An increase in the number of families refusing to have vitamin K administered at birth has pediatricians worried, again.
Newborns are at risk for vitamin K deficiency bleeding (VKDB) and subsequent bleeding unless given the preventive shot at birth.
Nearly a decade ago, neonatologists at Monroe Carell Jr. Children’s Hospital at Vanderbilt noticed a VKDB diagnosis uptick and called for a state and national tracking system.
“We noticed that as the rates of vaccine hesitancy have gone up, so have vitamin K refusals,” said Anna Morad, MD, associate professor of Pediatrics at Monroe Carell and director of Newborn Nursery at Vanderbilt Health.
“Vitamin K is not a vaccine,” she stressed. “There is a lot of misinformation about vitamin K. We see refusals going hand in hand with families wanting to do everything naturally. Parents may not fully understand the risks associated with VKDB.
“Infant mortality rates have decreased dramatically because we are learning more and more about how to keep babies alive. This (vitamin K) is one of the things that keeps babies alive.”
The single-dose shot has been standard of care since 1961 when the American Academy of Pediatrics set the recommendation.
According to Morad, up to 60% infants impacted by VKDB will suffer a brain bleed, which can cause permanent brain damage or even death. Often, by the time an issue is discovered with the newborn, the damage has been done and may not be reversible.
“We are unfortunately seeing an increasing number of patients who have long-lasting damage due to severe bleeding related to VKDB,” said Shannon Walker, MD, assistant professor of Pathology, Microbiology and Immunology and of Pediatrics at Monroe Carell. “While VKDB is rare overall, it can have devastating effects on patients and their families.”
Vitamin K, needed to help blood clot, is produced naturally in adults within the gut or can be consumed in the diet, often through leafy greens. Babies don’t produce enough of the vitamin initially.
“The injection of vitamin K allows for babies’ blood to clot immediately and also provides them with stored vitamin K that lasts for several months,” Walker added.
VKDB is usually diagnosed in the first six months of life and is most often seen in breastfeeding babies and newborns with liver abnormalities. Breast milk does not provide sufficient vitamin K levels. Oral regimens have not been shown to be effective at preventing VKDB.
While the warning signs of VKDB can be subtle, Morad said there are symptoms that could be indicative of the life-threatening disorder including: bruising, bleeding from the umbilical stump or blood in the stool, or later signs of pale skin, vomiting and lethargy.
“We really want to educate the community about the devastating risk of not getting the injection at birth,” said Morad. “When families have questions, we want to discuss it with them. We have educational materials and handouts that our OB and midwifery groups are able to share with families.
“It’s a standard topic that is addressed in prenatal classes, and we encourage families to reach out if they have questions,” Morad added.
