By Erin K Costello
Last week a fellow page admin discovered a thread in an anti-vax Facebook group. This was the kind of thread we always fear finding. A mother had posted a comment informing the group her 5 week old baby had recently become very sick and was currently in the neonatal intensive care unit (NICU). It was discovered the baby was experiencing a subdural hematoma, or bleeding in the brain. The baby’s blood was unable to clot and because of this the little girl needed surgery. The mother revealed she had refused the vitamin K shot at the time of birth, and had done so in part because of the things she had read about vitamin K from inside this group. After her daughter became sick and was admitted to the hospital, she changed her mind and allowed the vitamin K to be administered. Sadly, the efforts of the NICU proved unsuccessful since the mother updated her post to say her daughter had passed away.
For granted, we don’t know what caused this little girl’s brain to begin bleeding, how long she had been bleeding for, or if this could’ve been prevented by the administration of vitamin K at the time of birth. The child’s medical team may not be able to learn the answers to these questions, let alone strangers on the internet. What we do know, however, is that her brain began to bleed sometime after birth and it’s very possible the infant's blood was unable to clot due to insufficient levels of vitamin k, and that the vitamin K shot might’ve saved the newborn’s life.
We see these posts in anti-vax Facebook groups all the time. There are posts made daily by group members asking for information on the vitamin K shot. What follows is largely lies, misinformation, and some of the worst advice possible. In this blog post I am going to share some examples of these misconceptions surrounding the vitamin K shot, and hopefully counter it with scientifically sound facts. I am not a scientist though, so don’t use my information provided here as a determining factor when deciding on the vitamin K shot. Even though I insist on pulling information from reputable sources, I am no substitute for a real medical professional. If you have any questions, concerns, or simply want more information regarding vitamin K therapy, please consult your physician or pediatrician for the most reliable information and advice.
WHAT IS VITAMIN K?
Vitamin K is a group of similar fat-soluble vitamins needed by the body to absorb certain proteins that aid in the process of blood coagulation. In other words, vitamin K helps the body take in what is needed to cause the blood to clot, or to stop bleeding. It is often found in leafy green plants since it is directly involved in photosynthesis. It does not pass well from mother to fetus during pregnancy. Because newborns are often born with lower than recommended amounts of vitamin K they are most at risk from complications caused by inadequate levels of vitamin K.
WHAT ARE THE RISKS FROM REFUSING VITAMIN K?
Since infants are born with a deficient amount of vitamin K, they are more prone to developing vitamin K deficiency bleeding (VKDB). VKDB is often classified depending on when the problem manifests; birth to early (0-24 hours), classical (1-7 days), and late (2-12 weeks). Early VKDB is usually severe and is mostly found in newborns whose mothers used certain medications during pregnancy. These medications are most commonly anticonvulsants or isoniazid. Classical VKDB is often described as bruising or bleeding from the umbilicus. Late VKDB is the most concerning type. This type usually occurs up to 6 months of age in infants who were previously believed to be healthy. About 30-60% of late VKDB cases tend to appear as intracranial bleeds. This complication is usually life threatening, and almost exclusive to breast-fed infants who received little to no vitamin K prophylaxis. Without the vitamin K shot, early and classical VKDB occur in about 1 in 60 to 1 in 250 newborns. Late VKDB occurs less frequently, 1 in 14,000 to 1 in 25,000 infants. Newborns who do not receive the vitamin K shot at birth are 81 times more likely to develop late VKDB than in those who do receive the shot at birth.
Since there are often no warning signs before a life threatening VDBK event begins, the complication isn’t usually found in a timely manner, especially in cases of late VDBK. However there are some signs that may appear in an infant after they’ve developed VDBK:
* Bruises, especially around the baby’s head and face
* Bleeding from the nose or umbilical cord
* Skin that turn pale, or gums that become pale
* After 3 weeks of age the white area of the eyes may appear yellow
* Bloody stool, stool that appears black or dark like tar, or vomiting blood
* Irritability, seizures, extreme lethargy, or excessive vomiting.
“THE BRAIN BLEEDS....WOULD HAVE ALREADY HAPPENED"
It is frightening how little anti-vax radicals truly know, especially when compared to how much they believe they know. The brain bleeds, or intra-ventricular hemorrhages (IVH), are most common to appear in the first several days of life, though can appear up to six months of age. IVH is rarely present at the time of birth. They are also more commonly seen in infants born prematurely, especially those born 10 weeks or more prematurely. The smaller and more premature an infant is, the higher they are at risk for IVH. This is largely because blood vessels grow stronger in the last 10 weeks of pregnancy. There can also be an increased risk for IVH in premature babies with respiratory distress, unstable blood pressure, or other medical conditions at birth.
Considering the baby mentioned here in the image was only a day old when the mother made this post, and given that medical professionals placed her baby at 34 weeks of age gestationally at the time of birth, there was a substantial risk of IVH occurring.
Since internal hemorrhaging happens inside the body, we can't use breathing and feeding on one's own as cause to deny the vitamin K shot. This is why we turn to medically trained personal for sound health advice.
BLACK BOX WARNING OF DEATH
In this next image we see the ever favorite to anti-vaxers; The Black Box Warning. The FDA explains this warning to be “Box Warning: This type of warning is also commonly referred to as a “black box warning.” It appears on a prescription drug’s label and is designed to call attention to serious or life-threatening risks.” Walgreen’s Pharmacy describes it a bit further; “It is basically a warning with a black box around it, hence the name. Having the black box around the warning means that an adverse reaction to the drug may lead to death or serious injury. It's based on clinical data or serious animal toxicity data in the absence of clinical data. Sometimes a black box warning is necessary at the time a new drug is approved. More commonly however, it is added after the drug has been approved and the FDA has received reports of adverse events. After the FDA confirms the serious risk, then depending on the severity of adverse event and in collaboration with the pharmaceutical company, a boxed warning is implemented. This does not mean the drug is contraindicated in any way, but just a means of communication from the FDA to prescribers to highlight the risk.”
A “black box” warning is something we should all seriously consider before taking a medication, or agreeing to a medication for a child. That being said, it doesn’t mean death or serious harm is likely to happen from taking the medication. It simply means there is an increased risk of serious harm or death with that medication than what has been expected. The amount of increased risk will vary depending on the medication and person taking it. This is why it is important to discuss your options with your physician. You and your doctor can asses the risk/benefit ratio and then make a decision that best suits you or a loved one.
The part that anti-vaxers often leave out when mentioning this boxed warning is that the warning only applies to specific routes of administration. The warning is for intravenous (IV) applications, and intramuscular (IM) administration. The difference between these two routes is when wording becomes very important. The package insert (PI) for Merck & Co’s AquaMEPHYTON (phytonadione or vitamin K), gives the boxed warning for IV administration as, “Severe reactions, including fatalities, have occured [emphasis mine] during and immediately after INTRAVENOUS injection of AquaMEPHYTON." The insert then gives the boxed warning for intramuscular administration as, “Severe reactions, including fatalities, have also been reported [emphasis mine]. Typically these severe reactions have resembled hypersensitivity or anaphylaxis, including shock and cardiac and/or respiratory arrest." This wording implies that such reactions are known to have happened with IV use, and are reported to have happened with IM use. Additionally it states the most common reactions from IM use are allergic in nature, rather than caused by the drug itself. Almost all administrations of this drug given to newborns is done so IM.
It’s true that this drug comes with a boxed warning, and it’s true the warning does include IM route of administration, however it’s not true that this warning applies to all forms of administration equally, or at all.
VITAMIN K CAUSES JAUNDICE
This is one assertion from Avers that is loosely based in a grain of truth. According to Stanford, in the 1950’s there were reports of vitamin K2 (menadione) causing hemolytic anemia and hyperbilirubinemia (jaundice) severe enough to cause kernicterus when high doses were administered (50mg). The American Academy of Pediatrics (AAP) says it found that when large doses (more than 1-2mg) of water-soluble vitamin K and K1 were administered there was a higher concentration of bilirubin found than what was found in the control infants. However when vitamin K1 was administered intravenously there was no hyperbilirubinemic effect found. Considering that most infants are given a small enough dose of vitamin K today, 1-2mg usually, there is no increased risk of jaundice.
IF THEY NEEDED IT, NATURE WOULD’VE PROVIDED IT.
This. Is. Asinine. If we all believed this then those with Type 1 diabetes, insulin dependent, would be left to die. According to Pediatric Partners, babies are born with very little vitamin K. Breast milk also has small amounts of vitamin K. The most common ways our bodies accumulate vitamin K is by eating leafy green vegetables, and through the colonization of bacteria in our gut. Since babies won’t be eating these veggies any time soon, and since they don’t have gut bacteria when they are born, they are unable to produce enough of their own for the first 6 months. One way newborns can build up their vitamin K is through formula, since formula provides vitamin K. It can take up to a week for levels to build what is needed for protection.
I’LL JUST USE THE VITAMIN K ORAL DROPS
Where it is true that oral administration of vitamin K can be absorbed by the body, it hasn’t been found to last. According to AAP, “Oral administration of vitamin K has been shown to have efficacy similar to that of parenteral administration in the prevention of early VKDB. However, several countries have reported a resurgence of late VKDB coincident with policies promoting the use of orally administered prophylaxis, even with multiple-dose regimens. In a 1997 review of these experiences by Cornelissen et al, surveillance data from 4 countries revealed oral prophylaxis failures of 1.2 to 1.8 per 100 000 live births, compared with no reported cases after intramuscular administration. Newborns receiving incomplete oral prophylaxis tended to have a higher risk of developing VKDB, with rates of approximately 2 to 4 per 100 000.”
Oral administration, even when following a regimen, can help in protecting a newborn for a short time. The best method of protection is through IM administration.
Polysorbate 80 is an emulsifier, which means it is used to help combine two substances that wouldn’t normally blend well together. The polysorbate found in vitamin K shots is perfectly safe for humans, especially at the dose provided. One study found that “Following oral administration in rats, the ester bond sites of polysorbates are hydrolyzed, within the digestive tract, by pancreatic lipase. Free fatty acids are then absorbed from the digestive tract and oxidized and excreted, mainly as carbon dioxide in exhaled breath…Absorption of polyolyethylene sorbitan, generated by hydrolysis, from the digestive tract is very low; approximately 91% of polysorbate 80 is excreted in the feces and 2.1% in the urine….No migration of the polyoxyethylene sorbitan into the thymus lymph nodes has been demonstrated….At 24 hours after administration, only a small amount of dissociated fat sites and polyoxyethylene sorbitan structural sites remain within the body.” Your body breaks it down and expels it in exhaling, in feces, and in urine without issue or concern. Many skin care products, soaps, and make-up products contain polysorbate 80. It is often derived from coconut oil and is even found in some essential oils. It is estimated that people in America and Europe eat about 100mg of polysorbate 80 in foods per day. The PI for phytonadione lists 70 mg of poloxyethylated fatty acid derivative (polysorbate 80) per shot as an in-active ingredient. According to the World Health Organization (WHO), the acceptable daily intake (ADI) of polysorbate 80 is 25 mg per kilogram of body weight. Which means a person weighing 70 kilos (apx 154 lbs) could consume 1,750 mg of polysorbate 80 per day on a long term basis without any concerns for toxicity. Considering all of the food additives and preservatives we consume in a day, this one concerns me the least.
BUT IT’S SYNTHETIC
Where it is true that the synthetic form of vitamin K can be produces, and it is true this synthetic form can be toxic to humans, it is not true that the vitamin K shot given to humans is synthetic. This synthetic vitamin K form is known as vitamin K3 and is often used in pet foods. The vitamin K this is used medicinally for humans is naturally occurring, "The naturally occurring compounds are vitamin K1 (also known as phylloquinone, phytomenadione or phytonadione), and vitamin K2 (also known as menaquinone or menatetrenone). The former compound is the primary source of vitamin K in humans. It is acquired through the diet and is prevalently present in leafy green vegetables such as spinach, Swiss chard, Brassica (e.g. cabbage, kale, cauliflower, turnip, and Brussels sprout), some fruits such as avocado, banana and kiwi, as well as in some vegetable oils, especially soybean oil.”
It is extremely negligent for anti-vaxers to continue to spread misinformation or downright fallacies about medicinal treatment options that can and has saved the lives untold newborns. They adamantly ignore and avoid the correct information and insist others believe the same as they believe. They will become mean, or appear to be threatening (as seen in this image), and will harass you if you challenge them. Because of this we are seeing an increase in parents who decline routine safe, and effective preventative measures like vitamin K. We fear the unfortunate outcome of this newborn’s death is only the first of many to come. The realization of becoming a mom can be overwhelming for first time mothers, especially younger first time mothers. I shudder when I think of how naive I was during my first pregnancy at the age of 20. We owe it to these young women to provide honest and fact checked information when we can, or to say “I don’t know” when we can not. Only a monster would desire to wrongly influence important medical decisions for infants and their new mothers. These assholes just likely contributed to the death of one infant this past week. Let’s try to make this tragedy the last death they help facilitate.
What's The Harm?