Wednesday November 26, 2014

Anti-vax spawns anti-vitamin K


It comes as no surprise that the anti-vaccination movement has spawned yet another misinformed offspring in the form of parents refusing the newborn vitamin K shot and putting their children at risk of Vitamin K deficiency bleeding (VKDB)—formerly known as Hemorrhagic disease of the newborn.

All babies are born with deficiency of vitamin K, a blood coagulant.

One representative post on a forum by someone going by the name “earth-mama” (also representative of the types of handles on the site) stated: “I feel that overall it probably is not necessary because babies are born that way most likely for a reason (I don’t have any research though).”

Why people don’t just go and find the research rather than engaging in self-affirming circular forums of misinformation is beyond me. Nevertheless, like the anti-vaxxers, it seems their gut feelings are more trustworthy than decades of medical research.

Whether there is a good “natural” reason for babies being born this way or not is moot. Do you know what else is natural? Children suffering brain damage or even dying from VKDB.

According to the Centers for Disease Control and Prevention (CDCP), the incidence of early VKPD (first week of life) without the injection is between .25 and 1.7 per cent of live births, while 4.4 to 7.2 infants in 100,000 would develop late VKDB.

Furthermore, “The relative risk for developing late VKDB has been estimated at 81 times greater among infants who do not receive intramuscular vitamin K than in infants who do receive it,” CDCP states.

Unfortunately, there is no shortage of self-proclaimed “experts” out there with slick websites citing dubious science to scare the daylights out of prospective parents.

One such, who calls herself the “Healthy Home Economist” and goes simply by “Sarah” states in a blog post titled “Skip that Newborn Vitamin K Shot” that “Midwifery Digest, Vol 2 #3, September 1992 estimated that the chance of your child developing leukemia from the vitamin K shot is about one in 500! This means that the risk of developing leukemia from the vitamin K shot is much higher than the risk of bleeding on the brain which the vitamin K shot is supposed to prevent!”

Although one study in the early 1990s (more than 20 years ago to put a fine point on it) did raise some alarm bells, that research has been thoroughly discredited since and dredging up these erroneous fears or willfully ignoring the evidence is egregiously irresponsible.

Furthermore, Sarah recommends an alternative that is simply bad advice: “…eat lots of leafy greens in the weeks before your due date (I drank a cup or two of nettle tea every day in the final weeks which is loaded with vitamin K1) to make sure your blood is high in vitamin K and of course, this will transfer to your baby as well.”

This is debunked by myriad medical practitioners including Rebecca Dekker, PhD, RN, APRN (an actual expert), in a blog post titled “Evidence for the Vitamin K shot in Newborns” on the Evidence Based Birth website.

“There is no good evidence that giving the mother extra Vitamin K during pregnancy can prevent VKDB in infants,” Dekker writes citing real science.

She does, however, mention a couple of promising preliminary studies that demonstrated it may be possible to elevate the levels of vitamin K in breast milk to sufficient levels, but they involve enormous supplements for the mother and have not been tested to determine whether there is correlation between maternal vitamin intake and a reduced risk of VKDB. It also does not address potential risks to mothers of taking massive doses of the vitamin.

The great irony here is that breast-feeding has been elevated to a panacea of good health for infants in the circles most hostile to the vitamin K shot, but it is babies who are exclusively breast-fed who face the greatest risk of late VKDB.

There is ongoing research into alternatives to the shot, but in the meantime health authorities including the Canadian Paediatric Society (CPS) and the College of Family Physicians of Canada view injection as the preferred method.

“Vitamin K1 should be given as a single intramuscular dose of 0.5 mg (birthweight 1500 g or less) or 1.0 mg (birthweight greater than 1500 g) to all newborns within the first 6 h after birth following initial stabilization of the baby and an appropriate opportunity for maternal (family)-baby interaction,” the two groups said in a position statement dated February 2014.

Countries such as Germany, Britain, Sweden and Australia that switched to oral administration saw spikes in late VKBD. That was not the case in the United States where the American Academy of Pediatrics has never deviated from intramuscular administration since the practice became standard in 1961. The only spikes in the U.S. have been due to parents refusing the shot.

Another poster on the thread going by the handle “awallrising” said, “IMO (in my opinion) if we needed Vit K at birth, babies would make it before leaving the womb.” What struck me about this post—aside from the fact that basing medical decisions on unfounded opinion is reckless—was she tagged it with a quote attributed to Albert Einstein: “Unthinking respect for authority is the greatest enemy of truth.”

I agree with that concept in the sense that the process of science is never fully complete; we must always question seek to advance our knowledge. Maybe there is a good reason why babies are born this way. Maybe from an evolution standpoint, it is a mechanism of population control. In modern society, however, we have deemed preventable losses of infants unacceptable.  

“You could also make the argument that it doesn’t really matter why babies are born with low levels. The point is that they are born with low levels of Vitamin K, and that some babies will die from Vitamin K deficiency bleeding if they do not receive supplemental Vitamin K at the beginning of life. Most will not bleed. But some will, and some will experience brain injury or death. And these injuries and deaths are 100 per cent preventable.”

Scientific methodology compels researchers to continue to look for the reason why children are born deficient in vitamin K and for better ways to deal with the associated risks.

But that is the theory. In practice, when making informed medical decisions, the only logical choice is to depend on the best current evidence available. That evidence says to give babies a vitamin K shot within six hours of birth.

Until someone finds wbetter evidence, I think I’m going to have to go with the authorities on this one.



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