COLUMBUS, Ohio (PRESS RELEASE) – Vitamin K, which has been administered to newborns as an
injection since it was first recommended by the American Academy of Pediatrics in 1961, is
vital for blood to clot normally. Despite it being given as standard medical practice since
then, vitamin K-deficient bleeding (VKDB) is being seen more often in newborns than it has
in decades. Emergency department physicians at Nationwide Children’s Hospital have
recently seen several cases of intracranial bleeding due to parental refusal of the neonatal
vitamin K shot.
In a case study recently published by Karyn Kassis, MD, MPH, in The Journal of Emergency
Medicine, a 10-week-old infant presented to the emergency department with increased
fussiness over a two-week period. After thorough examination, the infant only appeared to
have a pale complexion, flecks of blood in stool and pale mucous membranes. Due to the
paleness of the infant, a complete blood count was obtained, demonstrating a profound
normocytic anemia. Additional history and testing determined that the infant was presenting
with VKDB. Vitamin K was administered via an IV and internal bleeding stopped within 24
hours.
“The risk of getting a vitamin K shot is very minimal, but the risk of not getting it is very
serious,” said Dr. Kassis, an emergency medicine physician at Nationwide Children’s.
“Babies who don’t get vitamin K can actually have silent bleeding internally, commonly into
their brains. This could result in seizures, coma or even death. Parents should know that
vitamin K-deficient bleeding is preventable.”
A vitamin K shot is typically given within minutes to hours of birth to ensure there is
enough vitamin K to prevent bleeding. Vitamin K is not sufficiently passed on by mothers
to their newborns, and very little vitamin K is present in breast milk. The single vitamin K
shot protects an infant until they develop enough to begin producing vitamin K and
consuming vitamin K-rich foods on their own.
Symptoms of VKDB are difficult for a parent or even a health professional to recognize in a
newborn, and can include fussiness, blood in the stool and even seizures, all of which will
increase as the bleeding increases. VKDB is preventable, and a single injection of vitamin K
at birth restores vitamin K levels in the blood to normal range within an about an hour.
“When parents request that no shots be given to their child at birth because they are
opposed to vaccines, the vitamin K shot has been accidentally included in that category,”
said Dr. Kassis. “The vitamin K shot is an injection of a vitamin. It has no immune
properties. It is purely to replace a critically important deficient vitamin.”
It is important that emergency medicine physicians are vigilant when it comes to the vague
symptoms of early stage VKDB. Because the condition is still quite rare, clinicians are not
always looking for it, but physicians who treat infants in an acute setting should remember to
ask parents about whether their child has received a vitamin K shot and if they are
breastfeeding.
“I recommend that all children are vaccinated and receive all the recommended newborn
shots and screens,” said Dr. Kassis, also a faculty member at The Ohio State University
College of Medicine. “Expectant parents should speak with their obstetrician or at a prenatal
appointment with their pediatrician about