Vitamin K at birth: Your Questions Answered

Recently I recorded a video for the Independent Medical Alliance (IMA) about Vitamin K1 as a measure to prevent vitamin K deficient bleeding (VKDB) in infants. There are a lot of questions and controversy regarding this topic and so I wanted to address some of the issues. A shorter, <5min version, is posted here on X. 

VKDB is a rare but real risk for newborns, occurring in about every 1 in 250,000-300,000 babies. About 100 years ago it was discovered that vitamin K can lower the incidence of bleeding. The standard of care in the US is the intramuscular (IM shot) at birth, but a protocol with oral doses provide equivalent protection if given appropriately. The problem with the IM shots (there are 2 different formulations available in the US) is that they contain toxic substances such as benzyl alcohol, castor oil derivative, aluminum, or polysorbate 80. This is why so many parents are declining the IM shots. They need to know about the alternatives and the oral version does not carry the same risks. 

The Europeans have studied several protocols for oral vitamin K prophylaxis and the one that appears to be most effective is the one highlighted in the Swiss study highlighted above. Neither the IM nor the oral version provide 100% protection, but significantly reduce the chances of bleeding.  

There are also several factors that make babies at higher risk and sometimes the benefit of immediate protection with the shot is worth the risk. It's always a clinical decision for each individual. Risk factors for lower vitamin K include:

• Medications during pregnancy, including certain antibiotics and anti-seizure drugs that can reduce vitamin K.

• Prematurity, a difficult delivery, or newborn illness. A small study of preterm infants found laboratory evidence of low vitamin K after discharge among exclusively breastfed babies who had received the shot.

• Liver disease/cholestasis. These conditions can impair clotting and make oral vitamin K harder to absorb. Research involving infants with biliary atresia shows why an unrecognized bile-duct disorder can change how well oral vitamin K works. 

Families should work out their plan in advance of the baby's birth so they can get the vitamin k drops, and discuss situations in which they may opt for the IM shot. My patients/parents are very smart but they do make different choices. What matters is understanding what each choice offers, what it requires, and whether your baby’s circumstances change the decision. It is important to keep asking questions and to find a clinician who will answer them thoughtfully.