Organic Kids, Posts

Newborn oral vitamin K dose and recommended brand, a vitamin K shot alternative

The internet is full of articles, blogs, on vitamin K shot and why it may not be safe. Instead of re-iterating the same information over and over, I would like to focus on the newborn oral vitamin K dosage and supplementation.

If you are in the dark, start here and here.  But just in-case:

See all of the products mentioned in this article

Brief background

Vitamin K is a vitamin necessary for blood to clot and is essential in preventing vitamin K Deficiency Bleeding (VKDB). VKDB is rare but is life threatening.
There are three types:

  • Early onset disease – onset within first 24 hours
    • Maternal anti-sz meds that interfere with vitamin K metabolism (phenytoin, phenobarbital, carbamezepine, or primidone)
    • Maternal anti-coagulants (coumadin, aspirin)
    • Maternal antibiotics, especially cephalosporins
  • Classic disease – onset between day 2 – 7
    • Breastfeeding exclusively
  • Late onset disease – onset between 2 weeks and 6 months
    • Marginal levels of vitamin K in breast milk
    • (Infant) Cystic fibrosis
    • (Infant) Celiac disease
    • (Infant) Chronic diarrhea
    • (Infant) A1-antitrypsin deficiency
    • (Infant) Hepatitis                                                  (source)

“Late-onset vitamin K deficiency bleeding tends to be more severe than early-onset or classic disease and has a high frequency of intracranial hemorrhage. Intracranial hemorrhage is observed in more than 50% of infants with late-onset disease.” (source)

The practice of administering vitamin K at birth has been around since 1944; the recommendation has not been changed since or even followed up on with any research. Use of foreceps and later a vacuum was common, the umbilical cord was cut immediately and breastfeeding was delayed.

  • Delay cord clamping to provide baby with his/her nature intended blood that is rich with clotting factors
  • Breastfeed soon after delivery so baby gets the vitamin K rich colostrum

“One of the most disturbing aspects of the vitamin K controversy is that there is little research to determine whether such high levels of vitamin K might be harmful to a newborn in some way. Research regarding vitamin K has only looked at the effect on HDN, the bleeding issue.” (source)

Options

Vitamin K intramuscular prophylaxis at birth (shot)

There are two brands.

Hospira.

Read about it here but it is not pretty. “Each milliliter contains phytonadione 2 or 10 mg, polyoxyethylated fatty acid derivative 70 mg, dextrose, hydrous 37.5 mg in water for injection; benzyl alcohol 9 mg added as preservative. May contain hydrochloric acid for pH adjustment.” And “Benzyl alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants.”  Also, “Benzyl alcohol as a preservative in Bacteriostatic Sodium Chloride Injection has been associated with toxicity in newborns. Data are unavailable on the toxicity of other preservatives in this age group.”  In addition to “WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they required large amounts of calcium and phosphate solutions, which contain aluminum.  Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.”  And finally, “Deaths have occurred after intravenous and intramuscular administration.

Marcella Piper-Terry, M.S, long time vaccine safety advocate and founder of this website warns: “Hospira LOOKS like (from this photo) it contains 100 mcg of aluminum. It does not. The label reads “no more than 100 mcg of aluminum per LITER.” Each dose is .5mL (1/2 milliliter). There are 1,000 mL in 1 Liter.  ALUMINUM is NOT the problem. The problem with Hospira is that it contains 9 mg. benzyl alcohol, which damages the liver and contributes to the high frequency of infants who develop jaundice within two days of birth.  What IS VERY interesting about this is that the Hospira vial contains the information about aluminum at all. That’s because aluminum is limited in injectables to 5mcg/kg of body weight because at higher doses it causes kidney failure and brain damage. The information on the Vitamin K Injection is there because it is NOT a vaccine. Vaccines are somehow exempt from the rule about aluminum in other injectables.  Here’s another interesting tidbit…  At 100 mcg/L, you would have to inject TWO AND A HALF LITERS of the Hospira Vitamin K to reach the same level of aluminum that IS injected on the first day of life when an infant receives the Hepatitis B vaccine.”

Amphastar.

More here.  “Each 0.5 mL contains 1 mg phytonadione (Vitamin K1 ), 10 mg polysorbate 80, 10.4 mg propylene glycol, 0.17 mg sodium acetate anhydrous, and 0.00002 mL glacial acetic acid. Additional glacial acetic acid or sodium acetate anhydrous may have been added to adjust pH to meet USP limits of 3.5 to 7.0.”  Polysorbate 80 and Propylene Glycol are both neurotoxins.  See for yourself: MSDS sheet for Polysorbate 80 and MSDS sheet for Propylene Glycol.

Very similarly to Hospira, Amphastar brand warns that “Severe hypersensitivity reactions, including anaphylactoid reactions and deaths have been reported following parenteral administration. The majority of these reported events occurred following intravenous administration…  The possibility of allergic sensitivity, including an anaphylactoid reaction, should be kept in mind following parenteral administration….  Transient “flushing sensations” and “peculiar” sensations of taste have been observed, as well as rare instances of dizziness, rapid and weak pulse, profuse sweating, brief hypotension dyspnea and cyanosis…  Pain, swelling, and tenderness at the injection site may occur…  Infrequently, usually after repeated injection, erythematous, indurated, pruritic plaques have occurred; rarely, these have progressed to scleroderma-like lesions that have persisted for long periods. In other cases, these lesions have resembled erythema perstans…  Hyperbilirubinemia has been observed in the newborn following administration of phytonadione. The has occurred rarely and primarily with doses above those recommended…”

Going back to Marcella Piper-Terry: “In January 2016, The American College of Pediatricians issued a statement indicating their concern about the amount of Polysorbate 80 in the HPV vaccine and the increased risk of infertility from premature ovarian failure (POF). Each dose of Gardasil contains 50 mcg. of Polysorbate 80. Amphastar Vitamin K injection contains 20 TIMES the amount of Polysorbate 80, when compared to Gardasil. What do you suppose that is doing to the future fertility of our children? Polysorbate 80 is also used in research to increase the permeability of the Blood Brain Barrier (BBB) – not a good thing when you are talking about babies whose BBB is already not completely impermeable…  Here is the link to the press release about Polysorbate 80 and POF”

Lets note that the injection is 20,000 times greater than the levels at birth. It is recommended this massive dangerous dose is injected within an hour of birth.  Injecting and ingesting are two very different processes with very different effects.

Oral prophylaxis

When I was pregnant with my daughter, I have already been through quite a few adventures with my son. I am not advocating going in ‘naked’ and not administering anything. The proponents of no supplementation do have a point tough. If every infant is deficient in vitamin K, does that mean nature made a mistake? I don’t know, as it rarely does…  And the doctors dont know either.

Baby’s digestive system is not fully developed and the liver is not as functional.  Excess vitamin K may not be a great idea.  Interestingly, cord blood is full of stem cells that travel anywhere, including crossing the blood brain barrier to repair damage.  By administering vitamin K (oral or intra muscular), these stem cells cannot move as freely and get to where they need to go and repair the damage.  Read more here.

I however did not feel comfortable not giving anything and instead opted for oral vitamin K supplementation.

Lets talk dosage

These oral vitamin K doses were recommended most often:

  • 1 mg oral vitamin K at birth, followed by daily doses of 25 mcg from 1 week to 3 months of age
  • 1 mg oral vitamin K at birth, followed by 1 mg weekly oral doses to 3 months of age

Even Stanford has conflicting recommendation:

  • 2 – 4mg PO vitamin K after first feeding then 2mg at 2 – 4 weeks and again at 6 – 8 weeks OR
  • 2 – 4mg PO vitamin K after first feeding then 2mg within first week and weekly while breastfeeding OR
  • 2mg PO vitamin K after first feeding then 2mg within first week followed by 25mcg daily for 13 weeks

So which is it?

When in doubt, ask pub med. Be sure to take these to the hospital in case anyone tries to pressure you into the shot.
My protocol is based on the following:

Infants with biliary atresia (rare liver disease) is the main argument against oral vitamin K vs injection; however there is research that includes newborns with biliary atresia.  See this 2008 study. Vitamin K deficiency bleeding was noted in

  • 25 of 30 of breastfed infants on 25 microg of daily oral prophylaxis (77.5%)
  • 1 of 13 on 1 mg of weekly oral prophylaxis (7.2%)
  • 1 of 10 receiving 2 mg of intramuscular prophylaxis at birth (9.3%)
  • 1 of 98 formula-fed infants (P < .001)

It would seem that even if your baby has that rare condition, the oral vitamin K regimen is sufficient. In fact, it is more effective than the shot.

“A daily dose of 25 microg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia. One milligram of weekly oral prophylaxis offers significantly higher protection to these infants and is of similar efficacy as 2 mg of intramuscular prophylaxis at birth.” (here is that study again)

Another good study that looked at 507,850 babies. “Weekly oral vitamin K supplementation during the first 3 mo of life was an efficient prophylaxis against VKBD. Parental compliance with the regimen was good.”  In addition, “… late VKDB, with onset from 2 to 12 weeks of age, is most effectively prevented by parenteral (oral) administration of vitamin K.” (source)

Why I do not like the 25 micrograms daily, even for healthy infants:

  • We don’t know which infant will have the rare liver condition and there is a dose that would cover such baby.
  • This 2009 review… “If given orally, prophylaxis should be continued by either weekly administration of 1 mg untill 12 weeks or repeating 2 mg at weeks 1 and 4. Daily administration of 25 microg offers insufficient protection. The only infants not fully protected in this way are those with yet unrecognised liver disease.”
  • And finally, the 25 mcg dose is precise and I am not aware of a supplement with this particular dose.

What I did and where to buy:

2mg at birth followed by 1mg weekly for 3 months (until age 13 weeks) based on the above mentioned, this study and this study and this study.

2mg at birth because that is the amount in the injectable form; followed up with 1mg weekly because that seems to be the optimal dosage recommendation even for babies with the rare liver condition.

Where to get the infant oral Vitamin K drops

This brand has the correct, easy dosage 2drops = 1mg
*4 drops = 2mg Please note, this is the only correct form of K – vitamin K1. “There were reports of hemolytic anemia and hyperbilirubinemia severe enough to cause kernicterus in the mid 1950s with high doses (50mg) of vitamin K2 (menadione). As a result, use of this form of vitamin K was abandoned. We now give infants vitamin K1 (phytonadione).” (source)

So…  4 drops within hours of birth, followed by 2 drops weekly until 13 weeks of age.

 

Don’t forget the vitamin D. I love this brand. Basic organic ingredients. We supplement 400 IU daily in the summer and up to 1,000 IU daily in the winter.  Mayo Clinic says “If you’re breast-feeding or partially breast-feeding your baby, give your baby 400 international units (IU) of liquid vitamin D a day — starting in the first few days after birth.”

Slightly off topic but important…  Recommended daily intakes from various organizations:

vitamin-k-dose-for-infants

 

Final Notes

Whatever option you choose, some babies do not respond in the intended way.

If you are taking drugs that inhibit vitamin K, consider the vitamin K shot for your baby.

If a baby has a traumatic birth and experiences bruising or shows any clotting difficulties, then consider the vitamin K shot.

“There may be a very few babies with undiagnosed liver disease who would not be protected by a physiological birth and weekly oral vitamin K supplementation, so parents need to be vigilant for unusual signs of bruising or bleeding, regardless of whether the baby receives vitamin K supplementation. It is generally believed that a prompt response to these signs will prevent long-term problems for the baby.”

When the blood is drawn from the placental blood vessels after birth to check the baby’s blood type, ask the provider to observe the clotting. If the needle entry point seems to bleed more than usual, consider vitamin K shot.

Do not let your baby out of sight. Nurses are tired and overworked, sometimes they ‘forget’ and will administer whatever is routine. Ask to explain everything they will do before they touch your child.

Have a written natural birth plan.  Check out my sample natural birth plan.

Consider a midwife instead of an obstetrician. Midwifes specialize in births; doctors specialize in critical births and labor situations such as C sections. Most likely you will not get your physician during your labor, rather whoever is on call from their practice anyway…

Delay cord clamping.

Reject eye ointment.

Consider forgoing circumcision. Many parents regret their decision. Current rates are 50% and it will be even less.

Say no to hepatitis B vaccine

Reconsider vaccines in general. Majority of the time the well read women who choose not to vaccinate do so AFTER a vaccine reaction. I was once a proponent of vaccines and vaccinating my son is one of my biggest regrets. There are hundreds of thousands of women like me.

Products mentioned in this article:
 


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18 Comments

  • Reply Stacy October 31, 2016 at 2:44 pm

    We did oral drops with my second but the nurses questioned just how good they are. The studies you link to are fantastic. Nobody can debate the effectiveness of the oral drops with these! I am printing and will be bringing with me. This time I am truly prepared. Thanks!

  • Reply Juliana November 3, 2016 at 7:26 pm

    Great read. Thank you.

  • Reply Isabella November 7, 2016 at 9:07 pm

    OhMyGod! I was so tired of finding these conflicting recommendations for how much to give, some say daily, some say weekly… Finally, thank you for linking to published research. Finally, a recommendation based on science!

  • Reply Lindsey November 15, 2016 at 9:15 pm

    Hello,

    Any thoughts on the science behind why oral drops can be stopped at 13 weeks or 3 months? Does the gut start making vitamin k better then? Or has enough built up over the weeks?

    I didn’t think I would supplement but then got freaked out and started at 2 weeks with 1mg a week. Baby is now 14 weeks so I’m trying to decide if I can stop or should give them for a full 13 weeks. The drops contain sesame seed, and I’m trying to do an elimination diet so want to quit as soon as possible.

    Thanks for your thoughts!

    • mm
      Reply Anele November 22, 2016 at 3:17 am

      Great question! Majority of medical literature defines late onset VKDB to be between 2 weeks and 2 months of age. Some say between 2 weeks and 12 weeks. Stanford University is of the more conservative and states it can be seen as late as 6 months after birth.

      I have seen studies that say VKDB can be seen anytime between 8 days and up to 12 months of age. Most literature though states that late VKDB generally presents itself between four to eight weeks. Hence a conservative recommendation for oral supplementation up to 13 weeks? It would seem so, however I do not know exact reasons. Oral vitamin K supplementation is not widely recommended so it is very hard to find good information… But every study I have seen talks about that 13 week date.

  • Reply Lisa Groth November 16, 2016 at 4:47 pm

    “Even Stanford has conflicting recommendation”
    I know!!! I googled until I was literally blue in the face. Just exhausting and so confusing. Like I dont have enough on my plate being 36 weeks pregnant and still working… This clears it up and nobody can fight the quoted study. A huge weight lifted off my shoulders.

  • Reply Eliza Rose November 22, 2016 at 2:40 am

    This is super. Thank you.

  • Reply Terri B December 2, 2016 at 5:16 am

    Printing as we speak. Let them come at me with the shot. I’d like to see their published research. Thank you, I really, really did not want to do the vitamin K shot. I feel at ease, and at peace with my decision. And most of all I am confident enough now, armed with studies so I can fight off any uneducated nurse or doctor. Thank you!!

  • Reply Readsunlove December 5, 2016 at 4:52 pm

    I think this is a great synopsis of what’s out there on this topic – thank you!

    From my attempts at reading up on this topic here is what I have determined to be indisputable FACT:
    – there is NO DOUBT that giving the shot gives the greatest level of protection against VKDB
    – there is NO DOUBT that giving oral vitamin K provides increased protection against VKDB over nothing at all
    – there IS DOUBT that giving newborns vitamin K in the first place is even necessary
    – there IS DOUBT that the shots are harmless and there are no side effects whatsoever

    It is very rare that any given newborn would experience the problems that vitamin K protects against (which is true with a great number of medical interventions designed at prevention…but will your baby be one of the rare ones with an issue, which can be prevented? Hard to know!)

    I’m opting for oral vitamin K. I don’t REALLY think it’s necessary, but I also don’t think there’s a risk of harm with the oral version, versus the shot.

  • Reply May January 31, 2017 at 11:20 am

    Hi where can I buy oral vitiman k1? I have been searching but only find oral vitiman k2 which is not recommended first new born.

    • mm
      Reply Anele February 3, 2017 at 9:16 pm

      May,

      The only supplement that has a correct dose that I am aware of is available here. 2mg at birth followed by 1mg weekly for 3 months (until age 13 weeks) based on studies mentioned in the blog post.

      With this particular brand, the correct, easy dosage is 2 drops = 1mg… So 4 drops at birth, followed by 2 drops weekly for 3 months.

      This is the only correct form of K – vitamin K1. According to quoted studies, K2 should NOT be given to newborns. As always, consult a healthcare professional to confirm.

  • Reply Adrienne March 4, 2017 at 1:19 pm

    Thank you for providing a concise synopsis of the Vit K. We will be doing oral drops and have printed your studies to bring along with us. I wanted to ask you if you had a particular way of GIVING the drops? I’ve read several mothers who give during breastfeeding by dropping on the nipple. What do you recommend? I’ve asked 3 Periatricians and they say they can’t comment bc the AAP doesn’t discuss oral only the injectable (hard to find a holistic minded physician). TIA!

  • Reply Kayla May 19, 2017 at 8:53 pm

    Hi. I was interested in doing a plant based K1 supplement instead of the synthetic form of Vit K but am unclear about dosage. Do you have any recommendations for that?

  • Reply Kendra May 29, 2017 at 10:17 pm

    As the birth of our 2nd baby neared I decided against the Vit K Shot and wanted to go with oral drops. While laboring at the birth center (within a hospital) I found out that opting for oral drops meant we had to provide the drops (did not know that) Fast-forward a week later after the birth & I finally remembered to order the drops (which I happened to get the brand listed in this article) but could NOT find a good dosage info site. So I’ve been winging it the last 2 weeks on what she’s supposed to get daily. She’ll be 4wks old on June 2,2017……….I’m hoping that since she’s gotten on average 1-2 drops every other day for the last 2wks that she’s getting the right amount of Vit K to prevent VKDB. Now reading that some studies suggest that late VKDB can happen up to 6months post birth I’m confused. Docs at the birth center told me up to 3months of age is when VKDB can happen. And I’m exclusively breastfeeding, which according to these studies increases her chances of VKDB. :/
    Now I’m just hoping & praying that our late start to getting the Vit K drops won’t hurt our 2nd baby in the long run.

  • Reply Bre June 7, 2017 at 11:23 pm

    When you did your protocol at birth and weekly, was it before or after feedings?

    • Reply Bre June 7, 2017 at 11:32 pm

      If you did during feeding or after did you apply the drop on your breast or in the baby’s mouth/cheek? Did the 1 fl oz bottle of the Vit K last you the entire protocol or was another bottle required? Thanks again!

  • Reply Rhonda September 13, 2017 at 2:11 am

    I know I’m not doing the K shot but I’m concerned about the dosage of oral vitamin K. 4 mg is about 4800 times the recommended daily dose for adults. Is that amount safe for a tiny newborn that has no detoxing capabilities? Is that high of a dose really necessary?
    Thanks so much for all your great research!

  • Reply Monika October 18, 2017 at 3:36 am

    Hi there, Great article. Could you please send me this article to my email. I am having difficulties printing it from here.
    Monika

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