Vitamin K is a fat soluble vitamin that is found in many foods and is synthesized by the bacteria in our intestinal tract. It is an essential component of our blood clotting mechanism. It is stored in our liver and released at times of deficiency or as needed. The mechanisms by which vitamin K work within our system are very poorly understood.
At birth babies have very low levels of vitamin K stores. This however takes adult concentrations to be the “norm” despite the fact that it is well acknowledged that many norms for adults do not apply to infants. (For example, the infant gut at birth is not colonized with the healthy bacteria that allow our digestive systems to function well. This, however is not seen as pathological but rather one of many things that infants acquire over time and exposure). Breastmilk is also considered to have low levels of vitamin K. Again, however the levels are considered low in comparison to recommended daily intake of vitamin K for an adult. By day 8 vitamin K levels begin to rise and by one month, newborn levels are comparable to adult levels.
Although it is generally accepted that vitamin K is essential to normal functioning, it should be considered whether perhaps there is an evolutionary reason that infants are born with low levels of vitamin K and that nature’s intended food also has similarly low levels. Could it really be that ALL babies are born in a pathological state of vitamin K deficiency? With how poorly understood vitamin K is by the scientific and medical community it should give us reason to pause and wonder what the best course of action is regarding routine administration of vitamin K supplements.
The rationale for routine supplementation with vitamin K is growing concern over a condition known as Hemorrhagic Disease of the Newborn (HDN). HDN presents in three ways: early HDN occurring within 24 hours and almost exclusively the result of medications mom took during pregnancy, classic HDN which occurs between day 2 and 7 and late onset HDN which occurs between 2 and 8 weeks. Many theories exist on the cause of classic HDN however it is thought by many to be related to poor feeding habits and/or lower than normal breastmilk concentrations of vitamin K. Because the infant/breastmilk levels of vitamin K are so low to begin with there is little room for fluctuation. Although birth trauma or asphyxiation are not necessary to develop HDN, there are considered to be predisposing factors. All forms of HDN result in an impaired ability of the blood to clot, which could result in a devastating hemorrhage.
Choices in vitamin K supplementation:
-Administration of 1mg Vitamin K by intramuscular injection just after birth (this is the only method endorsed by the American Academy of Pediatrics and they recommend it for ALL babies)
-Oral administration of vitamin K. 1mg at birth followed by two more doses of 1 mg in the following weeks. Babies who are formula fed do not need continued supplementation because formula is fortified with vitamin K.
-Oral, liquid K-Quinone (a vitamin K preparation that is widely available). 2mg at birth followed by 12 weekly doses of 1 mg (which will help protect the infant through the period of late onset HDN)
-Administration of vitamin K either orally or by injection only if there is birth trauma, surgical delivery (including the use of forceps or a vacuum extractor), bruising, the formation of a cephalohematoma, or a planned circumcision or other surgery.
-Mom can choice to supplement herself through dietary addition, herbs or liquid K-Quione for 4-6 weeks prior to birth and while breastfeeding.
*The use of supplemental vitamin K (especially injected) may increase your baby’s risk of developing jaundice or childhood leukemia.*