Vitamin K and Vitamin K

Deficiency Bleeding (VKDB)

Kennedy Fitzgerald
NTRI 7510
Background
• Vitamin K refers to a group of fat-soluble
compounds involved in coagulation, bone
formation, and CV health. (1)
• Deficiency: significant bleeding, poor bone
development, osteoporosis, and increased risk
of CVD (1)
• Sources: (2)
• Phylloquinones: green leafy vegetables
(spinach, broccoli, turnip greens, kale),
fats and oils (soybean and canola oil)
• Menaquinones: animal products and
fermented foods
• Synthesized by intestinal bacteria (limited
amounts)
What is VKDB?

• VKDB: condition in which newborns bleed uncontrollably due to the lack of

vitamin K in blood (1)
• Types
• 1. Early VKDB: within 24 hours of birth
• 2. Classic VKDB: within the first week of life
• 3. Late VKDB: between 1 and 12 weeks of life
• Symptoms: (3)
• Main symptom is uncontrollable bleeding
• Bruises on baby's head, external bleeding (nose, umbilical cord), unnatural
skin color, vomiting blood, sticky/dark stool
Why are babies at risk? (3)
• Receive very little vitamin K from mothers
during pregnancy
• Exclusively breast-fed do not get enough from
breastmilk
• Lack intestinal bacteria to needed to synthesize
vitamin K
• Mothers using certain medications during
pregnancy, including TB and seizure medications
• Babies who have liver disease, which can cause
the vitamin K to become ineffective
• Babies who have diarrhea, celiac disease, or
cystic fibrosis. These infants are often unable to
absorb vitamins from food.
Treatment/Management of VKDB
• Prophylaxis in newborns: 1 mg of vitamin K1
by intramuscular injection within 1 hour of
birth. (1)
• Alternatively, 2 mg of vitamin K1 orally at
birth, at 4-6 days and at 4-6 weeks.
• Another alternative oral administration is 2
mg Vitamin K1 at birth and a subsequent
weekly dose of 1 mg for three months.
• Intramuscular injection is preferable for
efficacy.
• Babies who do not receive shot are 81 times
more likely to have VKDB
• 20% of babies who have VKDB will die (3)
Refusal of Vitamin K by Parents of Newborns: A
Qualitative Study (4)
• Despite AAP recommendation, some parents refuse intramuscular injection of vitamin K
as a prophylaxis agent against VKDB.
• Parent's refusal of vitamin K in US and other countries has increased
• Reasoning not well understood
• Little qualitative data on parent perspective and decision making
• Objective: to describe attitudes and perceptions of parents who choose to defer IM
vitamin K for their newborns.
 Study cont.

• Method: Using qualitative

methodology, conducted in depth
semi-structured interviews with
parents of newborns in 3 hospitals
in Connecticut and California.
• Data collection done through
interviews.
• 15 interviews in CT (13 M, 2 M&F)
4 interviews in CA (M only)
4 Major Themes

1. Risk to Benefit Ratio: risks outweighed the benefits

• Concerns relating to fear of preservatives, doubt regarding necessity,
perceived threat of harm from injection
2. “Natural” approaches
• Natural alternatives, oral administration, increasing the mother’s intake,
religious reasons etc.
3. Placement of trust and mistrust
4. Informed by Experiences
Study Cont.

• Limitations:
• Limited sample size
• Lack of diversity (all Caucasian, private insurance, hospital delivery, English
speaking)
• Interviews conducted with mother and father present
• Future studies:
• Utilize findings to develop a survey for US parents to quantify the prevalence of
themes found in this study
• Explore decision making among parents with initial resistance to vitamin K
prophylaxis
• Impact of open communication with clinicians
• Considered developing educational interventions to change behavior
 Conclusion

• Parents’ perception of risk, preference for

alternative options, trust, and communication with
health care providers were pivotal factors when
making decisions about IM vitamin K.
• Demonstrates shift of doctor-patient relationship
• Parents are informed health consumers
• Clinician’s role as educator while still respecting
patient’s opinions
Questions

This Photo by Unknown Author is licensed under CC BY-NC

References
1. Eden RE, Coviello JM. Vitamin K Deficiency. [Updated 2020 Nov 21]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK536983/
2. National Institutes of Health Office of Dietary Supplements: Vitamin K Fact Sheet for Health
Professionals https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/. Accessed 6/25/2018.
3. Centers for Disease Control and Prevention. (2021, January 1). Frequently Asked Questions: Vitamin K
and the Vitamin K Shot Given at Birth. https://www.cdc.gov/ncbddd/vitamink/faqs.html
4. Loyal J, Weiss TR, Cheng JH, Kair LR, Colson E. Refusal of Vitamin K by Parents of Newborns: A
Qualitative Study. Academic pediatrics. 2019;19(7):793-800. doi:10.1016/j.acap.2019.04.003