::New Feature!:: Discussing the Evidence: Vitamin K

We thought we would introduce a new feature here on SMNET to help support us all to become evidence informed practitioners and help get us all used to reviewing and discussing up to date evidence. We will have a monthly or bi-monthly (depending on how it goes) topic to discuss.

As this feature was in part inspired by some posts in the current vitamin K thread the topic for this first discussion will be vitamin K. The difference is that here we discuss evidence in order to help us form our own answer to a relevant clinical question and therefore inform our own practise and help us provide up to date relevant information to women to enable them to make an informed decision.

The question: Is there a need for every infant in the UK to receive a dose of vitamin K at birth?

The rules: This is a thread for discussing evidence that we have read ourselves only, there are other places to discuss our own experiences and what we have been taught/seen at uni or on placement on the forum. Please provide a reference where appropriate but do not quote large parts of the literature as part of the purpose is for people to learn to look for and read the evidence for themselves and form their own opinion on it. We are not going to be picky on how you reference as long as sufficient information is given to be able to find the source.

Two reccomended sources are:

The Cochrane library

NICE

as these sources are freely accessible so SM2B's may not feel excluded and they are sources we all need to get used to using on a regular basis.

I hope we'll see some good discussion and debate x

Please do let us know where your evidence is coming from Trabonite as from what I have read so far on what's available in the cochrane library, Vitamin K deficiency bleeding (VKDB) can be early, classic or late onset and from what I can gather Vitamin K administration is ineffective against early onset VKDB which is typically intercranial bleeding and occurs in first 24 hours (and associated with anitcoagulent or anticonvulsent exposure in utero).

However Classic VKDB (1 to 7 days post delivery) most commonly occurs as mucocutaneous bleeding and late onset VKDB occurs mainly in babies with liver or Gastrointestinal diseases that impair the uptake of fat soluble vitamins from diet so I'd be interested to know why babies who have had ventouse/forceps are more at risk. I suspect it is a misconception that babies without obvious trauma are less at risk of developing VKDB.

I am currently of the opinion all babies should be offered it as it's just not worth the risk for something so easily prevented when you just can't tell which babies are at risk until it's too late. If parebts refuse it on the grounds of no obviuos trauma I would explain what I have just written above, if they still refuse it's their choice but it wouldn't be an informed one if I agreed their baby was at less risk due to lack of trauma imo as it currently stands.

Excellent thread

hey can we use references from anywhere or does it have to be 'proper' sources like NICE etc?

What do you mean anywhere? Ideally a recognised source but as the point of this thread is to discuss evidence, as long as you say where it is from then we can discuss it as we can also discuss how reliable we think said evidence is. It's pretty much a given that a cochrane review is reliable, but everything is up for discussion.

Ok here's my input why I think all mothers should be 'encouraged' WITH the facts and information to let their babies have the vit K injection:

The department of health recomend that all babies should be given vitamin k after birth because although there are some factors which make certain babies slightly more at risk ANY baby can get vkdb, even with NO risk factors and it can cause brain damage and be fatal and have no warning signs at all! isn't it better to prevent it happening whatsoever than taking the risk of thinking that because it was a normal birth or whatever they are at a 'low' risk.

After the study that showed there was a slightly increased chance of cancer with the jab vit k was switched to oral instead of injection and what happened? Instances of vkdb (or hdn as it was called) went up! So this one of the reasons I think that the injection is a better method. After the initial study further studies were conducted which showed absolutely no link between the vit k injection and childhood cancer.

Some people think it should only be offered or suggested to babies at a higher risk (e.g. c sections, breastfed etc) but it is thought babies with other problems such as liver problems that may be hard to detect until it is too late are at a high risk as well, and as for feeding mothers can easily swap between bf/formula so in my mind that should not be taken into account

(from NCT, midirs and department of health)

I don't know, i never know what is classed as a valid source or whatever lol ignore me