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 9 0 .

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.

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Dial NHS Direct 0845 4 6 4 7 for health advice and reassurance

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