8 questions with our pediatric experts about brain bleeds and the big benefits of vitamin K for your baby
Vitamin K injections within 6 hours of birth have been the standard of care for all infants born in the United States since 1961. Recently, there’s been an alarming increase in the number of families choosing to decline this potentially life-saving safety measure recommended by doctors for decades.
Dr. Danielle Mercurio-Porter, a physician in our emergency department, and Dr. Jennifer Raffaele, pediatrician and medical director of our mother-infant unit, explain the danger in this decision and what they wants parents to know.
Are you seeing an increase in families choosing to skip vitamin K shots?
Yes. Unfortunately, misinformation is spreading rapidly today. It permeated into the world of newborn care several years ago with many influencers discussing opinions, rather than validated scientific evidence, on social media. We now see families choosing not to give their newborns vitamin K injections due to fear of undue pain and perceived lack of necessity.
We feel so strongly about the safety and importance of this vitamin that when parents choose not to administer it to their baby, we have them sign a form acknowledging the risks of declining so we can be sure they’ve received all the education to make an informed decision.
Why is it important for newborns to receive vitamin K?
Vitamin K is essential for the activation of many proteins needed for normal blood clotting. With inadequate levels, people at any age are vulnerable to bleeding.
Newborns have low levels of vitamin K for a couple reasons. Humans derive vitamin K from the bacteria in our gut called the microbiome. Infants are born with very little microbiome. It must accumulate over time. In addition, the placenta doesn’t transport vitamin K efficiently, so nearly all babies are born with a relative deficiency. It’s also important to note that the liver uses vitamin K to activate our clotting factors. Infants have immature livers that can delay functional clotting factors for weeks to months.
Lack of vitamin K has been associated with brain bleeds in babies. Why?
When you combine the immature processes explained above with an immature support structure of veins in the brain, you can get spontaneous bleeding from simple activities babies do all the time like crying, feeding or having a bowel movement. That is the most important thing to remember with these brain bleeds—there doesn’t need to be any injury for them to happen. These spontaneous bleeds can occur for the first 6 months of life in infants who did not receive their one-time dose of vitamin K at birth.
Non-brain-related bleeding can also occur at circumcision, or with accidental injuries from motor vehicle collisions, falls/dropping, bumping into something, etc. Exclusively breastfed infants are at an increased risk of bleeding due to lower vitamin K content in breast milk.
How do you diagnose and treat babies with brain bleeds?
Infants often present with unexplained tiredness, fussiness or a completely altered mental status. Sometimes, we’ll see patients with a history of head trauma, but the lack of vitamin K administration isn’t discovered until later, when the degree of bleeding in the brain is greater than what would be expected from the traumatic incident.
Once the bleeding is detected by brain imaging, we administer vitamin K and clotting factors, and consider if surgery is needed. We often admit these patients to our pediatric intensive care unit for weeks of close monitoring as it’s common for bleeding to continue until the vitamin K levels normalize and can be maintained. Depending upon the degree of bleeding, some babies may need a breathing tube.
All babies who suffer any degree of bleeding in the brain should also have long-term developmental surveillance with their pediatrician and in some cases other specialists.
What are the long-term impacts of a baby’s brain bleed?
The long-term side effects of bleeding in the developing brain depend on many factors such as age, severity of bleeding, and how long it took to detect and intervene. The care team will employ strategies to prevent secondary brain injuries such as fever, too much oxygen, seizures, etc. By preventing these other complications of brain injury, we hope to provide a healthy healing potential within the vulnerable brain tissues.
Significant developmental delays and even death are possible in severe cases. It’s important to recognize that while bleeding in the brain is rare, when it occurs it can be catastrophic, with about 20% of these infants dying from their immediate injury.
In primary care clinic, we care for these patients throughout their childhood. If they survive their initial bleed, many children will require lifelong 24/7 care to manage problems such as inability to eat, requiring a G-tube to provide liquid directly into the stomach, and breathing difficulties, requiring artificial support with a tracheostomy (breathing tube into the neck) or a ventilator.
Isn’t there a Black Box Warning for the vitamin K shot?
This is sometimes a concern parents bring to us and we want to make sure it’s clear that this warning does NOT apply to the intramuscular injection given to infants. It comes from a possible allergic reaction that can occur when IV injection of the vitamin is given too quickly. There have been no reported cases of allergic reactions from the low dose intramuscular injection that is given to newborns.
Can vitamin K be given orally?
Oral vitamin K is an alternative, but must be administered over several weeks to be effective, and its efficacy is still less than the intramuscular version. Oral vitamin K is also dependent on not missing any doses of the schedule, which can be extremely hard to keep up with while caring for a newborn, as well as gut absorption which is immature in newborns.
What else do you want parents to know about vitamin K shots?
Though we always hope every child is free of injury and disease, there’s no guarantee. You can’t prevent everything, but you can significantly reduce your baby's risk of bleeding injury with vitamin K.
As healthcare providers, we’ve dedicated our careers to keeping children healthy. We only recommend interventions that have been shown to be safe and effective. Please ask us when something on social media interests or concerns you. We are happy to answer your questions with information based on the latest research and medical evidence so you can feel comfortable making an informed decision.