Guest guest Posted February 9, 2007 Report Share Posted February 9, 2007 In a message dated 2/10/2007 4:55:02 AM Eastern Standard Time, ingrid_schebesch@... writes: About jaundice - breastfed babies are more and better able to shed the excess billirubin levels but only if brf excl. from birth and the first feed is not delayed too long. did not even have the slightest hint of jaundice. I ended up w/a c-section w/her (argh, long story). I breastfed her w/in 20 min of her birth. I thought that was pretty good for a c-section. Some c-section babies have difficulty breathing, so the hospital needs to administer aid, and the mom isn't able to feed right away. Even w/a c-section, I refused Vit K. She was full term (actually 2 weeks " overdue " ). I had been taking good whole food vitamins all throughout pregnancy. I excercised daily, etc. I looked at her after birth and didn't see any bruising. So I refused (along w/everything else!). I'm so glad I did. Holly Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2007 Report Share Posted February 10, 2007 I am still not satisfied with this response... sorry. I believe that all these factors that help the blood to coagulate, including vit k, are all present in the perfect amount in colostrum and breastmilk and are being produced by the bacteria in the gut, if the birth was natural. Any MD should look at this process first. Breastmilk contains the perfect balance of nutrients, micronutrients and other factors that work together very well to help the blood coagulate. About jaundice - breastfed babies are more and better able to shed the excess billirubin levels but only if brf excl. from birth and the first feed is not delayed too long. You really need a Health Professional who is knowledgable about brf and and natural birth to help answer this question. Ingrid > > > Here is one response I received from an MD to these concerns of Meryl's > > You argue that " vitamin K is a vitamin which promotes clotting of the > blood. " While this statement is partially true, a more accurate statement > would be 'vitamin k is a vitamin which ALLOWS FOR clotting of the blood.' > Within the blood there is a complex system of proteins that balances blood > clotting (or coagulation) and the breaking apart of blood clots (or > fibrinolysis). Vitamin K is necessary for the modification of clotting > proteins to make them functional. (More specifically, it is necessary for > the carboxylation of amino acid residues on clotting factors V, VII, IX and > X and prothrombin of the coagulation cascade). Without these functional > proteins, the platelets that work to prevent bleeding are not well > stabilized by an overlying mesh of fibrin. Therefore with deficiencies of > vitamin K, the body is more prone to bleeding (or becomes coagulopathic), > whether in infants or adults. But now lets examine the reverse. Because > vitamin K does not act itself to clot blood, but rather is a necessary > cofactor in the production of functional clotting factors, increasing levels > of vitamin K do not increase the risk of clotting. One can generally > understand this by saying that vitamin k is a permissive factor rather than > an inductive factor in blood clotting. In fact, excess vitamin k has never > been associated with an increased tendency for clotting. > > > > You are very correct in saying that babies are likely to have physiologic > jaundice for a number of reasons. They do have an increased amount of red > cells when compared to adults, and an immature liver slow to process (or > conjugate) bilirubin. However, the break down of red blood cells, > processing of bilirubin and excretion of bile in the feces is a process > relatively unrelated to the clotting of blood in the circulatory system. I > am unaware of a connection between vitamin K administration and neonatal > jaundice (although I would be very interested in any studies that show > this). For more on the benefits of vitamin K prophylaxis, I would refer you > to the Cochrane Database review of the subject at the following url. > > > > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed > <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=A > bstractPlus & list_uids=11034761 & query_hl=2 & itool=pubmed_docsum> > & cmd=Retrieve & dopt=AbstractPlus & list_uids=11034761 & query_hl=2 & itool=pubmed_d > ocsum > > > > > > Randall Neustaedter OMD > > Classical Medicine Center > > 1779 Woodside Rd., 201C > > Redwood City, CA 94061 > > 650 299-9170 > > www.Cure-Guide.com <http://www.cure-guide.com/> > > Author of Child Health Guide: Holistic Pediatrics for Parents, North > Atlantic Books, 2005, and The Vaccine Guide, 2002 > > > > Subscribe to my free e-newsletter by using this > <http://www.cure-guide.com/MySubscribe/mysubscribe.html?from=email> link. > > > > _____ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2007 Report Share Posted February 10, 2007 Well done you, Holly, just goes to show how amazing colostrum can be!!! Ingrid > > > did not even have the slightest hint of jaundice. I ended up w/a > c-section w/her (argh, long story). I breastfed her w/in 20 min of her birth. I > thought that was pretty good for a c-section. Some c-section babies have > difficulty breathing, so the hospital needs to administer aid, and the mom > isn't able to feed right away. Even w/a c-section, I refused Vit K. She was > full term (actually 2 weeks " overdue " ). I had been taking good whole food > vitamins all throughout pregnancy. I excercised daily, etc. I looked at her > after birth and didn't see any bruising. So I refused (along w/everything > else!). I'm so glad I did. > > Holly > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 In a message dated 2/11/2007 5:21:41 PM Eastern Standard Time, afaltotten@... writes: What vitamins did you take, if I may ask? Thx, -angie I took and still take MegaFood Baby and Me 100% whole food vitamins. There are several good whole food vitamins out there. The important thing to look for in a vitamin is the whole food. The ingredients in my vitamins are things like alfafa, blueberry, cranberry, citrus, etc. It is real food. If you can't pronounce the ingredients on the label you don't want to take it. You will not find a decent vitamin in the grocery store. I notice when I don't take my vitamins (probably b/c I'm sooo addicted to sugar). That's my opinion on vitamins. Hope that helps. Holly Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 Holly, What vitamins did you take, if I may ask? Thx, -angie > I had been taking good > whole food > > vitamins all throughout pregnancy. I excercised daily, etc. I > looked at her > > after birth and didn't see any bruising. So I refused (along > w/everything > > else!). I'm so glad I did. > > > > Holly Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 You know, after all this, I still feel confused and not sure whether to administer oral Vitamin K or not. :-( -angie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2007 Report Share Posted February 11, 2007 From Michel Odent, MD Mothering.com What are the risks/benefits to letting your baby have a shot of vitamin K after birth? Today there are many reasons to de-dramatize the topic and to reassure at the same time the parents who are inclined to refuse the shot and also those who prefer to do it. To the parents who refuse the injection, we can say that they don't take a great risk, since the chances of their breastfed baby having a hemorrhagic disease related to vitamin K deficiency is in the region of one in 15,000. It is even probable that the risks are still lower if the birth and the initiation of lactation were undisturbed. My view is that vitamin K deficiency of breastfed babies is probably no more physiological than the weight loss in newborn babies. After thousands of years of culturally controlled childbirth and lactation, we usually underestimate the amount of 'colostral milk', and therefore of vitamin K, a human baby has been programmed to consume during the first days following birth. A well-constructed Japanese study showed that babies who consume 350 ml of breast milk in the first three days following birth are protected against vitamin K deficiency. Let us also remember that vitamin K deficiency is unheard of among formula fed babies. Some parents who accepted the injection might feel guilty or anxious afterwards when hearing about two British studies suggesting that vitamin K injected at birth (not vitamin K given orally) is a risk factor for cancer in childhood. These parents must be reassured as well because the British findings have not been confirmed by other studies, particularly a huge authoritative Swedish study involving more than one million children. However one cannot hide the fact that the routine injection of 1 mg of vitamin K at birth is always associated with the injection of 10 mg propylene glycol and 5 mg phenol, the effects of which are unknown. >From: " Randall Neustaedter " <randalln@...> >Reply-Vaccinations ><Vaccinations > >Subject: RE: Re: vitamin K >Date: Wed, 7 Feb 2007 22:01:30 -0800 > > The simple answer is no. This is a disease that causes internal bleeding >and intestinal bleeding. Not what you want in a new infant. And not >something you want to monitor. >It's just an oral dose of one drop of vitamin K. I really don't understand >why there is such an objection to this when this very serious problem can >be >so easily prevented. > > >Randall Neustaedter OMD >Classical Medicine Center >1779 Woodside Rd, 201C >Redwood City, CA 94061 >650 299-9170 >www.cure-guide.com Free e-newsletter - Subscribe > >Author of Child Health Guide: Holistic Pediatrics for Parents, 2005 > > Re: Re: vitamin K > > > > In a message dated 2/7/2007 4:07:42 PM Eastern Standard Time, > > randalln@cure- <mailto:randalln%40cure-guide.com> guide.com writes: > > > > Perhaps Christian > > Scientists would agree that a genetic defect means that babies should > > not live, but in the age of scientific research and genetic testing, > > there are conditions which if undetected and untreated would result in > > the deaths of babies who could otherwise live. > > I think Rolinda was trying to make a valid point. From what I have > > read every baby is " deficient " in Vit K. (I have read a different > > opinion on here, but I can't remember exactly what it was) If every > > baby is deficient, this is not a genetic defect. They compare this > > deficiency to an adult's levels. > > (Just like they give the same vaccine to an adult they do a baby). > > This level is normal for babies. > > > > Instead of giving high risk babies Vit K, like preterm or w/obvious > > liver problems, they (the medical profession) give Vit K to every > > baby. This is just wrong. > > > > I agree w/Rolinda. > > > > Holly > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 28, 2007 Report Share Posted February 28, 2007 This article came from Edda West's fine newsletter. ------------------ Vitamin K By Karin Rothville DipCBEd. For the last 40 or 50 years, it has become a generally accepted fact that vitamin K prevents haemorrhagic disease of the newborn, and routine administration of vitamin K to all newborns has been recommended.3, 6, 21, 34, 72 This recommendation has been questioned because results released in 1990 from a study by Golding and colleagues26 in the UK showed a two to three times increased risk of childhood cancers, especially leukaemia, in children given prophylactic drugs (usually intramuscular vitamin K) in their first week. A further study in 1992 seemed to confirm this risk.25 There was widespread anxiety among parents when these findings were published. Parents were, understandably, reluctant to have their baby receive a substance that could predispose it to cancer in childhood, and many health workers were also reluctant to give, without prescription, a possibly cancer-causing substance to prevent a disease that few, if any, of them had ever seen. These concerns are not the first time that vitamin K safety has been questioned. So, what is the controversy about vitamin K? And does it predispose babies to childhood cancer? WHAT IS VITAMIN K AND WHAT DOES IT DO? Vitamin K is a fat-soluble substance which triggers off the blood-clotting process. Blood clotting is a complex process and can be described as a sequence of three stages, requiring up to 12 different coagulation factors.72 The liver needs vitamin K to synthesise four of these factors. Vitamin K is also needed for the formation of other proteins found in plasma, bone and kidney.33, 58 As with other fat-soluble vitamins, a normal flow of bile and pancreatic juice is necessary for digestion, and the presence of dietary fat, especially short-chain fatty acids, enhances absorption. Absorbed vitamin K is transported via the lymph into the systemic circulation.58 Normally, a significant portion (up to 55%) of absorbed vitamin K is excreted so the amount in the body is small and its turnover is rapid (about 30 hours).58 Vitamin K is stored and re-utilised in the body for 3-4 weeks.33 Vitamin K is found in many foods. Leafy, dark green and deep yellow vegetables are the best sources.58 Alfalfa18 is a good source; and milk and dairy products, eggs, cereals, fruits and other vegetables also provide small but significant amounts. As the liver of adults contains about equal amounts of plant and animal forms of Vitamin K, it is assumed that vitamin K is produced in the intestinal tract by bacterial flora. One of the reasons given for the low levels of vitamin K in newborn babies is because their gut has not yet been colonised by the required bacteria. Recommended daily dietary intakes of vitamin K58CategoryAgeAmount ((g)Infants0 – 110Children1 – 3154 – 6207 – 1025Adolescents11 – 143015 – 1835Adult Male19 – 70+45Adult Female19 – 70+35Pregnancy+ 10Lactating+ 20 The dietary requirements for vitamin K in infants and children are estimates and are based on weight and growth rates as compared to adults. Many unsupplemented breasfed infants do not show clinical signs of vitamin K deficiency on intakes of less than 3 (g daily and the mean requirement for infants is estimated to be 5 (g daily based on weight. The higher amount of 10(g is recommended for prevention of Haemorrhagic Disease of the Newborn.58 WHAT IS HAEMORRHAGIC DISEASE OF THE NEWBORN? Haemorrhagic Disease of the Newborn (HDN) is a bleeding disorder associated with low levels of vitamin K in newborn babies. It was first defined in 1894 by Townsend69 as spontaneous external or internal bleeding occurring in newborn infants not due to trauma, accident or inherited bleeding disorders such as haemophilia. Previously, there were no generally agreed upon criteria to determine causes of haemorrhaging, so any diagnosis was based solely on the opinion of the attendant medical personnel. Infants are born with low levels of vitamin K23 compared to adults and this is termed ‘vitamin K deficiency’. Up to 50% of babies develop this ‘vitamin K deficiency’, but bleeding occurs in only a fraction of these cases.37 In most it starts after birth, becomes Page 2 progressively more severe over 48-60 hours, then spontaneously corrects itself by 72-120 hours.9 HDN has always been rare – in Britain where maternity units practised a selective policy of vitamin K administration, the incidence was no more than 1 in 20,000 in the years 1972-80. Estimates for late onset HDN are 4-8 per 100,000.45 Incidence also seems to vary from country to country. HDN is divided into three categories: Early onset HDN occurs in the first 24 hours. It is very rare and mainly associated with mothers who have taken anticonvulsant, antibiotic, antituberculous or anticoagulant drugs during pregnancy. Classic HDN occurs in the first week after birth. It is manifested by the oozing of blood from the intestines, the nose, the cord site and broken skin sites. Bruising at sites where there has been no trauma can also appear. Late onset HDN occurs after the first week, with a peak incidence between the second and sixth weeks, and about half the cases present with intracranial bleeding (bleeding into the brain). WHAT ARE THE RISK FACTORS FOR HDN? There has been some debate over the years as to whether or not HDN is actually caused by vitamin K deficiency. Certainly, giving vitamin K does arrest bleeding in the majority of cases, but this does not mean that vitamin K deficiency causes HDN. One may as well say that an antibiotic deficiency causes bacterial infection. There is also no consensus as to what level of vitamin K in plasma protects against HDN. Some researchers have found no evidence of vitamin K deficiency in babies in their studies43, 49 and other factors have also been suggested.52, 73, 74 Most, if no all, of the reported cases of late onset HDN have presented with problems which affect the baby’s ability to absorb or utilise vitamin K.45, 56 These include: hepatitis, cystic fibrosis, chronic diarrhoea, bile duct atresia, alpha-1-antitrypsin deficiency, coeliac disease of insufficient plasma transport capacity. Subclinical cytomegalovirus has also been implicated. Vitamin K-responsive bleeding syndrome has been well documented after antibiotic therapy, especially with cyclosporins.33 There are other factors which place the newborn at higher risk. These include pre-term birth (as the liver is very immature), low birth weight, instrumental or traumatic delivery, bruised or bleeding in the first few days after birth, requiring surgery or circumcision, taking inadequate feeds and breastfeeding.33 BREASTFEEDING – WHY IS IT A RISK? Several authors have noted the higher incidence of HDN in solely breastfed babies.9, 30 The incidence has been quoted as 1 in 1200.30 Studies comparing breastmilk with formula and cow’s milk have shown that breastmilk is lower in vitamin K.22, 28, 32 Breastmilk substitutes are heavily supplemented with vitamin K, however, it is possible that, like iron, vitamin K is biologically more available to the baby from breastmilk, and so such high levels are not necessary. Measured levels of vitamin K in breastmilk seemed to vary depending on the type of measurement used; however, they all come out lower than cow’s milk. Fournier22 and Greer28 found levels of around 8-9(g/l, which would mean that if a baby was taking in about 500ml per day, it would be getting the recommended 3-5(g daily. Vitamin K content and availability are greater in the hind milk because of its higher fat content and vitamin K levels are also higher in colostrum.32 As an extra plus, breastmilk contains thromboplastin, one of the factors in blood clotting.18 Vitamin K levels in the breastmilk rise markedly in response to the mother eating vitamin K rich foods or taking vitamin K supplements.29, 54 Nishiguchi found no cases of low vitamin K levels in breastfed infants whose mothers had been given supplements, as opposed to infants who had only been given 1 or 2 doses of oral vitamin K.54 Unrestricted access to the breast in the early days after birth is important, due to the higher levels of vitamin K in colostrum. The importance of early feeding has been recognised since the 1940’s. Babies who have been fed within their first 24 hours have significantly better coagulation times than babies not fed until after 24 hours.24 It is essential that, to receive the full complement of vitamin K in breastmilk, the baby completely finishes one breast before being offered the other. Any practice that involves restricting either the baby’s time at the breast or the number of feeds will not allow the baby to receive optimum amounts of vitamin K and will also prolong the time it takes for the baby’s intestine to be colonised by friendly, vitamin K manufacturing bacteria. THE HISTORY OF VITAMIN K USE TO PREVENT HDN. The search for the cause of HDN began in 1913 when Whipple82 postulated that a lack of prothrombin activity could be a cause of HDN. In 1929, Henrik Dam14 noticed that chicks fed a fat-free diet suffered subcutaneous and intramuscular haemorrhages, which could be prevented if the chicks were fed seeds, cereals and green, leafy plants. Dam described the condition as a vitamin deficiency and named the deficient vitamin ‘vitamin K’, from the Danish word ‘koagulation’. Research in 19378 found that prothrombin times in normal neonates were between 30-60% adult levels, falling to 15-30% on day two, and then gradually rising again until about day 10. This research led to the continuing belief that these low levels in the newborn are a deficiency and need to be corrected. In 1939, vitamin K1 was isolated from alfalfa by Dam, for which he later received the Nobel Prize, along with Doisy, who isolated vitamin K2.45 Further research in 1939 by Waddell and Guerry81 found that low plasma prothrombin levels could be elevated by the administration of oral vitamin K. Armed with this ‘proof’ that vitamin K deficiency caused HDN, vitamin K was synthesised and various trials were commenced Page 3 to ascertain which was the most effective amount and route to use in prophylaxis. It is difficult for us to assess these trials nowadays as they were mostly neither double blind nor well controlled. The dosage of vitamin K given, the route of administration and the time of administration all varied. In many cases, the conclusions did not seem to match the results.72 Some of the studies assessed the effect on neonatal vitamin K levels if the mother was given vitamin K during labour.72 Results varied, with the effectiveness of the vitamin K given depending on how soon the woman gave birth and the dosage given. More recent studies have shown increases in cord blood levels where mothers were supplemented antenatally with vitamin K.1, 66 Two showed a significant difference between the supplemented and unsupplemented groups and found that the effect of prenatal vitamin K persisted until the fifth day after birth.1 Because of the variations in results from these early studies, further research focussed on treating the baby after birth. One particular study done in 194231 was intended to determine the minimal effective oral dose of Synkavite (K3), a water-soluble synthetic form of vitamin K. The results showed that very small daily doses were effective and that a dose of 5(g daily would probably prevent the development of HDN, except in early onset cases. The study also found that 1.25mg was effective in lowering an excessively high prothrombin time to normal. However, the author admitted that several workers found prothrombin deficiencies in babies with no abnormal bleeding. By 1950, most maternity units had a policy of giving infants oral vitamin K (usually Synkavite) immediately after birth.70 This prevented the fall in prothrombin levels that occurred in the first few days and, presumably, the risk of excessive bleeding. This risk was higher in male babies because of routine circumcision, and, indeed, vitamin K proved to be of great clinical value in preventing post-circumcision bleeding.75 Then, in the mid-1950’s, reports of increased jaundice and kernicterus (brain damage caused by high bilirubin levels) associated with vitamin K prophylaxis began circulating. Reviews of maternity units found that some were giving Synkavite in doses exceeding 50mg.70 It was established that high doses of Synkavite caused haemolysis (destruction of red blood cells) and high serum bilirubin levels.48 Researchers and medical professionals queried the safety aspects of vitamin K, and there were many conflicting reports on the appropriate dosages. Some researchers queried the need for vitamin K at all, quoting results from studies that showed no difference in prothrombin times or vitamin K plasma levels between babies that bled and babies that didn’t.72 Eventually, a newer preparation, intramuscular vitamin K1 (phytomenadione), was developed and approved for use, solely on the grounds that it appeared to cause less haemolysis. Phytomenadione (trade names Konakion (Roche) or Aquamephyton (Merck, Sharpe & Dohme)) is a synthetic petrochemical derived from 2-methyl 1,4-naptha-quinone in a polyethoxylated castor oil base.18 In the US, polysorbate-80 is used as a base instead of polyethoxylated castor oil.15 In spite there being no long term trials of these preparations, the American Academy of Pediatrics recommended that phytomenadione be administered prophylactically to all newborn babies.72 The use of oral vitamin K preparations fell out of favour in the USA and the ‘safer’ intramuscular route became the route of choice. In Britain, after the jaundice scare of the1950’s, many maternity units began to practice a selective policy, giving vitamin K only to babies at risk of haemorrhaging. McNinch reported in 1980 that less than half the maternity units in the UK gave vitamin K to all newborns.47 Some of these babies were given oral prophylaxis and some were given intramuscular prophylaxis. In Germany, almost all newborn infants who required medical care and instrumental deliveries were given intramuscular vitamin K, and some healthy newborns also received it.76 Records have not always been kept in New Zealand hospitals, so it is impossible to say whether or not vitamin K was given routinely and by which route.17 Although vitamin K use seemed to prevent most cases of HDN, there was still controversy. Not everyone believed vitamin K deficiency was the cause of HDN. In 1977, van Doorm et al 52, 73, 74 suggested that HDN could be caused by a heparin-like inhibitor in the newborn and he concluded that babies given their first feed soon after birth do not have a vitamin K deficiency. Other researchers agreed with van Doorn.49 In 1980, Malia et al43 could find no evidence of vitamin K deficiency in babies in their study and concluded that low levels of vitamin K dependent clotting factors were due to the immature liver. The authors of these studies questioned whether vitamin K prophylaxis was really necessary for healthy newborns. Then, starting in November 1980, there was a cluster of six cases of HDN in Britain, all within 17 months.46 Half of these cases were classic HDN, the other half were a new manifestation of HDN – late onset. LATE ONSET HDN Late onset HDN was first reported in 1977.5 It mainly occurs in breastfed infants and ( to ¾ of cases have an underlying liver disorder or malabsorption syndrome,15 rather than insufficient dietary intake of vitamin K. This means the liver cannot adequately synthesise blood clotting factors or store adequate amounts of vitamin K. Liver function cannot be easily diagnosed at birth without a range of invasive tests and thus there exists an unknown risk of haemorrhaging. Many factors contribute to poor liver function, including hepatitis, cystic fibrosis, antibiotic therapy, biliary atresia, alpha-1-antitrypsin deficiency, a-beta-lipoproteinaemia, coeliac disease, chronic diarrhoea and exposure to pharmacologic agents such as anticonvulsants, rifampin, isoniazid cephalosporins and coumarin compounds33 When tested, most of the reported cases of late onset HDN had hepatitis, liver malfunction or enzyme Page 4 deficiencies.6, 35, 51, 80 Birkbeck6 believes there are two processes at work – low levels of prothrombin and vitamin K-dependent clotting factors VII, IX and X at birth, and a further fall in these in the neonatal period. In his view the initial low levels are not due to vitamin K deficiency as levels of 2 other non-vitamin K-dependent factors, XI and XII are also often reduced. Thus, the situation at birth may be simply due to hepatic immaturity. Birkbeck6 also reports that HDN is almost unknown in central Africa and he suggests an environmental mechanism as the cause. Associated with this, a discussion paper from the University of Amsterdam42 raises the idea that by-products of our industrial society such as PCBs, PCDDs and PCDFs are the cause of late onset HDN. These chemicals can induce enzymes in the liver which cause liver damage and prolong prothrombin time. Although overseas studies have reported contamination of breastmilk by these pollutants, a NZ Department of Health study on breastmilk reported that levels of these contaminants were at the lower end of the scale.7 The Health Department is currently conducting another study to see if levels have changed over the past few years. There seems to be a seasonal variance, with most cases of late onset HDN occurring in the warmer months.6 It has been suggested that the mother could have contracted a viral infection during pregnancy in the colder months and this has crossed the placenta. Since viruses have an affinity for the liver and mucous membranes, they can affect intestinal absorption and liver function.67 Another suggested cause of late onset HDN includes use of the food antioxidant BHT (butylated hydroxytoluene), which has produced vitamin K deficiency.68 BHT is present in many processed foods, including margarine. Our Western diets consist of a lot of processed food, and to reduce fat intakes, margarine is recommended rather than butter. The polyunsaturated fat in margarine is an inhibitor of vitamin K absorption.68 Both of these factors could have an effect on the amount of vitamin K available to pass through to the baby. A high level of vitamin K in the mother’s blood is necessary to ensure adequate transplacental transfer of vitamin K.9, 33 It is important for the baby to have adequate stores of vitamin K in its liver at birth to prevent bleeding until its feeding and gut flora are established. Of the six cases of HDN in Britain in 1980-1982, all were breastfed and none had received vitamin K at birth.46 Two of the cases were in the high-risk group – one was born by caesarean section and had an epileptic mother treated with phenytoin, and the other had an alcoholic mother who had taken anti-depressants – and obviously should have received vitamin K at birth. These cases prompted a call for the re-introduction of routine prophylaxis. Many opposed the idea of unnecessarily injecting otherwise healthy babies so studies40, 47, 55, 79 were therefore conducted to determine whether oral vitamin K was as effective as intramuscular. It was also proposed that oral vitamin K would be more cost-effective and thus better suited for use in Third World countries.55 Results of these studies varied. Some showed that oral vitamin K was effective in preventing classic haemorrhagic disease but not as effective as intramuscular vitamin K in preventing late onset HDN.47, 55, 78 Others found oral as effective, especially a 10 year study conducted on 38,000 infants in Sweden where no cases of HDN were observed over that period.40 Tripp and McNinch reported no cases in 25,000 babies in their maternity unit where only those at risk were given intramuscular prophylaxis and the rest oral prophylaxis.70 In spite of these findings that oral vitamin K prophylaxis was not effective in preventing late onset HDN, it continued to be used in British maternity units, especially for low risk infants. RISKS OF VITAMIN K PROPHYLAXIS Konakion ampoules contain phenol, propylene glycol38 and polyethoxylated castor oil as a non-ionic surfactant. Studies in animals given polyethoxylated castor oil have shown a severe anaphylactic reaction associated with histamine release. Strong circumstantial evidence implicates polyethoxylated castor oil in similar reactions in humans. Polyethoxylated castor oil, when given to patients over a period of several days, can also produce abnormal lipoprotein electrophoretic patterns, alterations in blood viscosity and erythrocyte aggregation (red blood cell clumping). Individuals sensitive to this base are contraindicated from using Konakion. New Ethicals Compendium also warns that the use of Konakion can cause jaundice and kernicterus in infants.53 Other listed side effects include flushing, sweating, cyanosis, a sense of chest constriction, and peripheral vascular collapse. Local cutaneous and subcutaneous changes may occur in areas of repeated intramuscular injections. This synthetic, injectable vitamin K formulation was never subjected to a randomised, controlled trial. In new drugs that are to be used for prophylaxis, the usual risk/benefit analysis does not apply, since the individual is not ill. The ethical principle of non-maleficence (primum non nocere – first do no harm) applies and the trials must thus be larger in order to identify any previously unrecognised side effects.65 Since this did not happen, nor was there any long term follow up, we actually have little idea of the effects of this drug on newborn babies. The risks of injecting vitamin K into a newborn baby are nerve or muscle damage as the preparation must be injected deeply into the muscle, not subcutaneously under the skin. There is also the documented risk of injecting the baby with the syntocinon intended for the mother.30, 70 As stated in the product information,53 infants can suffer from jaundice or kernicterus (brain damage from a build-up of bile pigments in the brain) from Konakion. Infants who have the enzyme deficiency G6PD (glucose 6 phosphate dehydrogenase) are at particular risk from vitamin K.30 The other risk factor is the possible increased chance of childhood cancer. THE LINK BETWEEN CHILDHOOD CANCER AND INTRAMUSCULAR VITAMIN K In 1970, a national cohort study of 16,193 infants born in one week in April was begun in Britain.26 This study was to test Page 5 hypotheses about childhood cancers and their associated factors. Thirty-three of the children had developed cancer by age 10 and were compared with 99 control children, matched on maternal age, parity and social class. One of the unlooked-for risk factors was the administration of prophylactic drugssuch as vitamin K in the first week after birth – a nearly three-fold risk. This association fitted no prior hypothesis and the authors recommended that their finding be tested in another series of cases. The authors of the study approached Roche, the manufacturers of Konakion, for funding for a further trial to examine the findings more closely. Roche was not interested until, a few months later, the media reported the results of the study and that vitamin K given to babies might cause childhood cancer. Roche then decided to fund a new study.27 The new study25 was a case-control study of 195 children with cancer born at either of two hospitals in Bristol, England, compared with 588 healthy children also born at these hospitals. One hospital predominantly gave vitamin K orally and the other intramuscularly. The authors found a nearly two-fold risk of leukaemia in children who had received intramuscular vitamin K. These findings were extremely worrying. Golding calculated that the extra cases of leukaemia caused by vitamin K injection could be as many as 980 in the UK alone.25 These results were supported by reports of the potential carcinogenicity of vitamin K from Israels et al, who suggested that low vitamin K levels in the newborn protect against the risk of mutations during a period of rapid cell growth and division.39 Pizer et al did not find any association between the route of vitamin K administration and mutations in cells but concluded that his study was too small to show any real effect.62 Another study reported no increase in abnormalities in newborn infants, but, with only 12 infants, the study was too small to show any real effect.10 It is worth noting that after an intramuscular dose of vitamin K, the baby’s plasma levels are almost 9000 times the normal adult levels.47 It has also been suggested that the cancer-causing agent could be a metabolite, N-epoxide, or some other component of the solution other than vitamin K itself.15 Golding’s study was criticised by many. One of the reasons was that the authors had to make assumptions for some cases, as the information on vitamin K administration was not clearly recorded. In spite of this, expert epidemiologists considered that the results were plausible and so could not be lightly dismissed.15 Further studies were proposed to answer the question of cancer and vitamin K. In 1993, results from three retrospective studies on vitamin K and childhood cancer were published. The studies were done in the USA, Denmark and Sweden.41, 57, 19 These studies, although large, did not confirm the association between intramuscular vitamin K and childhood cancer. One of the studies not only showed no association between IM vitamin K and childhood cancer, it also showed no association between maternal smoking and childhood cancer, a finding totally at odds with the results from many other studies.19 The other two studies were also not comparable to the British study. One because of differences in type of vitamin K given41 and the other because of the use of birth cohorts with differing regimens of vitamin K usage.57 Because of the design flaws in these studies, there was still a need for further case-control studies. Results from two were published in 1996.2, 77 They had carefully matched controls and more accurate information on whether vitamin K had been given or not, and by which route. One of the studies2 reported no association between intramuscular vitamin K and childhood cancer and the other77 found a risk of leukaemia, but only when cases were compared with local controls (i.e. from the same hospital) and not with controls randomly selected from the whole area under study. This, although suggestive, was not followed up but dismissed as a chance finding related to multiple testing. The suggestion was then put forward that, as these studies had failed to show a definite association between intramuscular vitamin K and childhood cancers, worries about any potential cancer risk should be abandoned.83 At that time, four more studies on vitamin K and cancer were in progress.44, 59, 60, 61 The results from these four studies were published in 1998. Two of them failed to confirm any increased risk of childhood cancers.44 61 One of the other studies showed a twofold risk of acute lymphoblastic leukaemia among 1-6 year olds,59 the other showed a significant risk for all cancers.60 So, the jury is still out on whether there is an increased risk of childhood leukaemia with the intramuscular form of vitamin K. Some recommend that intramuscular vitamin K should still be used, as the risk of leukaemia “seems more hypothetical than real”.76 Others believe that public confidence in IM vitamin K has been severely shaken and will be difficult to restore fully. They recommend an oral regimen similar to that used in the Netherlands of 25(g daily, given by the mother. This would avoid the grossly unphysiological peaks of vitamin K from both the IM route and the present oral route.71 ORAL VITAMIN K VS INTRAMUSCULAR The two main problems with giving vitamin K orally are that there is no licensed oral formulation, meaning that babies receive the intramuscular form orally, and that compliance with three oral doses is poor as many doctors and midwives are reluctant to give an unlicensed formula.13 The use of unlicensed preparations may theoretically expose professionals to litigation in the event of prophylactic failure or unforeseen adverse events.2 Roche, the manufacturers of Konakion, state that they do not recommend the administration of Konakion solution orally.63 Their reasons are: that they have no clinical studies to support oral use, phenol, which has been reported to be an irritant to newborns mouths, is used as a preservative, the variability in the production of bile salts in newborns may affect absorption, that Konakion given orally has a small association with anaphylactic reactions. Page 6 The preparation was also unpleasant to taste and babies were inclined to spit it out82 or to vomit it back up. Only about half of an orally administered dose is absorbed.47 Even so, the plasma concentrations in babies who were given oral vitamin K reached 300 times the adult levels, before dropping off slightly after about 24 hours.47 After the publication of Golding’s studies, further trials were done on oral vitamin K prophylaxis and whether it gave longer term protection. In 1992, Cornelissen11 found plasma vitamin K concentrations were higher in the group given IM vitamin K than the oral group, but blood coagulability, activities of factors VII, X and PIVKA-II concentrations showed no differences. By 3 months follow-up, vitamin K levels had dropped in both groups but more in the oral group. He suggests that neither give long term protection. One would assume that babies should be producing their own vitamin K by 3 months and, if not, what other mechanism could be hindering this process. Von Kries et al78 studied repeated oral vitamin K prophylaxis in Germany, with 3x 1 mg doses and found that it was not as effective as a 1mg intramuscular dose at birth. Another study by Cornelissen et al12 reported on the effectiveness of differing regimens of oral vitamin K in four different countries – the Netherlands, Germany, Switzerland and Australia (two differing regimes). In the Netherlands, babies are given 25 (g daily oral vitamin K for 3 months with I mg given at birth either orally for healthy newborns or intramuscularly for unwell babies. In Germany, the regime is 3 x 1 mg oral doses as was also the case in Australia from 1993 to 1994. In Switzerland 2 oral doses of a new ‘mixed-micellar’ oral vitamin K is given. The Netherlands had the lowest failure rate – 0 per 100,000. In Australia, where the regime was changed in 1994 from oral to IM, the failure rate was 1.5 per 100,000 for oral and 0.9 per 100,000 for IM, showing that 3 oral doses are less effective at preventing late onset HDN than one IM dose of vitamin K. Even if Roche are persuaded to bring the mixed-micellar preparation into New Zealand, results from Switzerland (failure rate of 1.2 per 100,000)12 show that further study needs to be done on the most effective timing of the doses. If New Zealand parents wish their baby to receive oral vitamin K, the recommended regimen is for 3 x 1mg doses, 1 at birth, 1 at 5 days and 1 at 6 weeks.6, 20 It is up to parents to ensure that their baby receives all 3 doses if they choose this form of prophylaxis. CONCLUSION It would seem an anachronism that babies are born with a deficiency of such an essential vitamin and require supplementation. In fact, although there have been many studies on differing aspects of vitamin K prophylaxis, there has only been one39 on the possible reasons for and the advantages (if any) of the physiological levels of vitamin K in newborns. The risks of prophylaxis for the majority of babies who are at low risk of HDN are also not understood. As plasma vitamin K levels in newborns reach 300 times normal adult levels for oral and almost 9000 times for IM vitamin K47, some research needs to be done on the effects this may have. Studies have shown that physiological levels of vitamin K maintain a careful balance between coagulation and anti-coagulation and we have no idea what the effects of upsetting that delicate balance would be. The number of children currently developing cancer during childhood is much higher than the number developing a life threatening or permanently disabling problem as a result of late onset HDN. The risk of childhood cancer is estimated to be 1.4 per 1000, from the 1970 British cohort. If IM vitamin K caused cancer, there would be 100 extra cases of cancer per case of HDN prevented.16 This could mean that giving IM vitamin K to every baby would be doing more harm than good.36 The decision rests on parents’ shoulders – the link between intramuscular vitamin K and childhood cancer has not been definitively proved, nor has it been completely disproved. It may be that an oral regimen as suggested by Tripp and McNinch71 could be the answer to the dilemma. If this is the case, then Roche needs to be lobbied to make the European preparations available in New Zealand. In the meantime, the choice is between no vitamin K, with the mother being aware of her dietary intake of vitamin K, an oral regimen or the intramuscular formulation. BIBLIOGRAPHY Anai T, Hirota Y, Yoshimatsu J et al. Can prenatal vitamin K1 supplementation replace prophylaxis at birth? Obst Gynec 1993;81:251-4. Ansell P, Bull D and Roman E. Childhood leukaemia and intramuscular vitamin K: findings from a case-control study. BMJ 1996;313(7051):204-5. Barton J, McNinch A. and Tripp J. Oral vitamin K prophylaxis and frequency of late vitamin K deficiency bleeding (letter). Lancet 1994 343(8906):1168. Barton J, Tripp J. and McNinch A. Neonatal vitamin K prophylaxis in the British Isles: current practice and trends. BMJ 1995; 310(6980):632-3. Bhanchet P, Tuchinda S, Hathirat P et al. A bleeding syndrome in infants due to acquired prothrombin complex deficiency. Clin Pediatr 1977;16:992 in, Hathaway W. New insights on vitamin K. Hematol Oncol Clin North Am 1987;1(3):367-379. Birkbeck J. Vitamin K prophylaxis in the newborn: a position statement of the Nutrition Committee of the Paediatric Society of New Zealand. NZMJ 1988;101:421-2. Birkbeck J. Despite the contamination breastmilk remains the best. NZ Doctor July 1990. Brinkhous K, H and Warner D. Plasma prothrombin level in normal infancy and in hemorrhagic disease of the newborn. Am J Med. Sci 1937;193:475-479 in, Ruby C. Vitamin K prophylaxis: a historical perspective. MIDIRS;7:3. son P and A. Parenteral vitamin K1: the effective prophylaxis against haemorrhagic disease for all newborn infants. NZMJ 14 March 1990. Cornelissen M, Smeets D, Merkx G et al. Analysis of chromosome aberrations and sister chromatid exchanges in peripheral blood lymphocytes of newborns after vitamin K prophylaxis at birth. Pediatr Res 1991;30:550-3. Cornelissen EAM, Kollée LAA, DeAbreu RA et al. Effects of oral and intramuscular vitamin K prophylaxis on vitamin K, PIVKA-II, and clotting factors in breastfed infants. Arch Dis Child 1992;67:1250-54. Cornelissen M, von Kries R, Loughnan P et al. Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K. Eur J Ped 1997;156(1):126-30. Croucher C. and Azzopandi D. Compliance with recommendations for giving vitamin K to newborn infants. BMJ 1994;308(6933):894-895. Dam H, Dyggve H, Larsen H and Plum P. The relationship of vitamin K deficiency to hemorrhagic disease of the newborn. Adv Pediatr 1952;5:129-153 (abstract). Darlow B. Vitamin K deficiency haemorrhage: dilemmas over prophylaxis continue. NZ Practice Nurse February 1995:35-37. Darlow B. and Nobbs P. The neonatal vitamin K debate: IM vs. oral: two views. New Ethicals May 1993:11-18. Dockerty J, Broadbent R and McNoe B. New Zealand hospital records insufficient for vitamin K study. NZMJ 10 May 1995. Donley J. Vitamin K in relation to haemorrhagic disease of the newborn. NZCOM Journal December 1992. Ekelund H, Finnstrom O, Gunnarskog I. et al. Administration of vitamin K to newborn infants and childhood cancer. BMJ 1993;307(6896):89-91. Fetus and Newborn Committee of the Paediatric Society of New Zealand. 1992. Vitamin K administration in the newborn. Foetus and Newborn Society, Canadian Pediatric Society. The use of vitamin K in the perinatal period. Canad MAJ 1988;139:127-130. Fournier B, Sann L, Guillaumont M and Leclerq M. Variations of phylloquinone concentrations in human milk at various stages of lactation and in cow’s milk at various seasons. Am J Clin Nutr 187;45:551-8. Garrow D, Chisholm M. and Radford M. Vitamin K and thrombotest values in full term infants. Arch Dis Child 1986;61:349-51. Göbel U, Sonnenschein-Kosenow S, Petrich C and von Voss H. (Letter). Lancet 1977;i:187-8. Golding J, Greenwood R, Birmingham K. et al. Childhood cancer, intramuscular vitamin K and pethidine given during labour. BMJ 1992;305 (6849):341-6. Golding J, Paterson M and Kinlen L. Factors associated with childhood cancer in a national cohort study. Brit. J Cancer 1990;62:304-8. Greenwood R. Vitamin K and childhood cancer. MIDIRS 1994;4(3):258-9. Greer F, Marshall S, Cherry J and Suttie J. Vitamin K status of lactating mothers, human milk, and breast-feeding infants. Pediatrics 1991;88(4);751-6. Greer F, Marshall S, Foley A et al. Improving the vitamin K status of breastfeeding infants with maternal vitamin K supplements. Pediatrics 1997;99(1);88-92. Hall M. and Pairaudeau P. The routine use of vitamin K in the newborn. Midwifery 1987;3(4):170-7. Hardwicke S. et al. Studies on the minimal effective dose of a water-soluble vitamin K substitute in the prevention of hypoprothrombinemia in the newborn infant. J Pediatr 1944;24:259-269 (abstract). Haroon Y, Shearer M, Rahim S et al. The content of phylloquinone (vitamin k1) in human milk, cow’s milk and infant formula foods determined by high performance liquid chromatography. J Nutr 1982;112:1105-17. Hathaway W. New insights on Vitamin K. Hematol Oncol Clin North Am 1987;1(3):367-379. -Smart, D. Giving vitamin K to newborn infants: a therapeutic dilemma. MJA 1996;165:414-5. Heron P, Cull A., Bourchier D and Lees H. Avoidable hazard to New Zealand children: case reports of haemorrhagic disease of the newborn. NZMJ 1988;101:507-8. Hey, Edmund. Vitamin K – the debate continues. MIDIRS 1998;8(2):234-6. Hilgartner, M. Vitamin K and the newborn. New Eng J Med 1993;329(13):957-8. Hull D. Vitamin K and childhood cancer. BMJ 1992;305:326-7. Israels l, Friesen E., Jansen A. and Israels E. Vitamin K1 increases sister chromatid exchange in vitro in human leukocytes and in vivo in fetal sheep cells: a possible role for ‘vitamin K deficiency’ in the fetus. Pediatr Res 1991;30:550-3. nsen F, Fielding P, Vinther S et al. Vitamin K to neonates. Peroral versus intramuscular administration. Acta Pediatr Scand 1991;80(3):304-7. Klebanoff M, Read J, Mills J. et al. The risk of childhood cancer after neonatal exposure to vitamin K. New Eng J Med. 1993;329(13):905-8. Koppe J, Pluim E and Olie K. Breastmilk, PCBs, dioxins and vitamin K deficiency: discussion paper. J Royal Soc. Medicine 1989;82:416-419 in, Donley, Joan. Vitamin K in relation to haemorrhagic disease of the newborn. NZCOM Journal Dec 1992. Malia R, Preston F and V. Evidence against vitamin K deficiency in normal neonates. Thromb Haemost 1980;44:159. McKinney P, Juszczak E, Findlay E, K. Case-control study of childhood leukaemia and cancer in Scotland: findings for neonatal intramuscular vitamin K. BMJ 1998;316:173-7. McNinch A and Tripp J. Haemorrhagic disease of the newborn in the British Isles: a two year prospective study. BMJ 1991;303(6810):1105-1109. McNinch A, Orme R and Tripp J. Haemorrhagic disease of the newborn returns. Lancet 1983;i:1089-90 (abstract). McNinch A, Upton C, s M et al. Plasma concentrations after oral or intramuscular vitamin K1 in neonates. Arch Dis Child 1985;60:814-818. Meyer T and Angus J. The effect of large doses of Synkavit in the newborn. Arch Dis Child 1956;31: 212-5 in, Ruby, C. Vitamin K: a historical perspective. MIDIRS 1997;7(3):362-4. Mori P, Bisogni C, Odino S et al. (letter). Lancet 1977;ii:188. Motohara K, Endo F and Matsuda I. Screening for late neonatal vitamin K deficiency by acarboxyprothrombin in dried blood spots. Arch Dis Child 1987;62:370-375. Motz R. Late haemothorax after oral vitamin K. NZMJ 11 November 1992:459. Muller A., van Doorm J and Hemker H. Heparin-like inhibitor of blood coagulation in normal newborn. Nature 1977;267:616-7. New Ethicals Compendium; 3c: 303-304. Nishiguchi T, Saga K, Sumimoto K. et al. Vitamin K prophylaxis to prevent neonatal vitamin K deficient intracranial haemorrhage in Shizuoka prefecture. Brit J Obstet Gynec 1996;103 (11):1078-84. O’Connor M. and Addiego J. Use of oral vitamin K1 to prevent hemorrhagic disease of the newborn infant. J Pediatr 1986;108:616-9. O’Connor M, Livingstone D, Hannah J. and Wilkins D. Vitamin K deficiency and breastfeeding. Am J Dis Child 1983;137:601-2 Olsen J, Hertz H, Blinkenberg K. et al. Vitamin K regimens and incidence of childhood cancer in Denmark. BMJ 1994;308(6933):895-6 in, Greenwood, R. Vitamin K and childhood cancer. MIDIRS 1994;4(3):258-260 Olson J. Recommended dietary intakes (RDI) of vitamin K in humans. Am J Clin Nutr 1987;45:687-92. L, Cole M, Craft A, Hey E. Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study. BMJ 1998;316:189-93. Passmore S, Draper G, Brownbill P, Kroll M. Case-control studies of relation between childhood cancer and neonatal vitamin K administration: retrospective case-control study. BMJ 1998;316:178-84. Passmore S, Draper G, Brownbill P, Kroll M. Ecological studies of relation between hospital policies on neonatal vitamin K administration and subsequent occurrence of childhood cancer. BMJ 1998;316:184-9 Pizer B, Boyse J, Hunt L. and Mott M. Neonatal vitamin K administration and in vivo somatic mutation. Mutat Res 1995;347:135-9. Roche Products Ltd. Position statement re: Konakion injection given orally. Roche Products Ltd. New oral vitamin K formulation for newborns (press release). Welwyn Garden City, 30 Aug 1996. Ruby . Vitamin K prophylaxis: a historical perspective. MIDIRS 1997;7(3):362-4. Shearer M. et al. Plasma vitamin K1 in mothers and their newborn babies. Lancet 1982:460-3 in, Hathaway, W. New insights on vitamin K. Hematol Oncol Clin North Am 1987;1(3):367-379. son, J. The vitamin K conundrum. Maternity Alliance Action Newsletter July/August 1992. Suzuki H, Nakao T and Hiraga K. Vitamin K deficiency in male rats fed diets containing butylated hydroxytoluene (BHT). Toxicol Appl Pharmacol 1979;50:261-6 in, Birkbeck J. Vitamin K prophylaxis in the newborn: a position statement of the Nutrition Committee of the Paediatric Society of New Zealand. NZMJ 1988;101:421-2. Townsend C. The hemorrhagic disease of the newborn. Arch Pediatr 1894;11:559-562 in, Birkbeck J. Vitamin K prophylaxis in the newborn: a position statement of the Nutrition Committee of the Paediatric Society of New Zealand. NZMJ 1988;101:421-2. Tripp J. and McNinch A. Haemorrhagic disease and vitamin K. Arch Dis Child 1987;62:436-7. Tripp J and McNinch A. The vitamin K debacle: cut the Gordian knot but first do no harm. Arch Dis Child 1998;79:295-299. Vail, B. Vitamin K prophylaxis and hemorrhagic disease of the newborn. ICEA Review 1985;9(3). Van Doorm J and Hemker H. Vitamin K deficiency in the newborn (letter). Lancet 1977;ii:708-9. Van Doorm J, Muller A. and Hemker, H. Heparin-like inhibitor, not vitamin-K deficiency, in the newborn (letter). Lancet 1977;i:852-3. Vietti T, T, J and Pritchard J. Observations on the prophylactic use of vitamin K in the newborn. J Pediatr 1960;56(3);343-6 (abstract). Von Kries R. Neonatal vitamin K prophylaxis: the Gordian knot still awaits untying. BMJ 1998;316 (7126):161. Von Kries R, Göbel U, Hachmeister A. et al. Vitamin K and childhood cancer: a population based case-control study in Lower Saxony, Germany. BMJ 1996;313(7051):199-203. Von Kries R, Hachmeister A and Göbel U. Repeated oral vitamin K prophylaxis in West Germany: acceptance and efficacy. BMJ 1995;310 (6987):1097-8. Von Kries R, Kreppel S, Becker A, Tangermann R and Göbel U. Acarboxyprothrombin activity after oral prophylactic vitamin K. Arch Dis Child 1987;62: 938-40. Von Kries R, Shearer M and Göbel U. Vitamin K in infancy. Eur J Pediatr 1988;147:106-12. Waddell W. and Guerry D. The role of vitamin K in the etiology, prevention and treatment of hemorrhage in the newborn infant. J Ped 1939;15:802 in, Ruby, C. Vitamin K prophylaxis: a historical perspective. MIDIRS 1997;7(3):362-4. Whipple G. Hemorrhagic disease; antithrombin and prothrombin factors. Arch Intern Med. 1913;12:637-641 in, Birkbeck, J. Vitamin K prophylaxis in the newborn: a position statement of the Nutrition Committee of the Paediatric Society of New Zealand. NZMJ 1988;101:421-2. Zipursky A. Vitamin K at birth. BMJ 1994;313(1051):179-180. -------------------------------------------------------- Sheri Nakken, R.N., MA, Hahnemannian Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK $$ Donations to help in the work - accepted by Paypal account earthmysteriestours@... voicemail US 530-740-0561 (go to http://www.paypal.com) or by mail Vaccines - http://www.nccn.net/~wwithin/vaccine.htm Vaccine Dangers On-Line course - http://www.nccn.net/~wwithin/vaccineclass.htm Reality of the Diseases & Treatment - http://www.nccn.net/~wwithin/vaccineclass.htm Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2007 Report Share Posted September 6, 2007 >*> >*> This article came from Edda West's fine newsletter. >*> ------------------ >*> >*> Vitamin K >*> >*> By Karin Rothville DipCBEd. >*> >*> For the last 40 or 50 years, it has become a generally >*> accepted fact that >*> vitamin K prevents haemorrhagic disease of the newborn, and routine >*> administration of vitamin K to all newborns has been >*> recommended.3, 6, >*> 21, 34, 72 This recommendation has been questioned because results >*> released in 1990 from a study by Golding and colleagues26 in the UK >*> showed a two to three times increased risk of childhood cancers, >*> especially leukaemia, in children given prophylactic drugs (usually >*> intramuscular vitamin K) in their first week. A further study in 1992 >*> seemed to confirm this risk.25 >*> >*> There was widespread anxiety among parents when these findings were >*> published. Parents were, understandably, reluctant to have their baby >*> receive a substance that could predispose it to cancer in >*> childhood, and >*> many health workers were also reluctant to give, without >*> prescription, a >*> possibly cancer-causing substance to prevent a disease that >*> few, if any, >*> of them had ever seen. These concerns are not the first time >*> that vitamin >*> K safety has been questioned. So, what is the controversy >*> about vitamin >*> K? And does it predispose babies to childhood cancer? >*> >*> WHAT IS VITAMIN K AND WHAT DOES IT DO? >*> >*> Vitamin K is a fat-soluble substance which triggers off the >*> blood-clotting process. Blood clotting is a complex process >*> and can be >*> described as a sequence of three stages, requiring up to 12 different >*> coagulation factors.72 The liver needs vitamin K to >*> synthesise four of >*> these factors. Vitamin K is also needed for the formation of other >*> proteins found in plasma, bone and kidney.33, 58 >*> >*> As with other fat-soluble vitamins, a normal flow of bile >*> and pancreatic >*> juice is necessary for digestion, and the presence of dietary fat, >*> especially short-chain fatty acids, enhances absorption. >*> Absorbed vitamin >*> K is transported via the lymph into the systemic circulation.58 >*> >*> Normally, a significant portion (up to 55%) of absorbed vitamin K is >*> excreted so the amount in the body is small and its turnover is rapid >*> (about 30 hours).58 Vitamin K is stored and re-utilised in >*> the body for >*> 3-4 weeks.33 >*> >*> Vitamin K is found in many foods. Leafy, dark green and deep yellow >*> vegetables are the best sources.58 Alfalfa18 is a good >*> source; and milk >*> and dairy products, eggs, cereals, fruits and other vegetables also >*> provide small but significant amounts. As the liver of >*> adults contains >*> about equal amounts of plant and animal forms of Vitamin K, >*> it is assumed >*> that vitamin K is produced in the intestinal tract by >*> bacterial flora. >*> One of the reasons given for the low levels of vitamin K in newborn >*> babies is because their gut has not yet been colonised by >*> the required >*> bacteria. >*> >*> Recommended daily dietary intakes of vitamin K58CategoryAgeAmount >*> ((g)Infants0 – 110Children1 – 3154 – 6207 – >*> 1025Adolescents11 – 143015 – >*> 1835Adult Male19 – 70+45Adult Female19 – 70+35Pregnancy+ >*> 10Lactating+ 20 >*> The dietary requirements for vitamin K in infants and children are >*> estimates and are based on weight and growth rates as >*> compared to adults. >*> Many unsupplemented breasfed infants do not show clinical signs of >*> vitamin K deficiency on intakes of less than 3 (g daily and the mean >*> requirement for infants is estimated to be 5 (g daily based >*> on weight. >*> The higher amount of 10(g is recommended for prevention of >*> Haemorrhagic >*> Disease of the Newborn.58 >*> >*> WHAT IS HAEMORRHAGIC DISEASE OF THE NEWBORN? >*> >*> Haemorrhagic Disease of the Newborn (HDN) is a bleeding disorder >*> associated with low levels of vitamin K in newborn babies. >*> It was first >*> defined in 1894 by Townsend69 as spontaneous external or internal >*> bleeding occurring in newborn infants not due to trauma, accident or >*> inherited bleeding disorders such as haemophilia. >*> Previously, there were >*> no generally agreed upon criteria to determine causes of >*> haemorrhaging, >*> so any diagnosis was based solely on the opinion of the >*> attendant medical >*> personnel. >*> >*> Infants are born with low levels of vitamin K23 compared to >*> adults and >*> this is termed ‘vitamin K deficiency’. Up to 50% of babies >*> develop this >*> ‘vitamin K deficiency’, but bleeding occurs in only a >*> fraction of these >*> cases.37 In most it starts after birth, becomes >*> Page 2 >*> >*> progressively more severe over 48-60 hours, then >*> spontaneously corrects >*> itself by 72-120 hours.9 >*> >*> HDN has always been rare – in Britain where maternity units >*> practised a >*> selective policy of vitamin K administration, the incidence >*> was no more >*> than 1 in 20,000 in the years 1972-80. Estimates for late >*> onset HDN are >*> 4-8 per 100,000.45 Incidence also seems to vary from country >*> to country. >*> >*> HDN is divided into three categories: Early onset HDN occurs >*> in the first >*> 24 hours. It is very rare and mainly associated with mothers who have >*> taken anticonvulsant, antibiotic, antituberculous or >*> anticoagulant drugs >*> during pregnancy. Classic HDN occurs in the first week after >*> birth. It is >*> manifested by the oozing of blood from the intestines, the >*> nose, the cord >*> site and broken skin sites. Bruising at sites where there has been no >*> trauma can also appear. Late onset HDN occurs after the >*> first week, with >*> a peak incidence between the second and sixth weeks, and >*> about half the >*> cases present with intracranial bleeding (bleeding into the brain). >*> >*> WHAT ARE THE RISK FACTORS FOR HDN? >*> >*> There has been some debate over the years as to whether or not HDN is >*> actually caused by vitamin K deficiency. Certainly, giving >*> vitamin K does >*> arrest bleeding in the majority of cases, but this does not mean that >*> vitamin K deficiency causes HDN. One may as well say that an >*> antibiotic >*> deficiency causes bacterial infection. There is also no >*> consensus as to >*> what level of vitamin K in plasma protects against HDN. Some >*> researchers >*> have found no evidence of vitamin K deficiency in babies in their >*> studies43, 49 and other factors have also been suggested.52, 73, 74 >*> >*> Most, if no all, of the reported cases of late onset HDN >*> have presented >*> with problems which affect the baby’s ability to absorb or utilise >*> vitamin K.45, 56 These include: hepatitis, cystic fibrosis, chronic >*> diarrhoea, bile duct atresia, alpha-1-antitrypsin deficiency, coeliac >*> disease of insufficient plasma transport capacity. Subclinical >*> cytomegalovirus has also been implicated. Vitamin >*> K-responsive bleeding >*> syndrome has been well documented after antibiotic therapy, >*> especially >*> with cyclosporins.33 >*> >*> There are other factors which place the newborn at higher risk. These >*> include pre-term birth (as the liver is very immature), low >*> birth weight, >*> instrumental or traumatic delivery, bruised or bleeding in >*> the first few >*> days after birth, requiring surgery or circumcision, taking >*> inadequate >*> feeds and breastfeeding.33 >*> >*> BREASTFEEDING – WHY IS IT A RISK? >*> >*> Several authors have noted the higher incidence of HDN in solely >*> breastfed babies.9, 30 The incidence has been quoted as 1 in 1200.30 >*> Studies comparing breastmilk with formula and cow’s milk >*> have shown that >*> breastmilk is lower in vitamin K.22, 28, 32 Breastmilk >*> substitutes are >*> heavily supplemented with vitamin K, however, it is possible >*> that, like >*> iron, vitamin K is biologically more available to the baby from >*> breastmilk, and so such high levels are not necessary. >*> >*> Measured levels of vitamin K in breastmilk seemed to vary >*> depending on >*> the type of measurement used; however, they all come out >*> lower than cow’s >*> milk. Fournier22 and Greer28 found levels of around 8-9(g/l, >*> which would >*> mean that if a baby was taking in about 500ml per day, it would be >*> getting the recommended 3-5(g daily. >*> >*> Vitamin K content and availability are greater in the hind >*> milk because >*> of its higher fat content and vitamin K levels are also higher in >*> colostrum.32 As an extra plus, breastmilk contains >*> thromboplastin, one of >*> the factors in blood clotting.18 >*> >*> Vitamin K levels in the breastmilk rise markedly in response to the >*> mother eating vitamin K rich foods or taking vitamin K >*> supplements.29, 54 >*> Nishiguchi found no cases of low vitamin K levels in >*> breastfed infants >*> whose mothers had been given supplements, as opposed to >*> infants who had >*> only been given 1 or 2 doses of oral vitamin K.54 >*> >*> Unrestricted access to the breast in the early days after birth is >*> important, due to the higher levels of vitamin K in colostrum. The >*> importance of early feeding has been recognised since the >*> 1940’s. Babies >*> who have been fed within their first 24 hours have >*> significantly better >*> coagulation times than babies not fed until after 24 hours.24 >*> >*> It is essential that, to receive the full complement of vitamin K in >*> breastmilk, the baby completely finishes one breast before >*> being offered >*> the other. Any practice that involves restricting either the >*> baby’s time >*> at the breast or the number of feeds will not allow the baby >*> to receive >*> optimum amounts of vitamin K and will also prolong the time >*> it takes for >*> the baby’s intestine to be colonised by friendly, vitamin K >*> manufacturing >*> bacteria. >*> >*> THE HISTORY OF VITAMIN K USE TO PREVENT HDN. >*> >*> The search for the cause of HDN began in 1913 when Whipple82 >*> postulated >*> that a lack of prothrombin activity could be a cause of HDN. In 1929, >*> Henrik Dam14 noticed that chicks fed a fat-free diet suffered >*> subcutaneous and intramuscular haemorrhages, which could be >*> prevented if >*> the chicks were fed seeds, cereals and green, leafy plants. >*> Dam described >*> the condition as a vitamin deficiency and named the deficient vitamin >*> ‘vitamin K’, from the Danish word ‘koagulation’. >*> >*> Research in 19378 found that prothrombin times in normal >*> neonates were >*> between 30-60% adult levels, falling to 15-30% on day two, and then >*> gradually rising again until about day 10. This research led to the >*> continuing belief that these low levels in the newborn are a >*> deficiency >*> and need to be corrected. >*> >*> In 1939, vitamin K1 was isolated from alfalfa by Dam, for >*> which he later >*> received the Nobel Prize, along with Doisy, who >*> isolated vitamin >*> K2.45 Further research in 1939 by Waddell and Guerry81 found that low >*> plasma prothrombin levels could be elevated by the >*> administration of oral >*> vitamin K. >*> >*> Armed with this ‘proof’ that vitamin K deficiency caused >*> HDN, vitamin K >*> was synthesised and various trials were commenced >*> Page 3 >*> >*> to ascertain which was the most effective amount and route to use in >*> prophylaxis. >*> >*> It is difficult for us to assess these trials nowadays as they were >*> mostly neither double blind nor well controlled. The dosage >*> of vitamin K >*> given, the route of administration and the time of administration all >*> varied. In many cases, the conclusions did not seem to match the >*> results.72 >*> >*> Some of the studies assessed the effect on neonatal vitamin >*> K levels if >*> the mother was given vitamin K during labour.72 Results >*> varied, with the >*> effectiveness of the vitamin K given depending on how soon >*> the woman gave >*> birth and the dosage given. More recent studies have shown >*> increases in >*> cord blood levels where mothers were supplemented antenatally with >*> vitamin K.1, 66 Two showed a significant difference between the >*> supplemented and unsupplemented groups and found that the effect of >*> prenatal vitamin K persisted until the fifth day after birth.1 >*> >*> Because of the variations in results from these early >*> studies, further >*> research focussed on treating the baby after birth. One >*> particular study >*> done in 194231 was intended to determine the minimal >*> effective oral dose >*> of Synkavite (K3), a water-soluble synthetic form of vitamin K. The >*> results showed that very small daily doses were effective >*> and that a dose >*> of 5(g daily would probably prevent the development of HDN, except in >*> early onset cases. The study also found that 1.25mg was effective in >*> lowering an excessively high prothrombin time to normal. However, the >*> author admitted that several workers found prothrombin >*> deficiencies in >*> babies with no abnormal bleeding. >*> >*> By 1950, most maternity units had a policy of giving infants >*> oral vitamin >*> K (usually Synkavite) immediately after birth.70 This >*> prevented the fall >*> in prothrombin levels that occurred in the first few days and, >*> presumably, the risk of excessive bleeding. This risk was >*> higher in male >*> babies because of routine circumcision, and, indeed, vitamin >*> K proved to >*> be of great clinical value in preventing post-circumcision >*> bleeding.75 >*> >*> Then, in the mid-1950’s, reports of increased jaundice and >*> kernicterus >*> (brain damage caused by high bilirubin levels) associated >*> with vitamin K >*> prophylaxis began circulating. Reviews of maternity units >*> found that some >*> were giving Synkavite in doses exceeding 50mg.70 It was >*> established that >*> high doses of Synkavite caused haemolysis (destruction of red blood >*> cells) and high serum bilirubin levels.48 >*> >*> Researchers and medical professionals queried the safety aspects of >*> vitamin K, and there were many conflicting reports on the appropriate >*> dosages. Some researchers queried the need for vitamin K at >*> all, quoting >*> results from studies that showed no difference in >*> prothrombin times or >*> vitamin K plasma levels between babies that bled and babies that >*> didn’t.72 >*> >*> Eventually, a newer preparation, intramuscular vitamin K1 >*> (phytomenadione), was developed and approved for use, solely on the >*> grounds that it appeared to cause less haemolysis. >*> Phytomenadione (trade >*> names Konakion (Roche) or Aquamephyton (Merck, Sharpe & Dohme)) is a >*> synthetic petrochemical derived from 2-methyl 1,4-naptha-quinone in a >*> polyethoxylated castor oil base.18 In the US, polysorbate-80 >*> is used as a >*> base instead of polyethoxylated castor oil.15 >*> >*> In spite there being no long term trials of these preparations, the >*> American Academy of Pediatrics recommended that phytomenadione be >*> administered prophylactically to all newborn babies.72 The >*> use of oral >*> vitamin K preparations fell out of favour in the USA and the ‘safer’ >*> intramuscular route became the route of choice. >*> >*> In Britain, after the jaundice scare of the1950’s, many >*> maternity units >*> began to practice a selective policy, giving vitamin K only >*> to babies at >*> risk of haemorrhaging. McNinch reported in 1980 that less >*> than half the >*> maternity units in the UK gave vitamin K to all newborns.47 >*> Some of these >*> babies were given oral prophylaxis and some were given intramuscular >*> prophylaxis. >*> >*> In Germany, almost all newborn infants who required medical care and >*> instrumental deliveries were given intramuscular vitamin K, and some >*> healthy newborns also received it.76 Records have not always >*> been kept in >*> New Zealand hospitals, so it is impossible to say whether or >*> not vitamin >*> K was given routinely and by which route.17 >*> >*> Although vitamin K use seemed to prevent most cases of HDN, there was >*> still controversy. Not everyone believed vitamin K deficiency was the >*> cause of HDN. In 1977, van Doorm et al 52, 73, 74 suggested that HDN >*> could be caused by a heparin-like inhibitor in the newborn and he >*> concluded that babies given their first feed soon after >*> birth do not have >*> a vitamin K deficiency. Other researchers agreed with van Doorn.49 In >*> 1980, Malia et al43 could find no evidence of vitamin K deficiency in >*> babies in their study and concluded that low levels of vitamin K >*> dependent clotting factors were due to the immature liver. >*> The authors of >*> these studies questioned whether vitamin K prophylaxis was really >*> necessary for healthy newborns. >*> >*> Then, starting in November 1980, there was a cluster of six >*> cases of HDN >*> in Britain, all within 17 months.46 Half of these cases were >*> classic HDN, >*> the other half were a new manifestation of HDN – late onset. >*> >*> LATE ONSET HDN >*> >*> Late onset HDN was first reported in 1977.5 It mainly occurs >*> in breastfed >*> infants and ( to ¾ of cases have an underlying liver disorder or >*> malabsorption syndrome,15 rather than insufficient dietary intake of >*> vitamin K. This means the liver cannot adequately synthesise blood >*> clotting factors or store adequate amounts of vitamin K. >*> Liver function >*> cannot be easily diagnosed at birth without a range of >*> invasive tests and >*> thus there exists an unknown risk of haemorrhaging. >*> >*> Many factors contribute to poor liver function, including hepatitis, >*> cystic fibrosis, antibiotic therapy, biliary atresia, >*> alpha-1-antitrypsin >*> deficiency, a-beta-lipoproteinaemia, coeliac disease, >*> chronic diarrhoea >*> and exposure to pharmacologic agents such as >*> anticonvulsants, rifampin, >*> isoniazid cephalosporins and coumarin compounds33 When >*> tested, most of >*> the reported cases of late onset HDN had hepatitis, liver >*> malfunction or >*> enzyme >*> Page 4 >*> >*> deficiencies.6, 35, 51, 80 >*> >*> Birkbeck6 believes there are two processes at work – low levels of >*> prothrombin and vitamin K-dependent clotting factors VII, IX and X at >*> birth, and a further fall in these in the neonatal period. >*> In his view >*> the initial low levels are not due to vitamin K deficiency >*> as levels of 2 >*> other non-vitamin K-dependent factors, XI and XII are also >*> often reduced. >*> Thus, the situation at birth may be simply due to hepatic immaturity. >*> >*> Birkbeck6 also reports that HDN is almost unknown in central >*> Africa and >*> he suggests an environmental mechanism as the cause. Associated with >*> this, a discussion paper from the University of Amsterdam42 >*> raises the >*> idea that by-products of our industrial society such as >*> PCBs, PCDDs and >*> PCDFs are the cause of late onset HDN. These chemicals can >*> induce enzymes >*> in the liver which cause liver damage and prolong prothrombin time. >*> Although overseas studies have reported contamination of >*> breastmilk by >*> these pollutants, a NZ Department of Health study on >*> breastmilk reported >*> that levels of these contaminants were at the lower end of >*> the scale.7 >*> The Health Department is currently conducting another study to see if >*> levels have changed over the past few years. >*> >*> There seems to be a seasonal variance, with most cases of >*> late onset HDN >*> occurring in the warmer months.6 It has been suggested that >*> the mother >*> could have contracted a viral infection during pregnancy in >*> the colder >*> months and this has crossed the placenta. Since viruses have >*> an affinity >*> for the liver and mucous membranes, they can affect >*> intestinal absorption >*> and liver function.67 >*> >*> Another suggested cause of late onset HDN includes use of the food >*> antioxidant BHT (butylated hydroxytoluene), which has >*> produced vitamin K >*> deficiency.68 BHT is present in many processed foods, including >*> margarine. Our Western diets consist of a lot of processed >*> food, and to >*> reduce fat intakes, margarine is recommended rather than butter. The >*> polyunsaturated fat in margarine is an inhibitor of vitamin K >*> absorption.68 Both of these factors could have an effect on >*> the amount of >*> vitamin K available to pass through to the baby. A high >*> level of vitamin >*> K in the mother’s blood is necessary to ensure adequate >*> transplacental >*> transfer of vitamin K.9, 33 It is important for the baby to >*> have adequate >*> stores of vitamin K in its liver at birth to prevent >*> bleeding until its >*> feeding and gut flora are established. >*> >*> Of the six cases of HDN in Britain in 1980-1982, all were >*> breastfed and >*> none had received vitamin K at birth.46 Two of the cases were in the >*> high-risk group – one was born by caesarean section and had >*> an epileptic >*> mother treated with phenytoin, and the other had an >*> alcoholic mother who >*> had taken anti-depressants – and obviously should have >*> received vitamin K >*> at birth. >*> >*> These cases prompted a call for the re-introduction of routine >*> prophylaxis. Many opposed the idea of unnecessarily >*> injecting otherwise >*> healthy babies so studies40, 47, 55, 79 were therefore conducted to >*> determine whether oral vitamin K was as effective as >*> intramuscular. It >*> was also proposed that oral vitamin K would be more >*> cost-effective and >*> thus better suited for use in Third World countries.55 >*> Results of these >*> studies varied. Some showed that oral vitamin K was effective in >*> preventing classic haemorrhagic disease but not as effective as >*> intramuscular vitamin K in preventing late onset HDN.47, 55, >*> 78 Others >*> found oral as effective, especially a 10 year study >*> conducted on 38,000 >*> infants in Sweden where no cases of HDN were observed over >*> that period.40 >*> Tripp and McNinch reported no cases in 25,000 babies in >*> their maternity >*> unit where only those at risk were given intramuscular >*> prophylaxis and >*> the rest oral prophylaxis.70 >*> >*> In spite of these findings that oral vitamin K prophylaxis was not >*> effective in preventing late onset HDN, it continued to be used in >*> British maternity units, especially for low risk infants. >*> >*> RISKS OF VITAMIN K PROPHYLAXIS >*> >*> Konakion ampoules contain phenol, propylene glycol38 and >*> polyethoxylated >*> castor oil as a non-ionic surfactant. Studies in animals given >*> polyethoxylated castor oil have shown a severe anaphylactic reaction >*> associated with histamine release. Strong circumstantial evidence >*> implicates polyethoxylated castor oil in similar reactions in humans. >*> Polyethoxylated castor oil, when given to patients over a period of >*> several days, can also produce abnormal lipoprotein electrophoretic >*> patterns, alterations in blood viscosity and erythrocyte >*> aggregation (red >*> blood cell clumping). Individuals sensitive to this base are >*> contraindicated from using Konakion. New Ethicals Compendium >*> also warns >*> that the use of Konakion can cause jaundice and kernicterus >*> in infants.53 >*> Other listed side effects include flushing, sweating, >*> cyanosis, a sense >*> of chest constriction, and peripheral vascular collapse. >*> Local cutaneous >*> and subcutaneous changes may occur in areas of repeated intramuscular >*> injections. >*> >*> This synthetic, injectable vitamin K formulation was never >*> subjected to a >*> randomised, controlled trial. In new drugs that are to be used for >*> prophylaxis, the usual risk/benefit analysis does not apply, >*> since the >*> individual is not ill. The ethical principle of >*> non-maleficence (primum >*> non nocere – first do no harm) applies and the trials must >*> thus be larger >*> in order to identify any previously unrecognised side >*> effects.65 Since >*> this did not happen, nor was there any long term follow up, >*> we actually >*> have little idea of the effects of this drug on newborn babies. >*> >*> The risks of injecting vitamin K into a newborn baby are >*> nerve or muscle >*> damage as the preparation must be injected deeply into the >*> muscle, not >*> subcutaneously under the skin. There is also the documented risk of >*> injecting the baby with the syntocinon intended for the >*> mother.30, 70 As >*> stated in the product information,53 infants can suffer from >*> jaundice or >*> kernicterus (brain damage from a build-up of bile pigments >*> in the brain) >*> from Konakion. Infants who have the enzyme deficiency G6PD (glucose 6 >*> phosphate dehydrogenase) are at particular risk from vitamin K.30 The >*> other risk factor is the possible increased chance of >*> childhood cancer. >*> >*> THE LINK BETWEEN CHILDHOOD CANCER AND INTRAMUSCULAR VITAMIN K >*> >*> In 1970, a national cohort study of 16,193 infants born in >*> one week in >*> April was begun in Britain.26 This study was to test >*> Page 5 >*> >*> hypotheses about childhood cancers and their associated factors. >*> Thirty-three of the children had developed cancer by age 10 and were >*> compared with 99 control children, matched on maternal age, >*> parity and >*> social class. One of the unlooked-for risk factors was the >*> administration >*> of prophylactic drugssuch as vitamin K in the first week >*> after birth – a >*> nearly three-fold risk. This association fitted no prior >*> hypothesis and >*> the authors recommended that their finding be tested in >*> another series of >*> cases. >*> >*> The authors of the study approached Roche, the manufacturers >*> of Konakion, >*> for funding for a further trial to examine the findings more closely. >*> Roche was not interested until, a few months later, the >*> media reported >*> the results of the study and that vitamin K given to babies >*> might cause >*> childhood cancer. Roche then decided to fund a new study.27 >*> >*> The new study25 was a case-control study of 195 children >*> with cancer born >*> at either of two hospitals in Bristol, England, compared >*> with 588 healthy >*> children also born at these hospitals. One hospital >*> predominantly gave >*> vitamin K orally and the other intramuscularly. The authors found a >*> nearly two-fold risk of leukaemia in children who had received >*> intramuscular vitamin K. >*> >*> These findings were extremely worrying. Golding calculated >*> that the extra >*> cases of leukaemia caused by vitamin K injection could be as >*> many as 980 >*> in the UK alone.25 These results were supported by reports of the >*> potential carcinogenicity of vitamin K from Israels et al, >*> who suggested >*> that low vitamin K levels in the newborn protect against the risk of >*> mutations during a period of rapid cell growth and >*> division.39 Pizer et >*> al did not find any association between the route of vitamin K >*> administration and mutations in cells but concluded that his >*> study was >*> too small to show any real effect.62 Another study reported >*> no increase >*> in abnormalities in newborn infants, but, with only 12 >*> infants, the study >*> was too small to show any real effect.10 It is worth noting >*> that after an >*> intramuscular dose of vitamin K, the baby’s plasma levels >*> are almost 9000 >*> times the normal adult levels.47 It has also been suggested that the >*> cancer-causing agent could be a metabolite, N-epoxide, or some other >*> component of the solution other than vitamin K itself.15 >*> >*> Golding’s study was criticised by many. One of the reasons >*> was that the >*> authors had to make assumptions for some cases, as the information on >*> vitamin K administration was not clearly recorded. In spite of this, >*> expert epidemiologists considered that the results were >*> plausible and so >*> could not be lightly dismissed.15 Further studies were >*> proposed to answer >*> the question of cancer and vitamin K. >*> >*> In 1993, results from three retrospective studies on vitamin K and >*> childhood cancer were published. The studies were done in the USA, >*> Denmark and Sweden.41, 57, 19 These studies, although large, did not >*> confirm the association between intramuscular vitamin K and childhood >*> cancer. One of the studies not only showed no association between IM >*> vitamin K and childhood cancer, it also showed no association between >*> maternal smoking and childhood cancer, a finding totally at >*> odds with the >*> results from many other studies.19 The other two studies >*> were also not >*> comparable to the British study. One because of differences >*> in type of >*> vitamin K given41 and the other because of the use of birth >*> cohorts with >*> differing regimens of vitamin K usage.57 >*> >*> Because of the design flaws in these studies, there was >*> still a need for >*> further case-control studies. Results from two were >*> published in 1996.2, >*> 77 They had carefully matched controls and more accurate >*> information on >*> whether vitamin K had been given or not, and by which route. >*> One of the >*> studies2 reported no association between intramuscular vitamin K and >*> childhood cancer and the other77 found a risk of leukaemia, >*> but only when >*> cases were compared with local controls (i.e. from the same >*> hospital) and >*> not with controls randomly selected from the whole area under study. >*> This, although suggestive, was not followed up but dismissed >*> as a chance >*> finding related to multiple testing. >*> >*> The suggestion was then put forward that, as these studies >*> had failed to >*> show a definite association between intramuscular vitamin K >*> and childhood >*> cancers, worries about any potential cancer risk should be >*> abandoned.83 >*> >*> At that time, four more studies on vitamin K and cancer were in >*> progress.44, 59, 60, 61 The results from these four studies were >*> published in 1998. Two of them failed to confirm any >*> increased risk of >*> childhood cancers.44 61 One of the other studies showed a >*> twofold risk of >*> acute lymphoblastic leukaemia among 1-6 year olds,59 the >*> other showed a >*> significant risk for all cancers.60 >*> >*> So, the jury is still out on whether there is an increased risk of >*> childhood leukaemia with the intramuscular form of vitamin K. Some >*> recommend that intramuscular vitamin K should still be used, >*> as the risk >*> of leukaemia “seems more hypothetical than real”.76 Others >*> believe that >*> public confidence in IM vitamin K has been severely shaken >*> and will be >*> difficult to restore fully. They recommend an oral regimen similar to >*> that used in the Netherlands of 25(g daily, given by the mother. This >*> would avoid the grossly unphysiological peaks of vitamin K >*> from both the >*> IM route and the present oral route.71 >*> >*> ORAL VITAMIN K VS INTRAMUSCULAR >*> >*> The two main problems with giving vitamin K orally are that >*> there is no >*> licensed oral formulation, meaning that babies receive the >*> intramuscular >*> form orally, and that compliance with three oral doses is >*> poor as many >*> doctors and midwives are reluctant to give an unlicensed >*> formula.13 The >*> use of unlicensed preparations may theoretically expose >*> professionals to >*> litigation in the event of prophylactic failure or unforeseen adverse >*> events.2 >*> >*> Roche, the manufacturers of Konakion, state that they do not >*> recommend >*> the administration of Konakion solution orally.63 Their >*> reasons are: that >*> they have no clinical studies to support oral use, phenol, >*> which has been >*> reported to be an irritant to newborns mouths, is used as a >*> preservative, >*> the variability in the production of bile salts in newborns >*> may affect >*> absorption, that Konakion given orally has a small association with >*> anaphylactic reactions. >*> Page 6 >*> >*> The preparation was also unpleasant to taste and babies >*> were inclined to >*> spit it out82 or to vomit it back up. Only about half of an orally >*> administered dose is absorbed.47 Even so, the plasma >*> concentrations in >*> babies who were given oral vitamin K reached 300 times the >*> adult levels, >*> before dropping off slightly after about 24 hours.47 >*> >*> After the publication of Golding’s studies, further trials >*> were done on >*> oral vitamin K prophylaxis and whether it gave longer term >*> protection. In >*> 1992, Cornelissen11 found plasma vitamin K concentrations >*> were higher in >*> the group given IM vitamin K than the oral group, but blood >*> coagulability, activities of factors VII, X and PIVKA-II >*> concentrations >*> showed no differences. By 3 months follow-up, vitamin K levels had >*> dropped in both groups but more in the oral group. He suggests that >*> neither give long term protection. One would assume that >*> babies should be >*> producing their own vitamin K by 3 months and, if not, what other >*> mechanism could be hindering this process. >*> >*> Von Kries et al78 studied repeated oral vitamin K >*> prophylaxis in Germany, >*> with 3x 1 mg doses and found that it was not as effective as a 1mg >*> intramuscular dose at birth. Another study by Cornelissen et al12 >*> reported on the effectiveness of differing regimens of oral >*> vitamin K in >*> four different countries – the Netherlands, Germany, Switzerland and >*> Australia (two differing regimes). In the Netherlands, >*> babies are given >*> 25 (g daily oral vitamin K for 3 months with I mg given at >*> birth either >*> orally for healthy newborns or intramuscularly for unwell babies. In >*> Germany, the regime is 3 x 1 mg oral doses as was also the case in >*> Australia from 1993 to 1994. In Switzerland 2 oral doses of a new >*> ‘mixed-micellar’ oral vitamin K is given. The Netherlands >*> had the lowest >*> failure rate – 0 per 100,000. In Australia, where the regime >*> was changed >*> in 1994 from oral to IM, the failure rate was 1.5 per >*> 100,000 for oral >*> and 0.9 per 100,000 for IM, showing that 3 oral doses are >*> less effective >*> at preventing late onset HDN than one IM dose of vitamin K. >*> Even if Roche >*> are persuaded to bring the mixed-micellar preparation into >*> New Zealand, >*> results from Switzerland (failure rate of 1.2 per 100,000)12 >*> show that >*> further study needs to be done on the most effective timing >*> of the doses. >*> >*> If New Zealand parents wish their baby to receive oral vitamin K, the >*> recommended regimen is for 3 x 1mg doses, 1 at birth, 1 at 5 >*> days and 1 >*> at 6 weeks.6, 20 It is up to parents to ensure that their >*> baby receives >*> all 3 doses if they choose this form of prophylaxis. >*> >*> CONCLUSION >*> >*> It would seem an anachronism that babies are born with a >*> deficiency of >*> such an essential vitamin and require supplementation. In >*> fact, although >*> there have been many studies on differing aspects of vitamin K >*> prophylaxis, there has only been one39 on the possible >*> reasons for and >*> the advantages (if any) of the physiological levels of vitamin K in >*> newborns. >*> >*> The risks of prophylaxis for the majority of babies who are >*> at low risk >*> of HDN are also not understood. As plasma vitamin K levels >*> in newborns >*> reach 300 times normal adult levels for oral and almost 9000 >*> times for IM >*> vitamin K47, some research needs to be done on the effects >*> this may have. >*> Studies have shown that physiological levels of vitamin K maintain a >*> careful balance between coagulation and anti-coagulation and >*> we have no >*> idea what the effects of upsetting that delicate balance would be. >*> >*> The number of children currently developing cancer during >*> childhood is >*> much higher than the number developing a life threatening or >*> permanently >*> disabling problem as a result of late onset HDN. The risk of >*> childhood >*> cancer is estimated to be 1.4 per 1000, from the 1970 >*> British cohort. If >*> IM vitamin K caused cancer, there would be 100 extra cases >*> of cancer per >*> case of HDN prevented.16 This could mean that giving IM vitamin K to >*> every baby would be doing more harm than good.36 >*> >*> The decision rests on parents’ shoulders – the link between >*> intramuscular >*> vitamin K and childhood cancer has not been definitively >*> proved, nor has >*> it been completely disproved. It may be that an oral regimen >*> as suggested >*> by Tripp and McNinch71 could be the answer to the dilemma. >*> If this is the >*> case, then Roche needs to be lobbied to make the European >*> preparations >*> available in New Zealand. In the meantime, the choice is between no >*> vitamin K, with the mother being aware of her dietary intake >*> of vitamin >*> K, an oral regimen or the intramuscular formulation. >*> >*> BIBLIOGRAPHY >*> >*> Anai T, Hirota Y, Yoshimatsu J et al. Can prenatal vitamin K1 >*> supplementation replace prophylaxis at birth? Obst Gynec >*> 1993;81:251-4. >*> Ansell P, Bull D and Roman E. Childhood leukaemia and intramuscular >*> vitamin K: findings from a case-control study. BMJ >*> 1996;313(7051):204-5. >*> Barton J, McNinch A. and Tripp J. Oral vitamin K prophylaxis and >*> frequency of late vitamin K deficiency bleeding (letter). Lancet 1994 >*> 343(8906):1168. Barton J, Tripp J. and McNinch A. Neonatal vitamin K >*> prophylaxis in the British Isles: current practice and >*> trends. BMJ 1995; >*> 310(6980):632-3. Bhanchet P, Tuchinda S, Hathirat P et al. A bleeding >*> syndrome in infants due to acquired prothrombin complex >*> deficiency. Clin >*> Pediatr 1977;16:992 in, Hathaway W. New insights on vitamin >*> K. Hematol >*> Oncol Clin North Am 1987;1(3):367-379. Birkbeck J. Vitamin K >*> prophylaxis >*> in the newborn: a position statement of the Nutrition >*> Committee of the >*> Paediatric Society of New Zealand. NZMJ 1988;101:421-2. Birkbeck J. >*> Despite the contamination breastmilk remains the best. NZ Doctor July >*> 1990. Brinkhous K, H and Warner D. Plasma prothrombin level in >*> normal infancy and in hemorrhagic disease of the newborn. Am >*> J Med. Sci >*> 1937;193:475-479 in, Ruby C. Vitamin K prophylaxis: a historical >*> perspective. MIDIRS;7:3. son P and A. Parenteral >*> vitamin K1: >*> the effective prophylaxis against haemorrhagic disease for >*> all newborn >*> infants. NZMJ 14 March 1990. Cornelissen M, Smeets D, Merkx G et al. >*> Analysis of chromosome aberrations and sister chromatid exchanges in >*> peripheral blood lymphocytes of newborns after vitamin K >*> prophylaxis at >*> birth. Pediatr Res 1991;30:550-3. Cornelissen EAM, Kollée >*> LAA, DeAbreu RA >*> et al. Effects of oral and intramuscular vitamin K >*> prophylaxis on vitamin >*> K, PIVKA-II, and clotting factors in breastfed infants. Arch >*> Dis Child >*> 1992;67:1250-54. Cornelissen M, von Kries R, Loughnan P et >*> al. Prevention >*> of vitamin K deficiency bleeding: efficacy of different multiple oral >*> dose schedules of vitamin K. Eur J Ped 1997;156(1):126-30. >*> Croucher C. >*> and Azzopandi D. Compliance with recommendations for giving >*> vitamin K to >*> newborn infants. BMJ 1994;308(6933):894-895. Dam H, Dyggve >*> H, Larsen H >*> and Plum P. The relationship of vitamin K deficiency to hemorrhagic >*> disease of the newborn. Adv Pediatr 1952;5:129-153 >*> (abstract). Darlow B. >*> Vitamin K deficiency haemorrhage: dilemmas over prophylaxis >*> continue. NZ >*> Practice Nurse February 1995:35-37. Darlow B. and Nobbs P. >*> The neonatal >*> vitamin K debate: IM vs. oral: two views. New Ethicals May >*> 1993:11-18. >*> Dockerty J, Broadbent R and McNoe B. New Zealand hospital records >*> insufficient for vitamin K study. NZMJ 10 May 1995. Donley >*> J. Vitamin K >*> in relation to haemorrhagic disease of the newborn. NZCOM Journal >*> December 1992. >*> >*> Ekelund H, Finnstrom O, Gunnarskog I. et al. Administration >*> of vitamin K >*> to newborn infants and childhood cancer. BMJ >*> 1993;307(6896):89-91. Fetus >*> and Newborn Committee of the Paediatric Society of New Zealand. 1992. >*> Vitamin K administration in the newborn. Foetus and Newborn Society, >*> Canadian Pediatric Society. The use of vitamin K in the >*> perinatal period. >*> Canad MAJ 1988;139:127-130. Fournier B, Sann L, Guillaumont >*> M and Leclerq >*> M. Variations of phylloquinone concentrations in human milk >*> at various >*> stages of lactation and in cow’s milk at various seasons. Am >*> J Clin Nutr >*> 187;45:551-8. Garrow D, Chisholm M. and Radford M. Vitamin K and >*> thrombotest values in full term infants. Arch Dis Child >*> 1986;61:349-51. >*> Göbel U, Sonnenschein-Kosenow S, Petrich C and von Voss H. (Letter). >*> Lancet 1977;i:187-8. Golding J, Greenwood R, Birmingham K. et al. >*> Childhood cancer, intramuscular vitamin K and pethidine given during >*> labour. BMJ 1992;305 (6849):341-6. Golding J, Paterson M and >*> Kinlen L. >*> Factors associated with childhood cancer in a national cohort study. >*> Brit. J Cancer 1990;62:304-8. Greenwood R. Vitamin K and childhood >*> cancer. MIDIRS 1994;4(3):258-9. Greer F, Marshall S, Cherry >*> J and Suttie >*> J. Vitamin K status of lactating mothers, human milk, and >*> breast-feeding >*> infants. Pediatrics 1991;88(4);751-6. Greer F, Marshall S, >*> Foley A et al. >*> Improving the vitamin K status of breastfeeding infants with maternal >*> vitamin K supplements. Pediatrics 1997;99(1);88-92. Hall M. and >*> Pairaudeau P. The routine use of vitamin K in the newborn. Midwifery >*> 1987;3(4):170-7. Hardwicke S. et al. Studies on the minimal effective >*> dose of a water-soluble vitamin K substitute in the prevention of >*> hypoprothrombinemia in the newborn infant. J Pediatr 1944;24:259-269 >*> (abstract). Haroon Y, Shearer M, Rahim S et al. The content of >*> phylloquinone (vitamin k1) in human milk, cow’s milk and >*> infant formula >*> foods determined by high performance liquid chromatography. J Nutr >*> 1982;112:1105-17. Hathaway W. New insights on Vitamin K. >*> Hematol Oncol >*> Clin North Am 1987;1(3):367-379. -Smart, D. Giving >*> vitamin K to >*> newborn infants: a therapeutic dilemma. MJA 1996;165:414-5. >*> Heron P, Cull >*> A., Bourchier D and Lees H. Avoidable hazard to New Zealand children: >*> case reports of haemorrhagic disease of the newborn. NZMJ >*> 1988;101:507-8. >*> Hey, Edmund. Vitamin K – the debate continues. MIDIRS >*> 1998;8(2):234-6. >*> Hilgartner, M. Vitamin K and the newborn. New Eng J Med >*> 1993;329(13):957-8. Hull D. Vitamin K and childhood cancer. BMJ >*> 1992;305:326-7. Israels l, Friesen E., Jansen A. and Israels >*> E. Vitamin >*> K1 increases sister chromatid exchange in vitro in human >*> leukocytes and >*> in vivo in fetal sheep cells: a possible role for ‘vitamin K >*> deficiency’ >*> in the fetus. Pediatr Res 1991;30:550-3. nsen F, >*> Fielding P, Vinther >*> S et al. Vitamin K to neonates. Peroral versus intramuscular >*> administration. Acta Pediatr Scand 1991;80(3):304-7. >*> Klebanoff M, Read J, >*> Mills J. et al. The risk of childhood cancer after neonatal >*> exposure to >*> vitamin K. New Eng J Med. 1993;329(13):905-8. Koppe J, Pluim >*> E and Olie >*> K. Breastmilk, PCBs, dioxins and vitamin K deficiency: >*> discussion paper. >*> J Royal Soc. Medicine 1989;82:416-419 in, Donley, Joan. Vitamin K in >*> relation to haemorrhagic disease of the newborn. NZCOM >*> Journal Dec 1992. >*> Malia R, Preston F and V. Evidence against vitamin >*> K deficiency >*> in normal neonates. Thromb Haemost 1980;44:159. McKinney P, >*> Juszczak E, >*> Findlay E, K. Case-control study of childhood >*> leukaemia and cancer >*> in Scotland: findings for neonatal intramuscular vitamin K. BMJ >*> 1998;316:173-7. McNinch A and Tripp J. Haemorrhagic disease of the >*> newborn in the British Isles: a two year prospective study. BMJ >*> 1991;303(6810):1105-1109. McNinch A, Orme R and Tripp J. Haemorrhagic >*> disease of the newborn returns. Lancet 1983;i:1089-90 >*> (abstract). McNinch >*> A, Upton C, s M et al. Plasma concentrations after oral or >*> intramuscular vitamin K1 in neonates. Arch Dis Child 1985;60:814-818. >*> Meyer T and Angus J. The effect of large doses of Synkavit in the >*> newborn. Arch Dis Child 1956;31: 212-5 in, Ruby, C. Vitamin K: a >*> historical perspective. MIDIRS 1997;7(3):362-4. Mori P, >*> Bisogni C, Odino >*> S et al. (letter). Lancet 1977;ii:188. Motohara K, Endo F >*> and Matsuda I. >*> Screening for late neonatal vitamin K deficiency by >*> acarboxyprothrombin >*> in dried blood spots. Arch Dis Child 1987;62:370-375. Motz R. Late >*> haemothorax after oral vitamin K. NZMJ 11 November 1992:459. >*> Muller A., >*> van Doorm J and Hemker H. Heparin-like inhibitor of blood >*> coagulation in >*> normal newborn. Nature 1977;267:616-7. New Ethicals Compendium; 3c: >*> 303-304. Nishiguchi T, Saga K, Sumimoto K. et al. Vitamin K >*> prophylaxis >*> to prevent neonatal vitamin K deficient intracranial haemorrhage in >*> Shizuoka prefecture. Brit J Obstet Gynec 1996;103 >*> (11):1078-84. O’Connor >*> M. and Addiego J. Use of oral vitamin K1 to prevent >*> hemorrhagic disease >*> of the newborn infant. J Pediatr 1986;108:616-9. O’Connor M, >*> Livingstone >*> D, Hannah J. and Wilkins D. Vitamin K deficiency and >*> breastfeeding. Am J >*> Dis Child 1983;137:601-2 Olsen J, Hertz H, Blinkenberg K. et >*> al. Vitamin >*> K regimens and incidence of childhood cancer in Denmark. BMJ >*> 1994;308(6933):895-6 in, Greenwood, R. Vitamin K and >*> childhood cancer. >*> MIDIRS 1994;4(3):258-260 Olson J. Recommended dietary >*> intakes (RDI) of >*> vitamin K in humans. Am J Clin Nutr 1987;45:687-92. L, Cole M, >*> Craft A, Hey E. Neonatal vitamin K administration and >*> childhood cancer in >*> the north of England: retrospective case-control study. BMJ >*> 1998;316:189-93. Passmore S, Draper G, Brownbill P, Kroll M. >*> Case-control >*> studies of relation between childhood cancer and neonatal vitamin K >*> administration: retrospective case-control study. BMJ >*> 1998;316:178-84. >*> Passmore S, Draper G, Brownbill P, Kroll M. Ecological studies of >*> relation between hospital policies on neonatal vitamin K >*> administration >*> and subsequent occurrence of childhood cancer. BMJ >*> 1998;316:184-9 Pizer >*> B, Boyse J, Hunt L. and Mott M. Neonatal vitamin K >*> administration and in >*> vivo somatic mutation. Mutat Res 1995;347:135-9. Roche Products Ltd. >*> Position statement re: Konakion injection given orally. >*> Roche Products >*> Ltd. New oral vitamin K formulation for newborns (press >*> release). Welwyn >*> Garden City, 30 Aug 1996. Ruby . Vitamin K prophylaxis: a >*> historical perspective. MIDIRS 1997;7(3):362-4. Shearer M. >*> et al. Plasma >*> vitamin K1 in mothers and their newborn babies. Lancet 1982:460-3 in, >*> Hathaway, W. New insights on vitamin K. Hematol Oncol Clin North Am >*> 1987;1(3):367-379. son, J. The vitamin K conundrum. Maternity >*> Alliance Action Newsletter July/August 1992. Suzuki H, Nakao >*> T and Hiraga >*> K. Vitamin K deficiency in male rats fed diets containing butylated >*> hydroxytoluene (BHT). Toxicol Appl Pharmacol 1979;50:261-6 >*> in, Birkbeck >*> J. Vitamin K prophylaxis in the newborn: a position statement of the >*> Nutrition Committee of the Paediatric Society of New Zealand. NZMJ >*> 1988;101:421-2. Townsend C. The hemorrhagic disease of the >*> newborn. Arch >*> Pediatr 1894;11:559-562 in, Birkbeck J. Vitamin K prophylaxis in the >*> newborn: a position statement of the Nutrition Committee of the >*> Paediatric Society of New Zealand. NZMJ 1988;101:421-2. Tripp J. and >*> McNinch A. Haemorrhagic disease and vitamin K. Arch Dis Child >*> 1987;62:436-7. Tripp J and McNinch A. The vitamin K debacle: cut the >*> Gordian knot but first do no harm. Arch Dis Child >*> 1998;79:295-299. Vail, >*> B. Vitamin K prophylaxis and hemorrhagic disease of the newborn. ICEA >*> Review 1985;9(3). Van Doorm J and Hemker H. Vitamin K >*> deficiency in the >*> newborn (letter). Lancet 1977;ii:708-9. Van Doorm J, Muller A. and >*> Hemker, H. Heparin-like inhibitor, not vitamin-K deficiency, in the >*> newborn (letter). Lancet 1977;i:852-3. Vietti T, T, >*> J and >*> Pritchard J. Observations on the prophylactic use of vitamin K in the >*> newborn. J Pediatr 1960;56(3);343-6 (abstract). Von Kries R. Neonatal >*> vitamin K prophylaxis: the Gordian knot still awaits untying. BMJ >*> 1998;316 (7126):161. Von Kries R, Göbel U, Hachmeister A. et >*> al. Vitamin >*> K and childhood cancer: a population based case-control >*> study in Lower >*> Saxony, Germany. BMJ 1996;313(7051):199-203. Von Kries R, >*> Hachmeister A >*> and Göbel U. Repeated oral vitamin K prophylaxis in West Germany: >*> acceptance and efficacy. BMJ 1995;310 (6987):1097-8. Von >*> Kries R, Kreppel >*> S, Becker A, Tangermann R and Göbel U. Acarboxyprothrombin >*> activity after >*> oral prophylactic vitamin K. Arch Dis Child 1987;62: 938-40. >*> Von Kries R, >*> Shearer M and Göbel U. Vitamin K in infancy. Eur J Pediatr >*> 1988;147:106-12. Waddell W. and Guerry D. The role of >*> vitamin K in the >*> etiology, prevention and treatment of hemorrhage in the >*> newborn infant. J >*> Ped 1939;15:802 in, Ruby, C. Vitamin K prophylaxis: a historical >*> perspective. MIDIRS 1997;7(3):362-4. Whipple G. Hemorrhagic disease; >*> antithrombin and prothrombin factors. Arch Intern Med. >*> 1913;12:637-641 >*> in, Birkbeck, J. Vitamin K prophylaxis in the newborn: a position >*> statement of the Nutrition Committee of the Paediatric Society of New >*> Zealand. NZMJ 1988;101:421-2. Zipursky A. Vitamin K at birth. BMJ >*> 1994;313(1051):179-180. >*> >*> >*> -------------------------------------------------------- >*> Sheri Nakken, R.N., MA, Hahnemannian Homeopath >*> Vaccination Information & Choice Network, Nevada City CA & Wales UK >*> $$ Donations to help in the work - accepted by Paypal account >*> earthmysteriestours@... voicemail US 530-740-0561 >*> (go to http://www.paypal.com) or by mail >*> Vaccines - http://www.nccn.net/~wwithin/vaccine.htm >*> Vaccine Dangers On-Line course - >*> http://www.nccn.net/~wwithin/vaccineclass.htm >*> Homeopathy On-Line course - http://www.nccn.net/~wwithin/homeo.htm >*> >*> >*> >*> >*> >*> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2007 Report Share Posted September 6, 2007 Previously posted by Sheri... >*> At 01:43 PM 10/27/98 +1000, you wrote: >*> > >*> > Could someone tell me where I might find information on >*> the vitamin K >*> > injection given to infants at birth? >*> >*> >*> >From " How to Raise a Healthy Child in Spite of your Doctor " >*> by Dr. >*> Mendelsohn MD: >*> >*> p. 46 >*> " Many doctors routinely give vitamin K to newborn babies >*> because they have >*> been >*> taught that infants are born with a deficiency of this vitamin, which >*> influences how rapidly the baby's blood will clot. That's >*> nonsense, unless >*> the >*> mother is severely malnourished; but most doctors do it anyway. >*> Administration >*> of vitamin K to the newborn may produce jauncice, which prompts the >*> pediatrician to treat it with bilirubin lights >*> (phototherapy). These lights >*> expose the baby to a dozen documented hazards that may >*> requeire still further >*> treatement and possibly affect him for the rest of his life. " >*> >*> p. 265 (in Author's References) >*> " The value of routine administration of vitamin K to newborn >*> infants was >*> discounted by Drs. J.M. Van Doorm, A.D. Muller, and H.C. >*> Hemker in The Lancet, >*> April 17, 1977: " We Conclude that healthy babies, contrary >*> to current beliefs, >*> are not likely to have vitamin K deficiency... the >*> administration of vitamin K >*> to the newborn is not supported by our findings... " " >*> >*> If it helps, vitamin K administration started when >*> bottlefeeding became >*> commonplace. So, if you are breastfeeding, and don't have a >*> family history of >*> any type of blood clotting disease, I would say that it's >*> safe to forego. >*> >*> This is a good book to have; it also has some info on >*> vaccines, the other >*> " routine " things done to newborns, and many other common >*> health concerns. >*> >*> Barbara >*> -- >*> Barbara A. Palansky >*> bap@... >*> Cisco Systems, Inc. >*> >*> >*> >*> >*> >*> >*> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2008 Report Share Posted May 24, 2008 Hi , can't help you with the info. But check to make sure you are using the right search function. The one for the messages should be directly above the message section. I think there is one up the top of the page, but this is for internet search. If you use the right one, you will get all messages from the archives relevant. I am sure someone will get back to you with info anyway. But in the meantime you might be able to find what you are looking for. I can't really tell you anything, except that it is a practice that is unnecessary in almost all childbirths, and I think there is an adjuvant in there to be concerned about. I am past having any more kids, so haven't really absorbed the information I have read. Fieldman vitamin K Hello, I know this question has probably gone around before, but I cannot seem to locate anything when I search the past messages. Every time I type in " vitamin K " on the search section, I get a bunch of sites. Does anyone know why I should avoid this newborn shot? I am 7 months pregnant, and I want to refuse it, but my husband thinks I'm crazy, and I'm afraid the hospital will be horrible to me over it. If any of you have refused it, can you give me some advice? I'd also like some facts on why it's bad for my husband, who has reluctantly allowed me to stop vaxing our other kids. He still is not ready to switch doctors though. Baby steps. Thanks so much! **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4 & ?NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2008 Report Share Posted May 24, 2008 we let the nursers give our daugther the vit. k shot at time of birth- (and they gave us a choice knowing we weren't doing any other vaxes!) now that I have been researching vaccines- I found info that said the vit k vax has been linked to childhood lukemia- Liz barronfamily7@... wrote: Hello, I know this question has probably gone around before, but I cannot seem to locate anything when I search the past messages. Every time I type in " vitamin K " on the search section, I get a bunch of sites. Does anyone know why I should avoid this newborn shot? I am 7 months pregnant, and I want to refuse it, but my husband thinks I'm crazy, and I'm afraid the hospital will be horrible to me over it. If any of you have refused it, can you give me some advice? I'd also like some facts on why it's bad for my husband, who has reluctantly allowed me to stop vaxing our other kids. He still is not ready to switch doctors though. Baby steps. Thanks so much! **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4 & ?NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2008 Report Share Posted May 24, 2008 , make sure you have a birth plan. and the everyone has a copy BEFORE you get to the hospital. Liz barronfamily7@... wrote: Hello, I know this question has probably gone around before, but I cannot seem to locate anything when I search the past messages. Every time I type in " vitamin K " on the search section, I get a bunch of sites. Does anyone know why I should avoid this newborn shot? I am 7 months pregnant, and I want to refuse it, but my husband thinks I'm crazy, and I'm afraid the hospital will be horrible to me over it. If any of you have refused it, can you give me some advice? I'd also like some facts on why it's bad for my husband, who has reluctantly allowed me to stop vaxing our other kids. He still is not ready to switch doctors though. Baby steps. Thanks so much! **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4 & ?NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2008 Report Share Posted May 24, 2008 It also contains aluminum as a preservative. My baby is 3 months old now and fine. My doctor agreed that the Vit. K shot is unneccesary. I personally handed my Birth Plan to the labor and delivery nurses ahead of time and they put it in my folder. I read over it with them. None of them had a problem with it. I also had my doctor sign my Birth Plan. That made the nurses feel better that they were carrying out the " doctor's orders. " My baby is exempt from all vaccines. April > > Hello, > > I know this question has probably gone around before, but I cannot seem to > locate anything when I search the past messages. Every time I type in > " vitamin K " on the search section, I get a bunch of sites. Does anyone know why I > should avoid this newborn shot? I am 7 months pregnant, and I want to refuse > it, but my husband thinks I'm crazy, and I'm afraid the hospital will be > horrible to me over it. If any of you have refused it, can you give me some > advice? I'd also like some facts on why it's bad for my husband, who has > reluctantly allowed me to stop vaxing our other kids. He still is not ready to > switch doctors though. Baby steps. > > Thanks so much! > > > > > **************Get trade secrets for amazing burgers. Watch " Cooking with > Tyler Florence " on AOL Food. > (http://food.aol.com/tyler-florence?video=4 & ? NCID=aolfod00030000000002) > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2008 Report Share Posted May 24, 2008 Hi, I remember recent posts on this from a couple of months ago but I see what you mean about the search not working. Go to " advanced search " and put in " before April 2008, " then put Vitamin K in the search field there. The entire discussion came up. If I had to do it again, I wouldn't. I believed the doc when he said I had to. I thought it was just a vitamin... Winnie vitamin K Vaccinations > Hello, > > I know this question has probably gone around before, but I > cannot seem to > locate anything when I search the past messages. Every time I > type in > " vitamin K " on the search section, I get a bunch of sites. Does > anyone know why I > should avoid this newborn shot? I am 7 months pregnant, and I > want to refuse > it, but my husband thinks I'm crazy, and I'm afraid the hospital > will be > horrible to me over it. If any of you have refused it, can you > give me some > advice? I'd also like some facts on why it's bad for my > husband, who has > reluctantly allowed me to stop vaxing our other kids. He still > is not ready to > switch doctors though. Baby steps. > > Thanks so much! > > > > > **************Get trade secrets for amazing burgers. Watch > " Cooking with > Tyler Florence " on AOL Food. > (http://food.aol.com/tyler- > florence?video=4 & ?NCID=aolfod00030000000002) > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2008 Report Share Posted May 24, 2008 I actually started a thread on this subject about 2 months ago, when I was in my 8th month of pregnancy. I think I have have titled it " Vit K " rather than spelling out vitamin, so you could try searching that way. In the meantime, here's the package insert for the Vit K shot: http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf. Note that DEATH is included under " Adverse Side Effects " . Yeah, that's quite adverse, all right! I had both of my kids (2.5 yrs and 1 month old) at home. I did not have the Vitamin K (or the eye goops or anything else, for that matter) administered to either child. In my last couple months of pregnancy, I did up my leafy green intake, as well as took food-based supplements that consisted of kale and brussel sprouts to help with my own clotting factor as well as the baby's. It worked well. Some women take alfalfa supplements, but I'm alergic to alfalfa, so I did the kale/brussel sprouts. Good luck to you and your new little one! On Sat, May 24, 2008 at 5:16 PM, <barronfamily7@...> wrote: > Hello, > > I know this question has probably gone around before, but I cannot seem to > locate anything when I search the past messages. Every time I type in > " vitamin K " on the search section, I get a bunch of sites. Does anyone know > why I > should avoid this newborn shot? I am 7 months pregnant, and I want to refuse > it, but my husband thinks I'm crazy, and I'm afraid the hospital will be > horrible to me over it. If any of you have refused it, can you give me some > advice? I'd also like some facts on why it's bad for my husband, who has > reluctantly allowed me to stop vaxing our other kids. He still is not ready > to > switch doctors though. Baby steps. > > Thanks so much! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 At 12:16 AM 5/25/2008, you wrote: >Hello, > >I know this question has probably gone around before, but I cannot seem to >locate anything when I search the past messages. Every time I type in > " vitamin K " on the search section, I get a bunch of sites. Does >anyone know why I >should avoid this newborn shot? I am 7 months pregnant, and I want >to refuse >it, but my husband thinks I'm crazy, and I'm afraid the hospital will be >horrible to me over it. If any of you have refused it, can you give me some >advice? I'd also like some facts on why it's bad for my husband, who has >reluctantly allowed me to stop vaxing our other kids. He still is >not ready to >switch doctors though. Baby steps. > >Thanks so much! > I see search isn't working well Go here Vaccinations/messages and right after the box for search it says " advanced " - click there Under subject, contains - put vitamin K under author - put nakken You will get about 70 emails Let me know if that works for you Sheri listowner -------------------------------------------------------- Sheri Nakken, former R.N., MA, Hahnemannian Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK Vaccines - http://www.nccn.net/~wwithin/vaccine.htm or http://www.wellwithin1.com/vaccine.htm Vaccine Dangers & Homeopathy Online/email courses http://www.wellwithin1.com/vaccineclass.htm or http://www.wellwithin1.com/homeo.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 Yes, Sheri, thank you, it worked. I'm reading things right now. 2 questions if you happen to know... How do I find out if it's state law in CA? My husband thinks it is. And 2nd, how do you find out who really needs the shot? One of the articles suggested some high risk babies might. Thanks! **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4 & ?NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 I did it b/c I had my son cir'd and he obviously needs his blood to be clotting for that. Od if you are having a boy I would rethink it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 If you wait for the baby to be 7 days old or older to do the circ then you won't have to do the vit k shot. Babies naturally start producing their own vit k after a week old, that is why in the Jewish religion they wait until day 8 to do the circ. a **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4 & ?NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 At 04:49 PM 5/25/2008, you wrote: >Yes, Sheri, thank you, it worked. I'm reading things right now. 2 >questions if you happen to know... How do I find out if it's state >law in CA? My >husband thinks it is. And 2nd, how do you find out who really >needs the shot? >One of the articles suggested some high risk babies might. > >Thanks! > That is a hard question. I personally think no infant will need it but read through all. Some think if birth trauma with possible bleeding maybe. And you can get out of in California Just put in your birth plan Sheri Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 I found this site that discusses the Vitamin K shot. http://www.vaccination.inoz.com/VitaminK.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2008 Report Share Posted May 25, 2008 I found this site that discusses the Vitamin K shot. http://www.vaccination.inoz.com/VitaminK.html I also found this on a local parents group site written by one of the fathers there: The Vitamin K shot for newborns is basically one of those things that addresses a rare, but potentially dangerous condition. Because the shot is inexpensive, it is rutinely given in this country. Vitamin K helps with blood clotting. The potential risk is that a newborn may have some internal injury due to birth trauma, and may bleed internally without outward symptoms. My understanding is that there are two effective alternatives to the injection. The first is oral. Research shows this is just as effective as the shot. While it is routine in other countries, it is not commonly done here and an oral dose is not commercially available. You can ask for oral Vit. K and they will administer the dose prepared for injection orally. Apparently it is not very tasty, and often elicits grimaces and crying. The second option is dietary. Although Vit. K does not pass well through breast milk, it does readily cross the placenta. Research shows that the babies of women who eat diets rich in Vit. K during pregnancy have sufficient vit. k in their blood at birth. Leafy greens are the best source of vitamin k. Freezing destroys it, but it can withstand cooking/heat. According to the USDA, the best greens are amaranth greens (also known as hing choi or hin choi) which are sometimes available at Berkeley Bowl, Monterey Market, or other groceries catering to asian shoppers. Another excellent source are herbs such as alfalfa (presumably sprouts, too), red clover, nettles, and red raspberry leaf. Al these herbs are generally used for pregnancy and helpful in other ways as well (e.g., helping prevent pre-eclampsia). Using an infusion (herbal tea) of these 4 herbs is an excellent way to stay well-hydrated and increase your vitamin K intake. BTW, this worked well enough for our second child that the mid-wives had difficultly getting enough blood out of her before she clotted up during the PKU test. Of course, you should check with your provider and make a well-informed decision. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2008 Report Share Posted June 8, 2008 no, it seems not there are a lot of things they do routinely - not sure how they get away with it - I guess the same way they get away with everything else Sheri At 07:02 PM 6/8/2008, you wrote: >Is the hospital not required to obtain consent before administering >it? I just looked at my baby's records and released he was given it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2008 Report Share Posted August 31, 2008 > > I noticed some of you take Vitamin K. What is it for? > > Thanks! > > Sue > Hi Sue, I don't take Vitamin K but I noticed that you did not get a response to your earlier post so I thought I would help out a little here. http://en.wikipedia.org/wiki/Vitamin_K <http://en.wikipedia.org/wiki/Vitamin_K> Discovery In 1929, scientist Henrik Dam investigated the role of cholesterol by feeding chickens a cholesterol-depleted diet.[18] After several weeks, the animals developed hemorrhages and started bleeding. These defects could not be restored by adding purified cholesterol to the diet. It appeared that - together with the cholesterol - a second compound had been extracted from the food, and this compound was called the coagulation vitamin. The new vitamin received the letter K because the initial discoveries were reported in a German journal, in which it was designated as Koagulationsvitamin. General Info Vitamin K denotes a group of lipophilic, hydrophobic vitamins that are needed for the posttranslational modification of certain proteins, mostly required for blood coagulation. Chemically they are 2-methyl -1,4-naphthoquinone derivatives. Vitamin K2 (menaquinone, menatetrenone is normally produced by bacteria in the intestines, and dietary deficiency is extremely rare unless the intestines are heavily damaged or are unable to absorb the molecule[citation needed. Role in disease Vitamin K-deficiency may occur by disturbed intestinal uptake (such as would occur in a bile duct obstruction), by therapeutic or accidental intake of vitamin K-antagonists or, very rarely, by nutritional vitamin K-deficiency. As a result, Gla-residues are inadequately formed and the Gla-proteins are insufficiently active. Lack of control of the three processes mentioned above may lead to the following: risk of massive, uncontrolled bleeding, cartilage calcification and severe malformation of developing bone, or deposition of insoluble calcium salts in the walls of arteries. The deposition of calcium in soft tissues, including arterial walls, is quite common, especially in those suffering from atherosclerosis, suggesting that Vitamin K deficiency is more common than previously thought. Hope that is helpful. Maybe someone will jump in here and share their experience. Marti Quote Link to comment Share on other sites More sharing options...
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