Evidence Library · Newborn procedures

Vitamin K

The strongest case of the group, and the one most often refused.

Newborns are born with very little vitamin K, which is needed for blood clotting. Without prophylaxis, early bleeding occurs in 0.25% to 1.7% of births. The dangerous form is late bleeding, at 2 to 12 weeks, which often bleeds into the brain. Without prophylaxis it occurs in roughly 4.4 to 7.2 per 100,000 infants. The risk without the injection compared with the injection has been estimated at 81 times higher.

What that looks like in real life: in Tennessee in 2013, four babies were admitted with late vitamin K deficiency bleeding within eight months, three with bleeding into the brain. All four had parents who declined the injection. In the previous six years, across 493,259 births in that state, there had been none.

The leukaemia claimA 1992 British paper reported an association between vitamin K injection and childhood cancer. It has since been tested repeatedly and not confirmed, including in a pooled analysis of individual data from six case-control studies and in the largest UK childhood cancer study. The concern was reasonable in 1992. It has been answered.

If you want to avoid the injectionAsk about oral regimens rather than declining entirely. They are less effective than the injection and require multiple doses given reliably over weeks, but they are far better than nothing.

Where this comes from:

235. Hand I, Noble L, Abrams SA. Vitamin K and the newborn infant. Pediatrics. 2022;149(3):e2021056036.

236. Centers for Disease Control and Prevention. Notes from the field: late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis, Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(45):901-902.

237. Sankar MJ, Chandrasekaran A, Kumar P, Thukral A, Agarwal R, Paul VK. Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review. J Perinatol. 2016;36(Suppl 1):S29-S35.

238. Golding J, Greenwood R, Birmingham K, Mott M. Childhood cancer, intramuscular vitamin K, and pethidine given during labour. BMJ. 1992;305(6849):341-346.

239. Roman E, Fear NT, Ansell P, Bull D, Draper G, McKinney P, et al. Vitamin K and childhood cancer: analysis of individual patient data from six case-control studies. Br J Cancer. 2002;86(1):63-69.

240. Fear NT, Roman E, Ansell P, Simpson J, Day N, Eden OB. Vitamin K and childhood cancer: a report from the United Kingdom Childhood Cancer Study. Br J Cancer. 2003;89(7):1228-1231.

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