vitamin k.doc

8/18/2019 Vitamin K.doc

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Vitamin K for babies

• Vitamin K and newborn babies

• About VKDB

•

The history of vitamin K injections• The safety of vitamin K

• The eectiveness of vitamin K forbabies

• How is vitamin K given?

• The FA!s for "arents considering dec#ining vitamin K for their baby

What is vitamin K for?

Vitamin K is a fat$so#ub#e vitamin that is needed for our bodies to form asubstance ca##ed !"rothrombin!% &rothrombin is one 'of many( essentia# b#oodcom"onents re)uired to create our norma# b#ood c#otting mechanism* used to"revent and contro# e+cessive b#eeding% ,f the Vitamin K #eve#s in our body are #ow*the "erson is said to have a !Vitamin K De-ciency!* giving them a tendency tob#eed%

.ur bodies obtain vitamin K in two ways/

• A sma## amount comes from the foods that we eat* such as green* #eafyvegetab#es and other green vegetab#es* cau#i0ower* vegetab#e oi#s*diary "roducts* 1oya beans and eggs% This is 2nown as vitamin K3 'or!"hy##o)uinone!(%

• However* most of our vitamin K is obtained through the synthesis of

norma# bacteria "resent inside our bowe#* and then stored in our #iver% This is ca##ed vitamin K4 'or !mena)uinone!( and is "roduced in morethan ade)uate amounts to "rotect us from b#eeding* even if our diet isinade)uate%

Vitamin K and newborn babies

A## newborn babies have a natura# degree of vitamin K de-ciency at birth* usua##yabout 56 to 768 #ess than adu#t #eve#s% These #eve#s are ade)uate to "rotectbabies from b#eeding* but can be )uic2#y de"#eted if the baby is unab#e to re"#aceand bui#d u" their vitamin K stores in the wee2s and months fo##owing the birth 'to2ee" u" with what their body is using(% ,n rare cases the #eve#s can #ower even

further than those at birth* creating an unsafe de-ciency%

During the "regnancy vitamin K3* 'obtained through food eaten by the mother(*does not cross the "#acenta to the baby in #arge )uantities 'on#y about 9 to 5 8(% The Vitamin K4 that is "roduced by the mother!s bowe# bacteria is unab#e to betransmitted to the baby%

.nce babies are born* they start to obtain a #itt#e Vitamin K3 through feeding%Breast mi#2 contains very sma## amounts of vitamin K3* 'about 3 to 4 micrograms"er #itre(% ,nfant formu#a mi#2s are regu#ated by #aw to contain a minimum of 96micrograms "er #itre% This means that babies who are e+c#usive#y breastfed are atan increased ris2 of having a vitamin K de-ciency in the ear#y months%

:ost of the Vitamin K needed by the baby is obtained through a s#ow bui#d u" oftheir gut bacteria in the wee2s* or months* after the birth* "roducing their vitamin

&regnancy ;esource < Vitamin K 3 an2hara rose thera"eutics 3966 74= 6>3


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K4% A baby!s bowe# is !steri#e! when inside the uterus 'meaning no bacteria( anddoes not start "roducing vitamin K4 unti# after they are born% .nce in the !outsidewor#d! the baby!s bowe# starts co#onising the norma# !body$friend#y! bacteria% Thisis done by suc2ing on their hands* #atching on the breast etc% starting the"roduction of vitamin K4% The vast majority of babies wi## increase their vitamin Kto adu#t #eve#s by the time they are wee2s o#d%

@hi#e most newborn babies are ab#e to create ade)uate Vitamin K4 to maintainand increase their #eve#s* occasiona##y a baby does not achieve this and maye+"erience Vitamin K de-ciency% ,n rare cases a baby can ta2e u" to months toreach ade)uate #eve#s of vitamin K4* and therefore be "rone to b#eeding u" unti#this time%

This condition for babies is ca##ed !Vitamin K De-ciency B#eeding! or !VKDB!'"revious#y 2nown as Haemorrhagic Disease of the ewborn or !HD!(% ,t isdiagnosed after the baby shows signs of b#eeding with a b#ood test% Their b#oodtest shows #onger !c#otting times!* des"ite sti## having other norma# #eve#s of b#oodc#otting factors such as -brinogen and "#ate#ets% The condition is con-rmed oncethe baby!s b#ood c#otting returns to norma# soon after vitamin K has been given%

As a way of "reventing VKDB in a few babies* a## "arents in Austra#ia areencouraged to give their newborn baby some form of su""#ement of Vitamin Ksoon after the birth* just in case% Vitamin K su""#ements are aimed at "reventinga further dro" in the baby!s vitamin K #eve#s* whi#e they are bui#ding u" their gutbacteria in the ear#y wee2s or months after being born%

Vitamin K su""#ements are administered by your caregiver* either by one injectionwithin hours of the baby!s birth or as 9 ora# doses 'by mouth( in the -rst month ofthe baby!s #ife% 'This is the standard in Austra#ia other countries may havea#ternative recommendations%(

Vitamin K su""#ements are administered by your caregiver* either by one injectionwithin hours of the baby!s birth or as 9 ora# doses 'by mouth( in the -rst month ofthe baby!s #ife% 'This is the standard in Austra#ia other countries may havea#ternative recommendations%(



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The history of vitamin K injections

,njections of vitamin K for babies were -rstintroduced in Austra#ia in the ear#y 3=76!s% They were origina##y on#y given to sic2*"remature infants* but by 3=>6 were given

routine#y to a## babies 'sometimes without theforma# consent by the "arents* it was justdoneC(% The dose was usua##y 3 mg* or 6%mgfor very sma## "remature babies%

The origina# vitamin K injections '2nown as!Kona2ion!( were deve#o"ed in the 3=6!s% They contained "hytomenadoine'Vitamin K3( as we## as g#yco#* "heno# and "o#yethy#ated castor oi#% The #attersubstances mi+ed in with the Vitamin K3 were 2nown to "ossib#y cause #oca#irritation in the baby!s s2in when given as an injection and irritation of the baby!sstomach and bowe# when given ora##y%

,n the #ast 36 years or so some "arents started e+"ressing a desire to avoid givingtheir baby an injection soon after the birth% ,n res"onse to this caregivers used theorigina# Kona2ion injection medication and administered it ora##y to the baby* dueto the absence of having a s"ecia##y "re"ared ora# substitute avai#ab#e% A fewmajor hos"ita#s did deve#o" their own ora# Vitamin K "owder 'that cou#d be mi+edwith water or breast mi#2(* as an a#ternative to using the injectab#e medication% At-rst* on#y one dose was given* usua##y on the day the baby was born% This wassoon changed to 9 doses in the baby!s -rst month of #ife* to im"rove the"rotection for Eate VKDB%

,n .ctober 4666* the origina# Vitamin K injection 'or Kona2ion( was discontinued% ,thas now been re"#aced by a new formu#ation ca##ed !Kona2ion :: &aediatric! 'sti##usua##y referred to as just !Vitamin K! by most caregivers(% This contains the

Vitamin K3 'ca##ed !"hytomenadoine!( and natura##y occurring substances ca##edsodium g#ycocho#ate 'bi#e acid( and #ecithin* ma2ing it much more suitab#e for ora#administration* as we## as an injection%

At "resent about =8 of a## newborn infants receive an injection of Kona2ion ::&aediatric soon after birth* with most remaining babies receiving 9 ora# dosesduring the baby!s -rst month of #ife 'usua##y at the "arent!s re)uest(% A few"arents wi## choose to dec#ine any Vitamin K for their baby%

The safety of vitamin K

,n Austra#ia* Vitamin K injections have been given to most newborn babies sinceabout 3=>6% ,n 3==4 a we##$designed study from the K 'by Go#ding et a#(

indicated that Vitamin K injections 'not ora# doses( cou#d contribute to anincreased incidence of chi#dhood #eu2aemia% @hen this was "ub#ished* thecommunity made a shift towards choosing ora# Vitamin K and caregivers beganintroducing information sheets 'and in some cases consent forms(* before as2ing"arents to acce"t Vitamin K for their babies% ,n the years that fo##owed* sevensubse)uent studies fai#ed to -nd any so#id connections with chi#dhood cancer*unab#e to re"#icate the -ndings% @hen this was rea#ised there was a shift bac2towards injectab#e Vitamin K in Austra#ia%

The ationa# Hea#th and :edica# ;esearch ounci# 'H:;( in Austra#ia hasre#eased a statement in the year 4666* saying that Vitamin K injections A;I .Tbe#ieved to be #in2ed with chi#dhood cancer* and have recommended that babiescontinue to be given Vitamin K to "revent VKDB%

The eectiveness of vitamin K for babies



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The eectiveness of the 'old Konakion'

There have been no #arge studies conducted that de-nite#y demonstrate howeective the origina# Vitamin K 'or !Kona2ion!( was in "reventing VKDB% @e sim"#yhave e+tensive records documenting cases of VKDB and if the aected baby had

Vitamin K as an injection* or ora# dose's(* or no Vitamin K at a##%

The eectiveness of Vitamin K given to newborn babies is be#ieved to de"end onthe ty"e of VKDB and the way the Vitamin K was administered%

Iar#y VKDB% ,t is be#ieved that the incidence of Iar#y VKDB 'occurring on day 3( isgreat#y reduced if mothers ta2ing certain medications 'usua##y for e"i#e"sy*tubercu#osis or heart disease( receive tab#ets of Vitamin K* 'genera##y about 46 mgdai#y(* every day for the #ast 4 to 5 wee2s of their "regnancy% Babies born to thesemothers can a#so bene-t from receiving an injection of Vitamin K within the -rsthour of being born* as they may not be ab#e to absorb ora# Vitamin K%

#assica# VKDB% ,t is be#ieved that #assica# VKDB 'occurring from day 4 to 7( canbe virtua##y e#iminated if the baby receives either an injection of Vitamin K .; anora# dose of Vitamin K within 45 hours of being born%

Eate VKDB% ,t is be#ieved that the incidence of Eate VKDB 'occurring from day > to months* common#y occurring around 5 to 34 wee2s(* can be reduced from6%558 $ 3%8 down to #ess than 6%66698 with one injection of Vitamin K 'usua##ygiven on the baby!s day of birth(%

The a#ternative of giving babies 9 ora# doses* 'usua##y on Day 3* then Day 5 to 7*and then at 3 month after the birth(* wi## decrease the incidence of #ate VKDB toabout 6%663 to 6%663>8% This is if a## 9 doses are given% ,n "ractice* the rea#ity isthat some "arents over#oo2 giving a## 9 doses* and the true incidence is about

6%6648 to 6%6648%

,n countries such as the ether#ands and Denmar2* babies are given Vitamin Kora##y every wee2 for 34 wee2s% This has shown to be just as eective as thesing#e injection* but in rea#ity can be diJcu#t for "arents to com"#y with and is a#soe+"ensive%

A sing#e ora# dose 'which used to be recommended when ora# Vitamin K was -rstintroduced( is #ess eective with Eate VKDB occurring at a rate of about 6%6638to 6%668%

The eectiveness of the new 'Konakion MM Paediatric'

At "resent there is no de-nite data avai#ab#e to demonstrate the eectiveness ofthe new !Kona2ion :: &aediatric! for "reventing VKDB% Given as an injection* it isbe#ieved to be simi#ar to the "revious#y avai#ab#e !Kona2ion!% There is a sma##concern about how #ong the new injection #asts and if it is suJcient to "rotect thebaby from #ate VKDB% ,t has been shown that 768 of babies wi## have ade)uateVitamin K #eve#s at days of age after receiving Kona2ion :: &aediatric as aninjection%

1ome caregivers suggest a further ora# dose of the Kona2ion :: &aediatric whenthe baby is due for immunisation at > wee2s of age% This has not become agenera# recommendation because the majority of babies who "resent with Eate

VKDB after > wee2s wi## usua##y have been born with an under#ying #iver disorder*meaning that the e+tra dose of Vitamin K wi## not be bene-cia# to them% ',t is very



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rare for a baby without a #iver disorder to show signs of #ate VKDB after this time(%

Kona2ion :: &aediatric is absorbed very we## when given ora##y% @hen 9 doses aregiven as schedu#ed in the -rst month* it has shown that >=8 of babies wi## haveade)uate Vitamin K #eve#s at days of age%

,n 1witer#and =8 of babies have received two ora# doses '4mg( since 3=='usua##y on days 3 and 5 after the birth(% ,n a 9 year study #oo2ing at 457*666babies* there was 3 case of c#assica# VKDB '6%66658( and 33 cases of #ate VKDB'= of these 33 babies had #iver disease(% .f the other 4 babies* 3 baby had noVitamin K and the other had the norma# 4 doses 'again an incidence of 6%66658(%

How is vitamin K iven?

,n Austra#ia* vitamin K is oered by caregivers as either/

A sing#e injection on the day of the baby!s birth '3mg $ 6%3m#s* or 6%mg $ 6%6m#sfor very sma## "remature babies(*

.;9 .ra# doses '4mg "er dose* or 6%4m#s "er dose(% These shou#d be given on/

3% The 3st dose on the day of the baby!s birth%

4% The 4nd dose around about days 5 to 7 after the birth* usua##y when the babyreceives their ewborn 1creening Test%

9% The 9rd dose when the baby is 3 month o#d% This may need to be done by your#oca# doctor or ear#y chi#dhood hea#th wor2er%

.TI/ ,f your baby vomits within 3 hour of having their ora# Vitamin K the dosewi## need to be re"eated%

The Vitamin K shou#d be recorded on your baby!s "ersona# hea#th record boo2% The advantage of an injection is that it is a one o dose and there is no need toremember to give further doses% The disadvantage of an injection is that it can bebrie0y "ainfu# for the baby* and ho#ds sma## ris2s of bruising and infection at thes2in site of the injection '#ess than 38(%

The advantage of the ora# doses is that it is not "ainfu# for the baby and does notcarry the sma## ris2s of the injection% The disadvantage of the ora# doses is that"arents need to remember to give their baby a## the doses% sua##y the #ast one at3 month is the most fre)uent#y missed* as the caregiver wi## norma##y ensure the

-rst 4 doses are given%

&regnancy ;esource < Vitamin K an2hara rose thera"eutics 3966 74= 6>3

http://www.birth.com.au/class.asp?class=1115&page=1http://www.birth.com.au/class.asp?class=1115&page=1


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!onsiderations when declinin vitamin K

&arents who conscientious#y object to their newborn baby receiving some form ofVitamin K su""#ement soon after the birth may -nd they encounter negativecomments* criticism and often "ressure to give their baby Vitamin K by somecaregivers% ,f you have made this decision* then you shou#d "re"are yourse#f for

these ty"es of res"onses%

Lou may wish to be 0e+ib#e in your decision if your baby is unwe## or not feedingfre)uent#y% ,f you do notice signs of VKDB in the -rst months of your baby!s #ife*it is im"ortant that you see2 medica# attention immediate#y and that the baby isgiven an injection of Vitamin K as soon as "ossib#e%

&regnancy ;esource < Vitamin K an2hara rose thera"eutics 3966 74= 6>3

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