Vitamin K deficiency bleeding in newborn babies: why vitamin K is offered

Vitamin K helps blood to clot, which stops bleeding. NHS inform explains that when babies are born they have very little vitamin K in their bodies and a small number may bleed because of this. This is called vitamin K deficiency bleeding. Kingston and Richmond NHS Foundation Trust says newborns have low levels because only a small amount passes from mother to baby across the placenta, and breast milk contains only a small amount.

NCT notes the condition is sometimes called haemorrhagic disease of the newborn. The bleeding can be internal, so it may not be visible. Rotherham NHS Foundation Trust says that where bleeding occurs in the brain it can cause brain damage or even death, which is why it is taken seriously despite being rare.

Because the underlying problem is a shortage of a clotting vitamin, the condition is a clotting problem (a coagulopathy) that vitamin K replacement corrects.

NCT puts the chance of a baby getting VKDB at about 1 in every 8,500 babies, and says most babies who get VKDB recover if treated quickly. Kingston and Richmond NHS Foundation Trust says that 1 in every 10,000 babies who have not received vitamin K will experience bleeding in the brain, and between 2 and 17 babies in every 1,000 who have not received vitamin K after birth will have some type of bleeding. Rotherham NHS Foundation Trust gives the risk of VKDB as 1 in 10,000 for babies born at full term who do not receive extra vitamin K.

Rotherham NHS Foundation Trust says bleeding in the first 24 hours is a particular risk to babies of mothers on certain drugs such as anti-convulsants, and that bleeding after 24 hours is more common in babies who are premature, had a complicated delivery such as forceps, have liver disorders, cannot or find it hard to feed, or are ill for other reasons. It also says fully breastfed babies are more likely to develop VKDB than formula-fed babies, because manufacturers add vitamin K to formula milk.

NCT adds that if a baby is not feeding well or not getting enough milk they may be more likely to have low levels, that babies with liver disease are at greater risk, and that a baby still jaundiced after 14 days could need assessment.

NHS inform says there are two ways for a baby to have vitamin K: by injection, once just after birth, or by mouth. If by mouth, the most common form is Konakion. The baby needs 2 doses in the first week if formula-fed, because formula milk already has vitamin K in it, or 2 doses in the first week and a third dose at a month old if breastfed.

Rotherham NHS Foundation Trust says its trust, the Department of Health and NICE recommend a single injection into the thigh at birth, which only requires one dose and is more effective, with the disadvantages that it is invasive and can cause pain and a small bruise. Kingston and Richmond NHS Foundation Trust says oral doses are not as effective as an injection.

NCT says studies show vitamin K is very effective at preventing VKDB, especially by injection, and that oral vitamin K is not recommended for babies with a high risk of bleeding, who are unwell or who are born early.

NCT says vitamin K is given to millions of babies every year worldwide and is considered very safe. It says a baby may feel some pain when the injection is given, that skin-to-skin contact can help, and that there is a small chance of bruising or infection on the skin. Kingston and Richmond NHS Foundation Trust says mild bruising or swelling at the injection site can occur and infection is rare.

Rotherham NHS Foundation Trust refers to a suggestion in the early 1990s that vitamin K injections might increase the risk of leukaemia, and says many further reports have disproved this and that current well-informed scientific opinion is that there is no risk. Both NHS inform and NCT stress that it is parents' decision, and NCT says it is okay to take some time to decide. Anyone who does not want their baby to have vitamin K can talk to their midwife or doctor and should know the warning signs below.

Kingston and Richmond NHS Foundation Trust lists bleeding from the umbilical cord stump, in the urine, from the bottom, and from the skin and mucous membranes such as the nose and gums. NCT adds easy bruising, especially around the head and face, bleeding from the site of a previous medical intervention such as the heel prick test, jaundice after the first two to three weeks, blood in wee or poo, black tarry stool after the first 2 to 3 days, vomiting blood, paler than usual skin, seizures and changes in behaviour such as excessive sleepiness, not eating or irritability.

Rotherham NHS Foundation Trust notes that many babies who later suffer bleeding in the brain have had earlier minor bleeds from the skin, nose or mouth, so any minor bleeds or bruising in the first six months of life must be looked at urgently. Kingston and Richmond NHS Foundation Trust says to make an urgent GP appointment or call 111 if your baby has not had vitamin K and you notice signs of bleeding, and to call 999 in an emergency.