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By
Linda Folden Palmer, DC
Newborn infants routinely receive a vitamin K shot after birth
in order to prevent (or slow) a rare problem of bleeding into the
brain weeks after birth. Vitamin K promotes blood clotting. The
fetus has low levels of vitamin K as well as other factors needed
in clotting. The body maintains these levels very precisely.1 Supplementation
of vitamin K to the pregnant mother does not change the K status
of the fetus, confirming the importance of its specific levels.
Toward the end of gestation, the fetus begins developing some of
the other clotting factors, developing two key factors just before
term birth.2 It has recently been shown that this tight regulation
of vitamin K levels helps control the rate of rapid cell division
during fetal development. Apparently, high levels of vitamin K can
allow cell division to get out of hand, leading to cancer.
What's the Concern?
The problem of bleeding into the brain occurs mainly from three
to seven weeks after birth in just over five out of 100,000 births
(without vitamin K injections); 90 percent of those cases are breastfed
infants3 because formulas are supplemented with unnaturally high
levels of vitamin K. Forty percent of these infants suffer permanent
brain damage or death.
The cause of this bleeding trauma is generally liver disease that
has not been detected until the bleeding occurs. Several liver problems
can reduce the liver's ability to make blood-clotting factors out
of vitamin K; therefore extra K helps this situation. Infants exposed
to drugs or alcohol through any means are especially at risk, and
those from mothers on anti-epileptic medications are at very high
risk and need special attention.
Such complications reduce the effectiveness of vitamin K, and in
these cases, a higher level of available K could prevent the tragic
intracranial bleeding. This rare bleeding disorder has been found
to be highly preventable by a large-dose injection of vitamin K
at birth.
The downside of this practice however is a possibly 80 percent
increased risk of developing childhood leukemia. While a few studies
have refuted this suggestion, several tightly controlled studies
have shown this correlation to be most likely.4,5 The most current
analysis of six different studies suggests it is a 10 percent or
20 percent increased risk. This is still a significant number of
avoidable cancers.6
Apparently the cell division that continues to be quite rapid after
birth continues to depend on precise amounts of vitamin K to proceed
at the proper rate. Introduction of levels that are 20,000 times
the newborn level, the amount usually injected, can have devastating
consequences.
The Newborn's Diet
Nursing raises the infant's vitamin K levels very gradually after
birth so that no disregulation occurs that would encourage leukemia
development. Additionally, the clotting system of the healthy newborn
is well planned, and healthy breastfed infants do not suffer bleeding
complications, even without any supplementation.7
While breastfed infants demonstrate lower blood levels of vitamin
K than the "recommended" amount, they show no signs of
vitamin K deficiency (leading one to wonder where the "recommended"
level for infants came from). But with vitamin K injections at birth,
harmful consequences of some rare disorders can be averted.
Infant formulas are supplemented with high levels of vitamin K,
generally sufficient to prevent intracranial bleeding in the case
of a liver disorder and in some other rare bleeding disorders. Although
formula feeding is seen to increase overall childhood cancer rates
by 80 percent, this is likely not related to the added vitamin K.
The Numbers
Extracting data from available literature reveals that there are
1.5 extra cases of leukemia per 100,000 children due to vitamin
K injections, and 1.8 more permanent injuries or deaths per 100,000
due to brain bleeding without injections. Adding the risk of infection
or damage from the injections, including a local skin disease called
"scleroderma" that is seen rarely with K injections,8
and even adding the possibility of healthy survival from leukemia,
the scales remain tipped toward breastfed infants receiving a prophylactic
vitamin K supplementation. However, there are better options than
the .5- or 1-milligram injections typically given to newborns.
A Better Solution
The breastfed infant can be supplemented with several low oral
doses of liquid vitamin K1 (possibly 200 micrograms per week for
five weeks, totaling 1 milligram, even more gradual introduction
may be better). Alternatively, the nursing mother can take vitamin
K supplements daily or twice weekly for 10 weeks. (Supplementation
of the pregnant mother does not alter fetal levels but supplementation
of the nursing mother does increase breastmilk and infant levels.)
Either of these provides a much safer rate of vitamin K supplementation.
Maternal supplementation of 2.5 mg per day, recommended by one author,
provides a higher level of vitamin K through breastmilk than does
formula,10 and may be much more than necessary.
Formula provides 10 times the U.S. recommended daily allowance,
and this RDA is about two times the level in unsupplemented human
milk. One milligram per day for 10 weeks for mother provides a cumulative
extra 1 milligram to her infant over the important period and seems
reasonable. Neither mother nor infant require supplementation if
the infant is injected at birth.11
The Bottom Line
There is no overwhelming reason to discontinue this routine prophylactic
injection for breastfed infants. Providing information about alternatives
to allow informed parents to refuse would be reasonable. These parents
may then decide to provide some gradual supplementation, or, for
an entirely healthy term infant, they may simply provide diligent
watchfulness for any signs of jaundice (yellowing of eyes or skin)
or easy bleeding.
There appears to be no harm in supplementing this vitamin in a
gradual manner however. Currently, injections are provided to infants
intended for formula feeding as well, although there appears to
be no need as formula provides good gradual supplementation. Discontinuing
routine injections for this group alone could reduce cases of leukemia.
One more curious look at childhood leukemia is the finding that
when any nation lowers its rate of infant deaths, their rate of
childhood leukemia increases.12 Vitamin K injections may be responsible
for some part of this number, but other factors are surely involved,
about which we can only speculate.
Dr.
Linda Folden Palmer consults and lectures on natural infant health,
optimal child nutrition and attachment parenting. After running
a successful chiropractic practice focused on nutrition and women's
health for more than a decade, Linda's life became transformed
eight years ago by the birth of her son. Her research into his
particular health challenges led her to write Baby
Matters: What Your Doctor May Not Tell You About Caring for Your
Baby. Extensively documented, this healthy parenting book
presents the scientific evidence behind attachment parenting practices,
supporting baby's immune system, preventing colic and sparing
drug usage. You can visit Linda's Web site at www.babyreference.com.
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