменьшает риск кровотечения и желтухи, а также боль в месте инъекции и воздействия вредных консервантов. При этом витамин К поглощается через кишечник, как ему и предназначается.
Так ли все просто на самом деле, прелагаю копнуть глубже и обратиться к официальным источникам…
Научные данные орального Витамина К против инъекционного
Недавние research показывают:
- вероятность позднего ГБН составляет 1 из каждых 15 000-20 000 детей, когда не вводится витамин К,
- if a baby has one oral dose of vitamin K (1-2 milligrams) at birth, the risk is reduced to 1 in 25,000-70,000 children,
- the probability of late HDN for a newborn is reduced to 0.1 per 100,000 children when 1.0 mg of synthetic K1 is administered to the baby at birth.
In 2003 Swiss Surveillance of 6 Years Surveillance adapted recommendations for the prevention of vitamin K deficiency: “3 oral doses of 2 mg of vitamin K1 adequately prevent children from all types of HDN. The main risk factors for HDN in infants are the parental failure to prevent Vitamin K or unrecognized cholestasis due to atresia of the biliary tract in a baby. ”
In 2008 in Holland and Denmark conducted a comparative analysis of the effectiveness of various schemes for the introduction of vitamin K among babies with atresia of the biliary tract: “A daily dose of 25 μg of vitamin K does not prevent bleeding, but 1 mg of weekly oral prophylaxis provides significantly higher protection for these babies and has similar efficacy as 2 mg of intramuscular prophylaxis at birth.”
And more recent study in 2016 did not confirm the effectiveness of oral regimens in comparison with injection in infants with cholestasis.
In 2006, during research among premature babies Interesting conclusions were obtained: “To protect against bleeding due to vitamin K1 deficiency, premature infants who received a dose of 0.2 mg intramuscularly should receive an extra vitamin K supplement during breastfeeding.”
What are the benefits of vitamin K injections?
- Very effective in preventing classic and late HDN.
- The injection has a sustained release effect over time from the injection site, which provides a sufficient amount of vitamin K1 until its levels in the baby’s blood reach a completely natural value.
What are the benefits of oral vitamin K?
- Easy to give, not invasive, without harmful substances in the composition
- A 3-dose regimen reduces the risk of classic and late HDN, but not in the same way as an injection.
- The weekly regimen appears to protect children with undiagnosed gallbladder problems as well as an injection.
Findings: The effectiveness of oral prophylaxis is related to the dose and frequency of administration. Most multi-dose oral regimes provide protection for everyone except for a small number of babies with gallbladder or liver disease.
However, looking specifically at vitamin K levels, it was found that the injection of vitamin K resulted in elevated blood levels within one week and one month compared with a single oral dose.
And in all this time, none of the studies specifically considered whether there were any side effects from the injection.
What Vitamin K1 Drops to Use and What Dosage
Many scientific articles state that oral vitamin K1 is not available in the United States. This is due to the fact that there is no FDA-approved oral version for sale. However, all agglomerate sources for buying quality vitamin K1 in drops lead to Bio-K-Mulsion from the American manufacturer Biotics Research.
It contains another phylloquinone isomer - phytonadionecreated in the laboratory from natural bacteria. Of course, it is also synthetic, like Kanavit, but it is much safer to be taken orally than with an injection, and it has the advantage that it requires little drops per dose. Natural K1 drops require 40 to 150 drops to achieve a similar dosage. This may not be appropriate for an infant.
And actually where to buy liquid oral form of vitamin K1? Unfortunately, there was no vitamin K1 in my favorite iherb store, you can just as well make a purchase on Amazon, at the end of the post I’ll tell you about two important related products that are needed after childbirth.
Biotics Research - Bio-K-Mulsion 1oz, 30 ml
Active Ingredients: Vitamin K (as K1-phytonadione)
This is a manufactured form of vit k1, since the real form is unstable and too strong. This product is made from natural bacteria to achieve a stable and beneficial form.
Four drops provide 2 mg of vitamin K1.
Bio-K-Mulsion® supplies vitamin K1 (500 µg per drop) in emulsified liquid form to aid in the absorption and use of this important vitamin. Vitamin K oil was dispersed in microscopic particles to promote better absorption.
Other Ingredients: water, gum arabic oil and sesame oil.
Regimen: 2 mg (4 drops) within 6 hours after delivery,
on the 7th day of life - 1 mg (2 drops) and then weekly for the first 3 months of life.
If the child burped within 1 hour after oral administration, this dose should be repeated.
It is important to remember that this fat soluble vitamin on an empty stomach cannot be absorbed. Therefore, it is given before or after breastfeeding and make sure that the baby does not burp.
Many mummies interestingly trapped: a drop of vitamin K is dropped on a finger and there is squeezing fatty colostrum and giving the baby 4 times to suck it :)).
One of the difficulties of taking vitamin K is to follow the reception schedule for 3 months. Although you can set up a reminder in your smartphone. The fact is that repeated doses reduce the further risk of developing late CNT, which can occur even in perfectly healthy babies during ideal delivery.
Is there a diet rich in vitamin K during pregnancy and feeding, can it increase the level of vitamin K in newborns?
While there is no clear evidence that providing supplemental vitamin K during pregnancy can prevent HDN in infants. In the largest study on diets and vitamin K deficiency, researchers studied the diets of 683 mothers before pregnancy and after delivery. Blood was taken from mothers during labor and from the umbilical cord after birth. Mothers were asked about their diet during pregnancy and the postpartum period. The researchers did not find any connection between the status of vitamin K of mothers and newborns ( Chuansumrit, Plueksacheeva et al., 2010 ).
To the doctor Vermeer suggested that An alternative strategy to increase vitamin K intake in infants is for the mother to take a daily supplement after birth. There is a small amount of evidence supporting this strategy. ( A source)
In a large Japanese study with more than 3,000 pairs of mother babies, the researchers gave the mother an oral dose of 15 mg of vitamin K2 once a day. They found that this dose led to a low level of infant vitamin K levels in only 0.11% of the treatment group. It is important to note that babies also received oral vitamin K twice during the first week of life ( Nishiguchi, Saga et al., 1996 ).
What is the problem with taking vitamin K in mothers? Well, until now, the studies that were made looked at babies, in which both babies and their mothers received vitamin K supplements. No research was conducted solely on the maternal supplement, perhaps for ethical reasons. It seems that when a mother takes 2-5 mg of vitamin K per day, it very effectively increases the level of vitamin K in breast milk and probably increases the level of vitamin K in a child. But so far no one has tested the effect of mother-only vitamin intake on actual bleeding rates due to vitamin K deficiency in infants.
What to choose a preventive strategy for your child?
Of course this is a very difficult choice. My goal was to provide more information so that you can draw your own conclusions and assess the risks of various ways of administering vitamin K.
In the table at the bottom of this page fasting Approved preventive methods from different countries are collected.
The intramuscular route of administration of vitamin K has been widely adopted since it virtually eliminates the possibility of life-threatening HDN. At the same time, the Italian Society of Neonatology after injection supports it with oral drops to prevent late bleeding, especially in premature babies.
In any case, in all countries except the United States, parents have the right to refuse the injection and document the oral intake of vitamin K, warning their brigade during childbirth.
Danish regimen of 2 mg of oral vitamin K after birth and 1 mg weeklyIt appears to protect children at increased risk, who have undiagnosed gallbladder disease, but not 100%. It is important to observe all the weekly doses, so that this regimen will help reduce the risk of late HDN.
Using the same source, I want to focus your attention on the facts in which simply You must use a vitamin K injection:
- As soon as the diagnosis of HDN has been confirmed - it is advisable intravenous administration, determined by the doctor
- Premature newborns are physically unable to "digest" oral medications,
- Infants of mothers taking medications that inhibit vitamin K
Recently, there have been many myths, delusions and misinformation spread on the Internet and in social networks about vitamin K. It is important that parents look at the facts before making such an important decision.
Vitamin K deficiency in newborns.
The source of vitamin K are mainly green leafy vegetables, and it is also synthesized in the intestines. The intestine of a newborn is not yet mature, the colonization of bacteria is just beginning, so vitamin K in the right amount begins to form only after a few months.
At birth, the baby has a very small supply of vitamin K; it is almost impossible to get the right amount from nutrition, because it is very small in breast milk. Almost all newborns have a shortage of vitamin K, and in the first months of life in babies who are breastfed, it persists.
However, if an artificially fed baby is born, then he will most likely not have a vitamin K deficiency, since milk formulas are enriched with it.
Vitamin K newborns: why.
Vitamin K is involved in the process of blood coagulation and its lack can lead to bleeding. If the mother took anticonvulsants, anti-tuberculosis drugs and some antibiotics, or if the child was born prematurely or with a small weight, then the risk of bleeding is even greater.
When the amount of vitamin K in the child's body drops to a certain level (which is individual), the blood stops clotting. Bleeding can start suddenly, without any signs. This is called hemorrhagic disease of the newborn or bleeding, which is caused by a deficiency of vitamin K.
Moreover, bleeding does not require any damage, it arises spontaneously and can be not only external (from the umbilical wound), but also internal (from the brain). Internal bleeding immediately difficult to determine, and when the diagnosis is made, irreversible changes may occur.
There are late and early bleeding. Early (up to 7 days of life) may be gastrointestinal, bleeding from the umbilical wound, usually small, but sometimes significant. Early bleeding is more common, and usually does not pose a great danger. The treatment includes again the same vitamin K.
Late ones are associated with breastfeeding, occur from two to 12 weeks and are more dangerous, they are usually intracranial, mortality reaches 20% and neurological disorders are a frequent consequence.
Late bleeding is rare, but can have very serious consequences. Symptoms of onset of bleeding may be blurred, poor appetite, lethargy or, conversely, anxiety. While parents will seek medical help it may be too late. Yes, and doctors can not immediately determine the cause of the deterioration of the child.
Virtually all late and early bleeding can be prevented by injecting vitamin K into a newborn. This is a normal practice for many years in Australia, the United Kingdom and many other countries around the world. In the USA, these injections have been massively made since 1961.
Vitamin K is administered once by injection in a dose of 05-1 mg or three times as oral drops (given at birth, per week and per month). If vitamin K is injected intramuscularly, then it is released gradually, so it allows the body to provide for several months.
The oral form of vitamin K has the following disadvantages:
· You need three doses, the first newborn gets in the hospital, parents should clearly know when and how much to give the second and third dose,
· A child may spit out the drug,
· A plethora of data suggests that the effectiveness of the drops is lower than the injection.
Vitamin K newborn side effects.
On the Internet there is a lot of frightening data about the toxicity of the injection, pain, so parents often doubt "to do or not." Indeed, the composition of the drug, in addition to the actual vitamin K, includes other ingredients, for example, polysorbate 80, but they are all allowed for use in medicines and are unlikely to cause harm to the child.
As with any injection, the injection of vitamin K causes short-term pain, and can also give a reaction in the form of a burning sensation, redness, which happens infrequently and usually goes away without any intervention.
An allergic reaction to any drug may be due to the individual characteristics of a particular child, but this happens very rarely, literally isolated cases in global practice.
In the 90s, there was evidence that the injection of vitamin K was associated with an increased risk of childhood cancer, but conducted after the study (and there were many) did not reveal any connection.
To date, all reputable international organizations recommend injecting vitamin K to newborns, because although bleeding caused by vitamin K deficiency is rare, the risk of complications and even death is high.
Parents can choose oral administration of vitamin K, but it must be borne in mind that it is less effective and not all countries have the opportunity to buy oral forms.