Monday, October 5, 2009

Special treat for the midwifes/lactation consultants

Vitamin K in neonates (new borns) is a topic that is challenging. This is because 1 in 10 000 babies that are born develop significant internal bleeding, that without extra vitamin K will kill them. This is done via inject of 0.5 or 1.0mg of vitamin K. However in the NZ context were child birth is as natural as possible (and thank God for that, as in the USA they still give birth in stirrups!) there is the questioning of why such an invasive procedure is needed.

When I was up at EIT I was [again] asked about the vitamin K issue and [again] I side stepped it. Well it gives me great pleasure to have an answer! The folloing is a quote from my book, as I have just reworked this section so I am happy with it from a scientific perspextive. Please take note that it has not yet gone past my editor so will be cleaned up when it appears in print. Also my foot notes and ref's have been taken out....

Enjoy

As with other vitamins that we have looked at, one way of estimating an ODA for vitamin K would be to examine breast milk levels. It has been established that newborn infants are deficient in vitamin K because the placenta acts as a barrier to that vitamin in the womb. Therefore there is a risk of baby bleeding to death, with risk being about 1 baby per 10 000 born. Current recommendations are for either 0.5 or 1 mg of vitamin K to be administered to the baby normally by injection .

To avoid these problems, it would seem that the best solution is to administer vitamin K naturally through the mother’s milk. Some studies have proposed providing supplements or vitamin K booster shots to expectant mothers when the women arrive at the birthing facility. However this is unlikely to result in a massive increase in breast milk levels, especially if the mother’s own vitamin K levels are not already at an optimal level. Furthermore, for many vitamins, there is often a delay between taking the vitamin and a corresponding increase of vitamin levels in the organs. In other words, a big dose of vitamins administered on one day may not rise vitamin levels in an organ, whereas a smaller dose taken over a longer period may provide a corresponding increase.

Baby needs 15 micro g of vitamin K to achieve a normal blood clotting level. So instead of injecting baby, would increasing vitamin K in mothers diet increase breast milk levels. The 15 micro g would need to be delivered in breast milk within 48 hours when the risk of bleeding is the highest. Vitamin K is unusual in that it does not seem to be concentrated up in colostrum, where as other fat soluble vitamins can be found at higher concentrations. Assuming an “average” milk intake for baby of 500ml in first 48 hours, what level of vitamin K does mum need to consume to deliver enough vitamin K in the milk to baby. The answer is just over 2 000 micro g/day.

When baby is no longer a new born the recommendation for a baby’s vitamin K intake is 1 micro g a day per kg of weight. Typically western breast milk does not contain high enough levels to reach this target. However a “normal” diet supplemented with 800 micro g/day had enough to give slightly under 2 micro g/day per kg. Therefore assuming linear dose response the level to give baby enough vitamin K would be an increase of 400 micro g/day over a western diet .

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