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Parenting tip
Giving vitamin K by injection probably keeps levels higher for longer,
compared with by mouth, as the vitamin remains stored in the muscle where it
was injected.

Vitamin K: Injection or oral dose for newborns

You will decide how your newborn baby will be given vitamin K after birth; by
injection, orally, or whether it will be given at all. We discuss options, risks, HDN
and VKDB.

In the UK, parents of new babies are routinely asked if their baby is to have supplementary vitamin K
by injection or oral supplement, which is needed to make blood clot and prevent excessive internal
bleeding.

Compared with adults, newborn babies are born with low levels of vitamin K but the amount is
normally sufficient to prevent problems. Some babies are at risk, however, because they don’t have
sufficient vitamin K, and they have an increased risk of Haemorrhagic Disease of the Newborn (HDN),
also known as Vitamin K Deficiency Bleeding (VKDB).

While some babies are at a higher risk than others (see below), some babies who are at risk of
bleeding don’t show any risk factors and, for this reason, the Department of Health recommends all
babies are given vitamin K soon after birth, usually by injection. However, it is your choice as a parent
to decline, if you wish; you can also opt for vitamin K to be given by mouth instead.

Background of vitamin K after birth

HDN is a rare but very serious disease. Half of all babies who have HDN have a haemorrhage into
their brain (intracranial bleeding). This often causes brain damage, and the baby may die. In the
1950s and 1960s, it became standard practice for all babies to have an injection of vitamin K into a
muscle.
 Later, in the 1980s, some health professionals and parents wondered if it was necessary to give
vitamin K injections to every newborn baby. Instead, single doses by mouth became popular, and
some babies, if they were not deemed to be at higher risk, were not given the supplement at all.

A UK study published in 1991 confirmed that HDN was rare. The babies who had HDN were more
likely to have liver disease or be breastfed. Then, in 1990 and 1992, studies were published that
suggested a possible link between injected vitamin K and childhood cancers including leukaemia.
This meant more babies were given vitamin K by mouth. The number of babies with HDN went up
slightly as a result, perhaps because oral vitamin K is slightly less effective than when it is given by
injection.

Since then, further studies have failed to find any link between injected vitamin K and childhood
cancers of any type and, in 1997 an expert body for the UK Department of Health concluded that this
was no longer a concern.

Are some babies at higher-risk of HDN?

Babies at increased risk of HDN include:

 Babies born after less than 37 weeks of pregnancy.

 Babies whose birth involved the use of forceps, ventouse or caesarean, where bruising occurs.
 Babies who had trouble breathing and did not get enough oxygen when they were born.
 Babies whose mum are taking anti-convulsants, anti-coagulants, or drugs to treat tuberculosis.
 Babies who have liver disease that may show as prolonged jaundice or symptoms, such as pale
stools or dark urine.

This means that about a third of babies are at increased risk. Some studies suggest that many of the
babies who develop bleeding have unseen problems with their liver. It is hard to spot these babies
before they bleed, so vitamin K can be preventive.

What are the effects of giving vitamin K by injection?

Giving vitamin K by injection probably keeps levels higher for longer, compared with vitamin K by
mouth, as it remains stored in the muscle where it was injected.

Problems from the injection are very uncommon but may happen, as with any injection. Babies can
feel pain and, on rare occasions, may have an infection at the place where the injection goes in, or
bleeding and bruising in the muscle.

Mistakes are very occasionally made with the injection, and the wrong dose or drug may be given. To
minimise this risk, the injection is normally only given outside the labour room.

What are the effects of giving vitamin K orally?

Oral vitamin K is given in three separate doses, over the first month of life. Studies have shown that
sometimes, a dose is omitted, probably because it’s forgotten about, and this means full protection is
not given.

Why were breastfed babies thought to be at increased risk?

According to studies, HDN was more common among breastfed babies.

We know vitamin K levels are higher in colostrum (the first milk you produce) than in mature milk.

In the past, babies were not breastfed till some time after birth, and strict feeding routines were usual;
this probably meant that babies got less vitamin K than nature intended. Nowadays, babies are
usually breastfeed soon after birth, and they feed frequently for as long and as often as they want.
This means they get more colostrum than they used to, reducing the risk of HDN.

Formula milk has vitamin K added to it.

Should women take vitamin K?

Giving vitamin K to mums before and after they have their babies has been tried in small-scale
studies. Vitamin K does go across the placenta and into breastmilk, but it does not seem to be
sufficient to prevent HDN.

Possible vitamin K deficiency symptoms to watch out for

If your newborn bleeds, for example, if you find blood oozing from the cord stump, or if bleeding
continues for some time after the ‘heel prick’ blood test, or if your baby has a nose bleed or
unexplained bruising, then talk to your doctor or midwife. They need to be checked in case this
bleeding is a sign of HDN. If your baby has jaundice lasting longer than two to three weeks or is
producing pale poos and dark urine, you should raise it with your doctor or midwife, because this may
be a sign of liver problems, which increases the risk of abnormal bleeding.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early
parenthood: 0300 330 0700.

You might find attending one of NCT's antenatal courses or Early Days groups helpful.

Make friends with other parents-to-be and new parents in your local area for support and friendship by
seeing what NCT activities are happening nearby.

You can read Vitamin K in Neonates: facts and myths by Giuseppe Lippi and Massimo Franchini
(Blood Transfusion 2011; 9-4-9) for more information.
NHS Choices has some useful information in their Your baby after the birth section

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Vitamin K - Newborn Babies Patient Information

Vitamin K for Babies: Why?
Very rarely, a newborn baby may start to bleed, for
no reason. The baby may start to bleed inside, so
it is not possible to see the bleeding. This is bad
for the baby’s health and might even cause the
baby to die.
If babies are given Vitamin K shortly after they are
born, then this very small risk that they might start
bleeding is taken away.This is why the Department
of Health recommends all new babies have
Vitamin K.
We have produced this leaflet to explain more
about how Vitamin k can help your baby, and what
you can do to help.
There are more things you should know about
Vitamin K, so you may wish to show this leaflet to
your doctor, midwife, or health visitor and talk
through the leaflet with them.
What do I need to do and when do I need to start
thinking about this?
Vitamin K supplements are given straight after
birth, so during the pregnancy/antenatal period
you’ll need to consider:
Whether or not you would like Vitamin K to be
given to your baby.
If you do, whether it is given by mouth or by
injection.
This leaflet will help you do just that.
It tells you what Vitamin K deficiency bleeding is,
discusses the benefits of Vitamin K supplements
and possible disadvantages of its use, and gives
the best current advice.
Of course, there’s no substitute for talking the
issues through with your midwife, health visitor or
doctor.
What is Vitamin K?
Vitamin K is a vitamin, which occurs naturally in
food especially in liver and some vegetables. We
all need Vitamin K, it helps to make the blood clot
in order to prevent bleeding.
During early infancy when fed entirely on milk,
babies have very little Vitamin K. A very small
number of babies suffer bleeding due to Vitamin K
deficiency. This is called Vitamin K Deficiency
Bleeding or VKDB for short. This risk of bleeding is
effectively removed when sufficient extra Vitamin
K is given to babies.
What is VKDB?
VKDB is a rare disorder, which occurs in newborn
babies leading to bleeding from the nose, mouth or
into the brain. You won’t always be able to see the
bleeding. When it occurs in the brain it may cause
brain damage or even death.
What’s the risk?
The risk is very small. VKDB can happen in as
many as 1:10000 full term babies if they do not get
extra Vitamin K. If Vitamin K were not given, of the
800,000 recorded births in the UK every year, 10
to 20 babies could be brain damaged as a result of
a bleed in the brain, and 4 to 6 babies could die.
But this slight risk is eliminated when your baby is
given a Vitamin K supplement in sufficient
amounts.
Why give Vitamin K to all babies? Can’t high-risk
babies be recognized?
Bleeding happens unpredictably in some babies
and it’s not possible to identify babies as high or
low risk with absolute certainty. The range of risk
factors is broad but in some babies without risk
factors, bleeding occurs for unknown reasons in
the first few weeks of life and of babies who suffer
bleeding about a quarter have no evident risk
factor.
Which babies are at greater risk?
Bleeding in the first 24 hours after birth is a
particular risk to babies of mothers on certain
drugs, such as anti-convulsants.Bleeding after 24
hours following birth is more common and babies
at greater risk are those who:
Are premature.
Had a complicated delivery e.g. a forceps delivery.
Have liver disease that may show as prolonged
jaundice or as other symptoms, such as pale
stools or dark urine.
Fail to take or find it hard to absorb feeds.
Are ill for other reasons.
Have bleeding or spontaneous bruising in early
infancy.
Can Vitamin K be harmful?
Experts advise that the evidence suggests that it is
not. Concerns about a statistical possibility of a
link between the use of injected Vitamin K and
childhood cancer were raised by some studies in
the early 1990’s but other studies have not
confirmed this. In 1997 a joint expert group of the
Medicines Control Agency, the Committee on
Safety of Medicines and the Department of Health
considered all the studies. Though it is not
possible absolutely to exclude a small increase in
leukaemia due to limitations of the research data,
the experts concluded that overall the available
data do not support an increased risk of cancer,
including leukaemia, caused by Vitamin K.
How is Vitamin K given?
There are two methods of giving Vitamin K to your
baby:-
By mouth
By injection
What difference does it make, which one I
choose?
Both ways offer protection against VKDB. The
main difference is that if you choose ‘by mouth’ for
your baby the dose will have to be repeated –
twice for bottle fed babies and three or more times
for breastfed babies.
By injection
Intra-muscular (IM) injection of Vitamin K
(Konakion MM Paediatric) prevents VKDV in
virtually all babies. One dose is given at birth, by
the midwife or other healthcare professional. It
does not need to be repeated.
By mouth
This method can be just as good as having an
injection but only if doses are repeated.
There are variations in the advised courses. Two
doses are advised in the first week for all
babies. For exclusively breast fed babies, it is
recommended that a third dose of 2mg Konakion
MM be given at one month of age. On this regime
it is essential that you make sure the third dose is
given. Other oral regimes in use offer more
frequent lower doses.
If you choose to have doses of Vitamin K by mouth
for your baby, you need to be aware of the
necessity for further doses at the agreed
times. These may need to be given by your
healthcare professional and it is important that you
can be available for these to be given.
Vitamin K is already added to artificial or bottle
milk so that babies fed on these milks get Vitamin
K in the milk anyway. The second dose in the first
week is advised for artificial or bottle milk fed
babies as for breast fed babies, to be sure that
they get the maximum benefit.
Parents may decide that their babies should not
receive Vitamin K or may prefer a modified
course. In these circumstances the risk of bleeding
is increased and parents must be aware of the
warning signs of VKDB.
Breastfeeding and VKDB
Breastfeeding gives babies the best start in
life. Breast milk provides exactly the right nutrients,
growth factors, hormones and immunity a young
baby needs to grow and develop.
It is recommended that all newborn babies are
given a Vitamin K supplement at birth. This is to
avoid the rare but serious (and sometimes
fatal) disorder called Vitamin K Deficiency
Bleeding (VKDB)
Breast feeding without starting solids for the first 4
to 6 months gives your baby the best chance of
avoiding allergies later on in childhood.
Babies who are breast fed for the first 3 months of
life continue to have lower rates of infection
throughout the first year of life.
The only reason that babies who are breast
feeding are at greater risk of Vitamin K deficiency
bleeding is that Vitamin K is added to artificial or
bottle milk.
Artificial or bottle milk is fine, though it cannot
match the advantages of breast milk.
Breast feeding is preferred over artificial or bottle
milk where possible. Don’t swap simply for the
added Vitamin K in formula milk.
Recognising the warning signs of VKDB
Many babies who later suffer bleeding in the brain
have had prior minor bleeds from the skin, nose or
mouth. Thus minor bleeds or bruising any time in
the first six months of life, must be looked at
urgently.
Any baby who is still jaundiced after two weeks of
age must be seen by a doctor or health visitor –
especially if they are not gaining weight properly,
have pale stools and dark urine, or are ill in any
way.
It is recommended that all babies are given a
Vitamin K supplement at birth. However, the
decision is entirely yours about whether your baby
receives extra Vitamin K and how it is given.
We hope the information given in this leaflet will
help you to make your choice.
If you wish to discuss Vitamin K further please
speak to your midwife or doctor at your next
antenatal appointment.
Research
Research is undertaken to add to the existing
scientific knowledge on a particular subject. There
are a number of staff within the Trust who conduct
Research studies. It is possible that during the
course of your treatment you may be asked to take
part in a research study, however, you do have the
right to refuse, and this will not affect the care that
you receive.
Your NHS Number, Keep it Safe.
Every person registered with the NHS in England
and Wales has their own unique NHS Number. It
is made up of 10 digits for example 1 2 3 4 5 6 7 8
90.
Everyone needs to use the NHS Number to
identify you correctly. It is an important step
towards improving the safety of your healthcare.
Always bring your NHS number with you to all
hospital appointments or quote it if you need to
telephone the hospital for any enquires. This will
allow staff to check that they have the right patient
details by checking this against your NHS number.
To improve safety always check your NHS
Number on correspondence the NHS sends to
you.
Ways of finding out your NHS Number
If you do not know your NHS number, contact your
GP or local Primary Care Trust. You may be asked
for proof of identity, for example a passport or
other form of identity this is to protect your privacy.
Once you have obtained your NHS Number write it
down and Keep it Safe
Data Protection
The Trust will endeavour to ensure that your
information remains secure and confidential at all
times. The Data Protection Act 1998 explains how
personal information should be processed and this
applies to all information whether held on paper or
electronically on computer systems. We must
ensure that all personal information is processed
fairly, lawfully and as transparently as possible so
you:
Understand reasons for us processing your
personal information
Give your consent for the disclosure and use of
information where necessary
Gain trust in the way we handle your information
Understand your rights regarding the right to
request access about the information we hold
about you.
The Caldicott Guardian, who is a senior health
clinician, has the role to ensure we meet the
highest standards for handling personal
information at the Trust.
For further information regarding data protection,
please read our leaflet called “Protecting Your
Data - How we use your health records” or visit the
Information Governance pages on the Trust
website.
Patient Relations
The Patient Relations Department provides
confidential on the spot advice, information and
support to patients, relatives, friends and
carers. We will do our best to help you to resolve
any concerns you may have about the care you
received. We can also give you information on the
services provided by the Trust.
If you have a concern or there is a problem, the
best way to get it resolved is usually to tell
someone there and then. On a ward, talk to the
sister or charge nurse on duty. In a clinic, talk to
the receptionist or one of the nursing staff. If you
want to talk to a senior manager or to someone
who has not been directly involved in your care
and treatment, we can usually arrange this during
office hours. You can also ask to speak to a
member of the Patient Relations Department.
Staff in any ward or department will be able to
contact a member of the team for you or you can
telephone 01942 8 2 2 3 7 6.The Patient Relations
Department is open Monday to Friday between
9:00 am and 4:00 pm. Outside of these hours
there is an answer-phone service.
If you wish to make a formal complaint you can
telephone or write to:
The Patient Relations Manager
Wrightington Wigan and Leigh NHS Foundation
Trust
Royal Albert Edward Infirmary
Wigan Lane
Wigan WN1 2NN
Telephone: 01942 8 2 2 3 7 6
This leaflet is also available in audio, large print,
Braille and other languages upon request.
For more information call 01942 7 7 3 1 0 6.
© Wrightington, Wigan and Leigh NHS Foundation
Trust
All rights reserved. Not to be reproduced in whole
or in part without the permission of the copyright
owner
Dial NHS Direct 0845 4 6 4 7 for health advice and
reassurance
You have reached the end of this leaflet
Vitamin K at birth
Vitamin K helps the blood to clot and prevents serious bleeding. In
newborns, vitamin K injections can prevent a now rare, but potentially fatal,
bleeding disorder called ‘vitamin K deficiency bleeding’ (VKDB), also known
as ‘haemorrhagic disease of the newborn’ (HDN).

Babies can be given the injection in hospital after they’re born. Injections in public hospitals
are free. If you are giving birth in a private hospital, make sure you ask when you are making
your booking if there is a cost involved.
Why is vitamin K important for my baby?
Vitamin K helps blood to clot. It is essential to prevent serious bleeding. Babies do not get
enough vitamin K from their mothers during pregnancy, or when they are breast feeding.
Without vitamin K, they are at risk of getting a rare disorder called ‘vitamin K deficiency
bleeding’ (VKDB). VKDB can cause bleeding into the brain, and may result in brain damage
or even death. VKDB can be prevented by giving new babies extra vitamin K. By the age of
about six months,they have built up their own supply.

How is vitamin K given?

The easiest and most reliable way to give babies vitamin K is by injection. One injection just
after birth will protect a baby for many months. Since about 1980, most newborn babies in
Australia have been given a vitamin K injection. Vitamin K can also be given by mouth.
Several oral doses are essential to give enough protection, because vitamin K is not
absorbed as well when it is given by mouth and the effect does not last as long.

If you choose vitamin K by mouth, your baby must have three doses:

 dose 1 at birth
 dose 2 usually three to five days later
 dose 3 in the fourth week, if the baby is fully breast fed. (Babies fed mainly by
formula do not need the third dose.)
If your baby vomits within one hour of swallowing the vitamin K, the baby will need to have
another dose.

Can all babies have vitamin K?

All babies need to have vitamin K. Very small or premature babies may need smaller doses
– your doctor can advise you about this. Vitamin K by mouth is not suitable for some babies:

 Babies who are premature or sick should be given the vitamin by injection. There are
two main reasons for this: the very small dose needed is difficult to measure by
mouth, and these babies are also more likely to have feeding difficulties.
 If you choose vitamin K by mouth but your baby is unwell when a dose is due, the
baby may need to have the injection instead.
 If, while you were pregnant, you took medication for epilepsy, blood clots or
tuberculosis, you should tell your doctor or midwife. Your baby may not be able to
absorb vitamin K by mouth, and may need the injection instead.

Does vitamin K have any side effects?

Over the 20 years vitamin K has been given to new babies in Australia, it seems to have
caused no problems. A few years ago, one study suggested that injections of vitamin K
might be linked to childhood cancer, but six studies since could not find any link with cancer.
The National Health and Medical Research Council has looked carefully at these studies and
other evidence available, and has concluded that vitamin K is not associated with childhood
cancer, whether it is given by injection or by mouth.

Does my baby have to have vitamin K?

This is your choice. However, giving vitamin K to your newborn baby is a simple way of
preventing a very serious disease. Medical authorities in Australia strongly recommend that
all babies be given vitamin K. This includes babies who are premature or sick, and babies
having surgery (including circumcision). Parents who decide against vitamin K need to watch
very carefully for any symptoms of VKDB.

What should I look out for?

You should always see your doctor or healthcare worker:

 if your baby has any unexplained bleeding or bruising – this is particularly important if
your baby has not had vitamin K
 if, when your baby is over three weeks old, there are any signs of jaundice (yellow
colouring of the skin or whites of the eyes).
Babies with liver problems are particularly at risk, even if they have had vitamin K.

How do I get vitamin K for my baby?

During your pregnancy, your doctor or midwife should ask whether you want your baby to
have vitamin K by injection or by mouth, and they will arrange to provide it. Soon after birth,
your baby will have a vitamin K injection or the first dose by mouth. This will be given by a
doctor or midwife.

If you have chosen vitamin K by mouth:

 The second oral dose can be given when your baby has the newborn screening test
in the hospital, or by your local doctor or healthcare worker.
 You need to remember the important third oral dose when your baby is between
three and four weeks old. Talk to your doctor or healthcare worker if you need help
or advice.
Make sure that your baby’s vitamin K doses are recorded in the baby’s personal health
record.