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TalkingNutrition

Providing perspectives on recent research into vitamins and nutritionals

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Vitamin K and Infant Bleeding: What Happens When Parents Refuse Preventive Measures?

By Julia Bird

The CDC reports on four cases of vitamin K deficiency bleeding (VKDB) in infants aged 6 to 15 weeks in a Tennessee children’s hospital. This condition is preventable, but why does it happen, what can be done about it, and why would some infants not receive preventive measures? Vitamin K was given its “letter” by German scientists who noted its effects on Koagulation – vitamin K is essential for blood clotting. VKDB occurs when vitamin K deficiency prevents clotting, resulting in excessive bleeding at any sites where there is injury to the skin, bleeding from the gums or nose, blood in the stool and bleeding in the skull. Due to bleeding in the skull, the condition can be fatal or cause brain damage. Infants are at increased risk of VKDB because they are born with low stores.

Current recommendations vary by country and region, but include the use of vitamin K injections soon after birth (recommended in the US since the 1960s), or oral supplementation with vitamin K. Without the injections, rates of VKDB are around 1%, around 80 times higher than in infants that receive the injections. Strict meta-analyses have found this treatment to be safe and effective (Puckett and Offringa).

In the four cases mentioned by the CDC, all four infants did not receive the vitamin K injection as is recommended. The infants were developing normally until they experienced sudden bleeding; for three infants, bleeding was in the skull, and one experienced bleeding in the gastrointestinal tract. While the infant with gastrointestinal bleeding made a full recovery, one infant with intracranial bleeding experienced clear developmental problems, and the other two are being followed by neurologists.

Various reasons for declining the vitamin K injections were provided by the parents of the infants. One reason was concern about increasing risk of leukemia. This was based on two small case-control studies done in Great Britain by Golding and colleagues, published in 1990 and 1992. Later studies conducted in the south of England, Sweden, the United Kingdom in general, the US, Germany, Sweden, Scotland, and northern England failed to find the same association, so the original study results may have been due to chance or confounders. Another concern was that of toxins entering the body. Although the concept of toxins as used in this instance is not established in medical terminoloty, vitamin K is an essential nutrient and has shown to be non-toxic when used at the dosage and in the manner prescribed. A third reason given was a perception that the injections were not necessary. This is partly true, but does not tell the whole story. The majority of infants do not need vitamin K injections, as the rate of VKDB is low, and 99% of infants not receiving vitamin K will not experience VKDB. However it is not possible to say with certainty which infants will not get VKDB. The safety of supplemental vitamin K has been tested and proven. The consequences of VKDB include long term disability and death. The small risk of infection around the injection site and temporary discomfort for the infant vastly outweigh the serious negative effects of VKDB. A desire for an “intervention-free” infancy has resulted in a great deal of medical intervention for the infants of parents who refused the vitamin K injection. Whereas other interventions and parenting practiced are hotly debated, vitamin K injections should not be. VKDB is a serious condition and almost entirely preventable.


Main citation:

Centers for Disease Control and Prevention. Lead author: Michael Warren. Notes from the Field: Late Vitamin K Deficiency Bleeding in Infants Whose Parents Declined Vitamin K Prophylaxis — Tennessee, 2013. MMWR November 15, 2013 / 62(45);901-902 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6245a4.htm?s_cid=mm6245a4_x

 

Supporting citations:

Ekelund H, Finnström O, Gunnarskog J, Källén B, Larsson Y. Administration of vitamin K to newborn infants and childhood cancer. BMJ. 1993 Jul 10;307(6896):89-91. http://www.ncbi.nlm.nih.gov/pubmed/8343734

Fear NT, Roman E, Ansell P, Simpson J, Day N, Eden OB; United Kingdom Childhood Cancer Study. Vitamin K and childhood cancer: a report from the United Kingdom Childhood Cancer Study. Br J Cancer. 2003 Oct 6;89(7):1228-31. http://www.ncbi.nlm.nih.gov/pubmed/14520451

Golding J, Greenwood R, Birmingham K, Mott M. Childhood cancer, intramuscular vitamin K, and pethidine given during labour. BMJ. 1992 Aug 8;305(6849):341-6. http://www.ncbi.nlm.nih.gov/pubmed/1392886

Golding J, Paterson M, Kinlen LJ. Factors associated with childhood cancer in a national cohort study. Br J Cancer. 1990 Aug;62(2):304-8. http://www.ncbi.nlm.nih.gov/pubmed/2386748

Klebanoff MA, Read JS, Mills JL, Shiono PH. The risk of childhood cancer after neonatal exposure to vitamin K. N Engl J Med. 1993 Sep 23;329(13):905-8. http://www.ncbi.nlm.nih.gov/pubmed/8361503

von Kries R, Göbel U, Hachmeister A, Kaletsch U, Michaelis J. Vitamin K and childhood cancer: a population based case-control study in Lower Saxony, Germany. BMJ. 1996 Jul 27;313(7051):199-203. http://www.ncbi.nlm.nih.gov/pubmed/8696195

Lee, KG. MedlinePlus. Hemorrhagic Diseases of the Newborn. Last updated January 27, 2012. http://www.nlm.nih.gov/medlineplus/ency/article/007320.htm

McKinney PA, Juszczak E, Findlay E, Smith K. Case-control study of childhood leukaemia and cancer in Scotland: findings for neonatal intramuscular vitamin K. BMJ. 1998 Jan 17;316(7126):173-7. http://www.ncbi.nlm.nih.gov/pubmed/9468680

Parker L, Cole M, Craft AW, Hey EN. Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study. BMJ. 1998 Jan 17;316(7126):189-93. http://www.ncbi.nlm.nih.gov/pubmed/9468683

Puckett RM, Offringa M. Prophylactic vitamin K for vitamin K deficiency bleeding in neonates. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002776. DOI: 10.1002/14651858.CD002776 - http://summaries.cochrane.org/CD002776/prophylactic-vitamin-k-for-vitamin-k-deficiency-bleeding-in-neonates#sthash.gAYUp9LG.dpuf

Roman E, Ansell P, Bull D. Leukaemia and non-Hodgkin's lymphoma in children and young adults: are prenatal and neonatal factors important determinants of disease? Br J Cancer. 1997;76(3):406-15. http://www.ncbi.nlm.nih.gov/pubmed/9252212



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