In the last video, we reviewed the importance of vitamin K by identifying the sources of this vitamin in our diet, and the reasons why newborns lack this vitamin. Next, let's use what we learned to discuss vitamin K deficiency bleeding in newborns. Vitamin K deficiency bleeding or VKDB, is the term used to define a bleeding disorder in which the inability of the blood to clot is rapidly corrected by vitamin K supplementation. There are three different types of vitamin K deficiency bleeding in newborns. Depending on the timeframe in which the bleeding presents or occurs, these presentation timeframes are called early, classic or late-onset vitamin K deficiency bleeding. The first way that bleeding can present, is during the first 24 hours of life labeled as early onset vitamin K deficiency bleeding. This almost exclusively occurs in newborns who are born to mothers on certain medications that inhibit vitamin K. These medications include some anti-seizure medications, some anti-tuberculosis drugs, and medicines to help decrease blood clotting called vitamin K antagonist. Meaning they interfere with the formation of blood clots. The presentation is usually severe, presenting with bleeding and swelling of the scalp or Cephalus hematoma, intracranial bleeding or bleeding in the brain, and intra-abdominal hemorrhages which means bleeding into the abdomen. The next type of bleeding that can occur, is classic onset bleeding, which typically occurs between 24 hours and seven days of life. This may present with more mild symptoms but can also lead to significant blood loss. This may present as skin bruising, bleeding from the umbilical cord site, bleeding from puncture sites in the skin or from procedural sites such as circumcision or intestinal blood loss. Lastly, vitamin K deficiency bleeding can present as late onset disease. This can occur from two to 12 weeks, but may present as late as four to six months of age. Is associated with exclusively breastfed infants because formula fed infants will get vitamin K in their formula. Bleeding that occurs in late onset disease can be very severe, leading to severe damage to the brain and nervous system and possibly death. These bleeds can occur as spontaneous or sudden bleeding into the brain, and often occur without any warning signs. This may present as irritability, lethargy, meaning tiredness or lack of energy or seizures. There is a mortality rate or rate of death of up to 50 percent in late onset head bleeding, and permanent damage to the neurologic system is common if survival occurs. Late onset bleeding is rare, but infants who did not receive the vitamin K injection at birth are 81 times more likely to develop late bleeding compared to those infants who receive the injection at birth. So vitamin K deficiency bleeding can present in many ways in a newborn. Although vitamin K deficiency bleeding in newborns can be potentially devastating, fortunately, the vitamin K injection is available. It prevents virtually 100 percent of vitamin K deficiency bleeding in newborns. There are different formulations available of the vitamin K injection for newborns. Currently in the US, it is recommended that a one milligram dose of vitamin K be administered into the muscle for all newborns within the first six hours after birth. The risks of the vitamin K injection are similar to other injections. Pain at the injection site is the most common risk with rare cases of scarring at the injection site and only one single case of an allergic reaction ever noted. What are the ingredients of this life-saving vitamin K injection? These may vary slightly depending on the manufacturer of the drug. Pictured, is a list of the typical ingredients of a vitamin K injection. The main component of the injection is the dose of vitamin K itself, which may seem like a high dose compared to the daily requirement of vitamin K. However, this dose is appropriate for several reasons. First, the vitamin K has one part that gets absorbed right away into an infant's bloodstream to prevent very low vitamin K levels in the days after birth. The extra vitamin K that gets absorbed, is stored in the liver and is used to make more clotting factors. Second, the rest of the vitamin K dose is stored in the muscle, where it is injected and it is slowly released over the course of several months to prevent late onset vitamin K deficiency bleeding. This helps provide the necessary vitamin K amount until the infants get more of the vitamin from their diet. Other components of the injection are present in very small quantities. These include ingredients that keep the vitamin K mixed in liquid and those that keep the liquid from being too acidic. These ingredients are safe. Although we know the vitamin K injection has been found to be safe and effective, some parents may refuse this intervention for their newborn. There are many reasons why a parent may have concerns or fears over the administration of this injection. Here, we will review a brief, but not comprehensive list of common reasons for vitamin K injection refusal. Some concerns have circulated regarding a relationship of the vitamin K injection to childhood cancer. There has been no proven relationship between vitamin K and childhood cancer or Leukemia. Other concerns exist regarding toxic or poisonous components of the vitamin K injection. As described in the previous slides, the components are safe and effective. A parent may worry that the dose of vitamin K given to their newborn is too high. Again, as previously described, the dose is appropriate and is not fully released into the infant system all at once. Some parents may wish to avoid pokes to their baby due to the discomfort of an injection. Remember, a newborn who has just been delivered has been through a lot of discomfort compared to the brief pain from the injection, and the benefits of the injection can be lifesaving. Mothers may breastfeed during the injection to help reduce comfort. Lastly, some parents may want to provide oral vitamin K as an alternative for their infant. However, there is no consensus on the efficacy of oral vitamin K or the standard dose or regimen that should be used. Oral vitamin K is not consistently absorbed by the intestines and does not provide adequate amounts of the vitamin for a breastfed newborn. Most importantly, oral vitamin K has not been shown to prevent late onset vitamin K deficiency bleeding, which can be the most severe and life-threatening type of bleeding. This is a lot of information to learn regarding vitamin K, deficiency bleeding in newborns. Let's take a moment to review. Vitamin K deficiency bleeding in newborns can occur as early, classic or late onset bleeding. The consequences of this bleeding can be severe, but giving the vitamin K injection to newborns virtually 100 percent prevents classic and late onset bleeding. In the next video, let's demonstrate how to actually give an intramuscular injection, meaning an injection into the muscle such as the vitamin K injection to a newborn.
