A Step-By-Step Instruction on When to give Vitamin K
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For informational purposes only. Not intended to diagnose or treat. Contact your personal healthcare provider. Unfortunately medical questions will not be answered. Thank you.
Hi, I’m Dr. Brian Thornberg and I have been reading your comments about the vitamin K discussion that we’re having and whether we should give it to a healthy newborn, if we should give it to a sick baby, if we should use oral vitamin K or if we should use injectable vitamin K. And I’ve learned some new information and I wanted to share. I did comment on this particular question in the threads, but I thought it important enough that I add it as an independent video because it really nuances out the importance that we stratify or we level out the data that we’re using to understand the best choices. And we don’t just use a yes or no answer because the biology, the pharmacocinetics, the age of the child, the route of administration, all of this comes into play. So it’s not just a simple answer of yes, give the I am or the injectable form of vitamin K or oral is fine or if you have a term baby, it’s okay not to give anything. So I wanted to clarify that up by going through this a little bit more with just those specific questions about how to apply the data on a stratification basis so you can be empowered. So first vitamin K deficiency of the newborn results because there is I don’t want to call it poor but there is a lower amount of vitamin K that’s transported across the placenta from mom to baby. The reason this is is we don’t want the baby having clots during the traumatic delivery. So it is a purposeful divine style. When the baby does come out, obviously there’s some vulnerability. You can’t just emerge into our world outside of the womb and just be ready to go. So now the baby’s in a transition period. Those babies who are breastfed will receive nutrients that will help build vitamin K faster than those who are formulafed. If you have a healthy turn baby and you are nursing, then your baby’s gut flora, the bacteria that live in the gut of the baby, will start to make vitamin K faster if you’re nursing than if you give formula because of some of the ingredients that are in the breast milk. If vitamin K deficiency bleeding does happen, we have three different forms of vitamin K. The first is early, and this happens within the first 24 hours, and usually there’s something majorly wrong that the baby’s going to start to bleed immediately after birth. This is not that common. The most common type is the second one which is the classic form. And this happens from day two of life till day seven of life. And this is typically the one that’s associated with the vitamin K deficiency. And then last is the late form. This typically happens anywhere from 2 weeks to about 6 months out. This is the the really severe form. This is the rarest of all three. So this late form is something that really doesn’t happen. Again, there’s probably a lot of other things happening if a late form of vitamin K deficiency bleeding is happening in the newborn. So the one that is most likely to happen is the classic form, the one that happens from day two to day seven. The statistics that I quoted in my earlier videos of the vitamin K deficiency bleeding happens in one in 60 babies is an overall statistic for pre-term and term early classic and late forms of vitamin K deficiency bleeding. So it’s the entire spread from pre-term to term and all three different kinds of vitamin K deficiency bleeding. And that is for babies who do not receive vitamin K. It’s one in 60 chance. We get this data from the early 60s before vitamin K was widely distributed to infants. And if we look at the nutrition in the early 60s, it is very good. People were eating very healthy generally at that point. So I can’t contribute that the number is artificially high because of nutrition. I would have to argue just the opposite. I think people were eating quite well back then. Um I would say that they were eating no worse than we’re eating these days given the kind of food that we have now and the inflammation that comes from the modern American diet. Somebody pointed out on one of the threads that in the UK and the United Kingdom that the incidence of vitamin K deficiency bleeding was 1 in a 100,000. Obviously very different number than one in 60. And I researched that and this is the part that I answered on the thread and I looked at that and the 1 inund,000 is only the incidence of late that most rare form of vitamin K deficiency bleeding in those babies who did receive vitamin K. If a baby takes vitamin K and then later has that late severe form of intraanial bleed of vitamin K deficiency bleeding the incidence is one in 100,000. So that is why we see such a difference. It is the rarer form of vitamin K deficiency bleeding, the late form compared to the entire scope of vitamin K deficiency bleeding, which is what the US was reporting on. There are three studies I’m going to look at out of the UK and Europe. And what they’re reporting is that for those babies who do not receive vitamin K at birth, that the incidence of late vitamin K deficiency bleeding, remember if they do receive it, it’s one in a 100,000. if they don’t receive vitamin K and they develop the late form, the rare form, it’s about 35 newborns out of a 100,000. So there’s a 35fold increase in the risk of vitamin K deficiency bleeding late form if the baby does not receive vitamin K. And this is also collaborated with a few other studies. And these studies are more recent, I’d say in the last 40 years. Another study said that late vitamin K deficiency bleeding in populations without vitamin K was in this case they had 4.4 out of a 100,000. This is only a 4.4fold increase. But so you can see that the vitamin K decreases the incidence of late form compared to those who don’t receive vitamin K. So how do we apply this to each mom who’s looking at their baby and their own unique specific situation? And first we have to distinguish preterm versus term. So term we’ll roughly say is 37 to 38 weeks of gestation. Preterm babies have not had enough time to gain vitamin K. So they’ve had less time in the womb. So there’s less transfer of vitamin K. The vitamin K generally will come at the later portion of the pregnancy because obviously we don’t want the baby bleeding inside of mom. The most of the K is transported in the third trimester. So, a pre-term baby’s going to have less K than a term baby. And this is where my recommendation is. If you have a pre-term baby, the baby should always receive the injectable form of vitamin K. With a pre-term baby, we don’t know if the GI tract is working. Could be spitting up. It could be an immature GI tract. Maybe they can’t take anything by mouth. So, we’re just going to go with the conservative approach, which is injectable forms of vitamin K. Now, if we have a term baby starting at 37, 38 weeks or older, and now we can look at injectable form or oral vitamin K. And as some people were alluding to is don’t give anything. Again, watch my previous video. I’m not in agreement with that, especially when we have the oral vitamin K option. When we have a term baby, we have three options. And the injectable form is for those families who would have a difficult time organizing weekly doses for 12 weeks. This would also be the form if a baby is born term, but then becomes sick shortly after delivery because at that point, we can’t rely on the GI track. So that is one of those special exceptions that I’ve mentioned in my other videos. If we have a term and sick baby, we give the injectable form because again, we can’t rely on the GI tract as a method of delivery to deliver this vitamin K. But if we have a turnbaby without any medical complications and mom had or has seizure disorder and takes seizure medicines and specific seizure medicines, the ones that would affect the vitamin K concentration in mom, those are very specific seizure medicines, then that baby would also be one that would be a candidate and should receive the injectable form of vitamin K. So now we’ve now eliminated all of the special category groups and now we’re just left with the fullterm healthy babies without any surrounding complications or any evolving health issues with the baby itself. And this is then leaves us two options. We can either do oral vitamin K or you could do no vitamin K. Again, I’m not a fan of the no vitamin K just because of the low risk of the vitamin K, especially oral compared to nothing at all. We’ve already seen that the late form, which is the most rare form, can have a 4 to 35fold increased chance of incidence of bleeding if vitamin K is not given. I could not find any statistics that would clarify it simply for the classic form, which is the most common form, the bleeding that happens day 2 to 7. I only saw the one about the late form. And so just plain statistics, plain with numbers, we know that the classic form, the most common form, the day 2 to 7 is one that just statistically would happen more likely without the vitamin K. So hopefully this clarifies it. Thank you very much for watching.
