Neonatal Vitamin K: To Jab or Not to Jab

I’m going to have to pause the Circadian series this week to share a post that is slightly more relevant to my current family event. I have nearly a dozen articles on circadian ready for you, but I don’t think I have enough patience to wait before sharing what I want people to know about neonatal Vitamin K. If this is in your interest, be prepared for a longer read. This writing really was triggered by our recent antenatal visit at the Bundaberg Base Hospital.

Many of you know that my wife is expecting. We decided to engage with the conventional medical system and check out what our Bundaberg community has in terms of maternity services. At my wife’s request, I am present at every contact she has with the obstetric team. We thought, if we didn’t like the service they offer, we could always withdraw at any point. I had also heard from a number of patients about how some other maternity services are lacking in their outward demonstration of respect for mothers-to-be.

Our experience has been nothing but exceptional. We met multiple midwives, doctors, and consultant obstetricians who all seem to have the same high-standard work ethics—professional, understanding, caring, and respectful. Some don’t know that I am medical; others learned halfway through the consult that I am—but their performance didn’t seem to be influenced by that. We discussed our preferences when it comes to preventative health and I have not noticed an eyebrow being raised—not that it is wrong to raise one respectfully. I have confidence that they are working in our best interest. The current verdict is that, if you are expecting, give them a shot.

Talking about shots, most people know that newborns are advised to have Vitamin K injections in the muscle. It has only been since COVID that more and more people are really becoming sceptical about all jabs, and neonatal Vitamin K jabs are not spared. I think scepticism is healthy as long as it is paired with curiosity. Perhaps today we should exercise these two and see where they take us?

First of all, Vitamin K deficiency bleeding (VKDB) is a real life-threatening condition all newborns are at risk of. This is backed by epidemiology, physiology, research, and statistics. The placenta, although very good at accepting a lot of nutrients from the mother, takes very little Vitamin K to pass onto the fetus, as hypercoagulability is a huge risk factor for miscarriage. We know this from women with Factor V Leiden deficiency and positive antiphospholipid antibodies—a term pregnancy is akin to a miracle in these poor ladies. Vitamin K, if allowed to pass through the placenta, risks clotting in the fetus as it is an anti-bleeding vitamin. Countries which have not been able to take up the programme have continued to demonstrate ongoing infant mortality incidents from VKDB (about 8 per 1,000) when the rest of the world no longer registers a single case of it in neonates who are given the replacement.

Our knee-jerk reaction might make us think that there are more natural ways to prevent the VKDB deaths. What about breastmilk and colostrum? Surely they have everything that the infant needs? What if we increase the mother’s intake of the right foods? What about sunshine? Doc, you said sunshine can do great things, didn’t you?

Let’s put things into perspective. Here are the things we should consider: infants are born with zero Vitamin K storage in the liver, and the convention thinks they need around 2 micrograms of it daily. A litre of colostrum provides 3 micrograms of Vitamin K, but I promise you no baby will chug down a litre of colostrum. At most, they can manage a few tablespoons. A mature mother’s milk provides 2 micrograms of Vitamin K per litre, but it will be a few months before these little people can manage to take in a litre of milk. Formula milk is better in this particular subject, as we can put as much or as little vitamin as we want—it has around 50 micrograms per litre. You can ramp up the mother’s Vitamin K intake so it spills into the milk, but it is almost impossible to achieve this with food alone. Dr. Frank Greer did this in 1997 and showed that to get mother’s milk to have 80 micrograms of Vitamin K, mothers had to be given up to 5,000 micrograms of supplemental Vitamin K. A little bit over the top, I think, especially when adults only normally have about 100 micrograms a day. Because VKDB can happen anytime up until 6 months of age, you’ll have to keep this rate of supplementation for half a year, and the mother will probably still end up at the doctor's office at the end of this period from the unwanted consequence of oversupplementation.

The main reasons why this risk diminishes at 6 months are weaning and gut bacteria establishment. The infant is more likely to get Vitamin K when exploring foods other than their mother’s milk. Assuming that the infant has not had gut microbiome-destructive antibiotics, most children at 6 months are taking Vitamin K as rent payment from their little microscopic gut residents as an exchange for giving them their home. But again, if they are exclusively breastfed—and I am pro-breastfeeding whenever it is possible—the Vitamin K deficiency bleeding risk remains higher than baseline.

On the other hand, parents have genuine concerns about the injection to their pristine newborn. I think this is based on some valid points—that the accompanying aluminium, phenol, Cremophor EL, Polysorbate 80, and propylene glycol in the vial have been associated with a serious side effect. Jean Golding published this in 1992 after studying 17,000 babies born in the 1970s in the UK. The medical world got rightly concerned after reading the professor’s report and reevaluated neonatal Vitamin K injection risk in multiple major studies since, but found that the association was absent.

My opinion rhymes with theirs; I don’t think they will be able to reproduce Prof Golding’s findings. But I also think her finding was real. The trick is this: they didn’t study the same product. In 1995, most countries in the world shifted to the new and more natural form of Vitamin K injection called Konakion MM. I said most countries, as unfortunately the US sticks to their guns. They pooh-poohed Prof Golding’s study and therefore still use Polysorbate 80 as a solubiliser, although this might not be as harsh as Cremophor EL which was in the British injections. So, when the subsequent studies tried to look for the association, they weren’t able to find it as the big culprits had left the scene by then.

Konakion MM is a wonderful product. Roche, the same company that developed the Cremophor-based Konakion Neonatal, realised that they had to come up with a better one. Guess what? They agree with most of you readers—the more natural the better. They formulated Konakion MM with just Vitamin K, lecithin, and glycocholic acid. These carriers are what we have in our bodies anyway. We have lecithin as part of every cell membrane and the liver makes glycocholic acid as part of our bile mix. These gentle ingredients, plus its smaller volume, also reduce aluminium leach from the glass vial such that your baby gets less aluminium from a Konakion MM injection than they do from a single day of breastfeeding. Roche went natural for this instance, and suddenly all of our problems vanished. I wish more products were made with this mindset.

There is, however, one little catch. I will admit that I almost missed this, except for the fact that there are two countries that still resist giving their babies the "safe" Vitamin K injections: Switzerland and Germany. Granted, the health authorities may not know what risks are attached to these injections—they merely are tending to a Swiss and German culture of less invasive interventions. Instead of injections, babies in these countries are getting 3 oral doses of the same Konakion MM formulation that would have otherwise gone in their thighs. That sparked the neurons in my brain to go over physiology once again. What did I miss? What is the difference between oral and intramuscular deliveries of Vitamin K?

Once again, get ready for some of my favourite science subjects—physiology.

When 1,000 micrograms of Vitamin K enters the muscle, a huge gush of it will go into the bloodstream whilst the rest will slowly seep in over a period of 2-3 months. And I mean a huge gush, considering that the baby’s blood level of Vitamin K in the first 24 hours after the injection will be between 1,700 and 2,000 ng/ml. For context, healthy adults have a fasting level of 1 ng/ml. But no doctor, and that includes myself, is worried about Vitamin K toxicity as we have a very efficient way of processing this vitamin. However, something else needs to be considered.

In our bloodstream, we have plenty of large protein boats floating around doing what they do. They are called albumin. In normal physiology, these boats trap things that the body doesn’t need immediately for later use, or things that generally, if let loose, can be harmful for the body. They are like your storage system in the bloodstream itself. These boats carry a lot of a newborn’s unconjugated bilirubin (UCB); "unconjugated" means that these bilirubin molecules are not going to mix well with water in the bloodstream. UCBs are also quite potent, such that if you have too much going around in the bloodstream you can get poisoned—a medical condition called kernicterus. When there is more than 1,000 times the concentration of Vitamin K than what the body can handle, it will displace some of these UCBs from the albumin boats, just from its sheer pressure. Now you have UCBs floating around in the bloodstream when they should not.

Seeing this, the liver quickly clears all of the UCB out. How it does this is by conjugating the UCBs, so now they have a sugar acid tagged onto them. We call them conjugated bilirubin (CB). CB is a lot safer than UCB, and it is also more water-soluble. These CBs are flushed down the biliary drain into the gut and we hope that it is the end of the scary UCB story. Except that babies are cleverer than what we think.

In the gut, where the CBs are and are supposed to exit into the nappies with all of the other nice things that do, babies do their first ever mischief before you even see it by reversing this conjugation process. Their gut cells, unlike ours, actually make beta-glucuronidase, which is like a pair of scissors that snips that sugar acid away from CB, making them UCB again. Yes, giving your babies scissors at any age without supervision is dangerous!

These UCBs are potent. But the good news is that it is not in the bloodstream to attack your newborn’s brain and other organs. The bad news is that it is not going to do nothing in your newborn’s gut. UCBs almost instantly change their gut pH to become more acidic such that good bacteria like Bifidobacteria find it hard to build their colony there. Some less preferable strains of E. coli don't mind it so much, though. That is your first bad news.

UCB is also a detergent. It will strip the healthy mucous off the baby’s gut lining, leaving it exposed to the next UCB danger: being fat-soluble, it happily dissolves itself into the actual gut cells and makes its way into the mitochondria. This is where the cells make energy. UCB is not there to help intensify the production, rather the opposite. It slows the mitochondria down via a process called uncoupling of oxidative phosphorylation. I know we haven’t gone over mitochondria properly, but for today just think of this problem like throwing a spanner in the works.

The product information on Konakion MM has acknowledged this by mentioning the gastrointestinal side effects that often come from the IM injection. You have just read how one domino block pushes another until your newborn ends up with abdominal symptoms. Since making this link, I am looking back at my "mystery" medical cases and I think I have found the answer to why their gut may have had a problem since day 1, despite no unnatural or unhealthy inputs I could identify. I think we should ask the question: is it possible that some individuals continue to have an unfavourable microbiome from the effect of the bolus injection? Remember too, the seeping dose is going to continue for the next few months, potentially fuelling the already undesirable situation. Will that change the host epigenetics such that it thinks the less healthy microbiome is the norm and therefore continues to nurture this going forward? God only knows. I only have questions.

By contrast, an oral dose’s peak serum concentration is 80 ng/ml. Oral doses also disappear quicker as the seeping depot is absent. Infants taking oral doses will need 3 doses: one at birth, then within 1 week, and finally at 4 weeks. Most healthy infants can absorb Vitamin K from their gut as this process is not foreign to their physiology (remember breast milk has Vitamin K). But I won’t put it past babies born prematurely, whose mothers were on certain medications in pregnancy, or infants born with developmental or genetic disorders. I probably won’t take the risks either with infants born via assisted delivery as they might have an internal bruise that you might want to deal with quickly.

Ultimately, whatever your choice is, make the decision with your obstetric team and consider every option properly. You might have an ideal, but sometimes events don’t unfold exactly the way we want them to. Consider mitigating circumstances, and pray for the best for the mother and the newborn. This moment can be very stressful for the whole family but at the same time it carries one of the biggest blessings that we can experience in life. A brand new life to recharge your current (perhaps waning) life. Life replacing death, and vice versa. The world is essentially that.

To answer that last question, the sun still has a major role in this all. Whatever your outcome is, I still would not forget bub’s exposure to midday sun. This special light transforms our gut bacteria such that we colonise more of the Vitamin K generators—so much for our worry about Vitamin K intake.

As I always tell my patients, creation is perfect. It is our decisions and actions that are not. 

Now for the disclaimer: 

The information provided in this article is for general informational and educational purposes only, and is not a substitute for professional medical diagnosis, treatment, or a personalised consultation.

Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or before undertaking any diet, exercise, or supplement program. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

The author is a qualified healthcare provider and the information shared is based on professional knowledge, research, and opinion. However, this article does not constitute a doctor-patient relationship or personalised medical care. Reliance on any information appearing in this article is solely at your own risk. If you think you may have a medical emergency, call your doctor or emergency services immediately.