Vit K en D

Vitamin K deficiency is a rare but preventable disease. However, treatment for this deficiency has come under fire lately as being possibly linked to an increased risk of leukemia. But is this risk fact or fiction? 

Why is Vitamin K Given to Newborns?

There is a rare disease called Vitamin K deficiency bleeding, which occurs in approximately 1 in 10,000 babies. In about half of babies who suffer this bleeding problem after the first week of life, many will die or sustain significant brain-damage due to the disease, because of bleeding into the brain.

It occurs almost exclusively in breastfed babies and is almost completely preventable by giving extra vitamin K after birth.

Which Babies are Most at Risk of this Bleeding Problem?

The early type of bleeding is a particular risk for babies whose mothers were on certain drugs during pregnancy, such as anticonvulsants (for epilepsy). The late bleeding disease is more common in babies who are born premature, who have had a complicated delivery (such as a breech delivery, forceps or ventouse), or those who have liver disease or difficulty absorbing feeds. Many babies who go on to have more serious bleeding problems suffer smaller bleeds from the skin, nose or mouth in the weeks before this.

Why Not Just Give Vitamin K to Those at High Risk of Bleeding?

Unfortunately, in about 1/3 of cases, the vitamin K deficiency bleed occurs without prior warning or risk factor. It has been estimated that if vitamin K were only given to high risk babies, among the 800,000 or so annual births in the UK, there might be:

60 to 80 babies who suffer a bleed

15 to 20 babies suffering a bleed into the brain

4 to 6 babies who die from the bleed into the brain

10 to 20 babies who may be brain damaged because of the bleeding

Vitamin D

Human milk is a wonderful and complete source of nutrients. Many experts agree that vitamin supplements are not necessary for the normal, healthy, full-term baby that is being breastfed. There is still some controversy over the need for supplemental Vitamin D in the breastfed baby.

Most mothers have Vitamin D levels that are within the normal range (Lawrence, 1994). The amount of Vitamin D in your milk is directly related to the levels of this vitamin in your body. These levels can be influenced by diet, supplementation and exposure to ultraviolet light. Normal levels of Vitamin D in your milk are between 20 and 60 IU per liter of breastmilk (Greer, 1984.)

Breastmilk levels of this vitamin could be inadequate if you live in a cold, Northern climate where there is not much light, particularly if you are dark-skinned, but, since you have taken excellent care of yourself during your pregnancy (probably eating foods rich in Vitamin D, supplementing with Vit. D, if necessary, and getting exposure to the sun) there is a good chance that your baby’s stores are sufficient.

A baby does not need much exposure to sunlight each day to boost his Vitamin D levels. Allow your baby some exposure each day to sunlight (without sunscreen.) Only about 30 minutes of exposure each week, wearing just a diaper, is required, (or two hours each week if fully clothed, without a hat) to maintain normal levels of Vitamin D (Specker et al., 1994, 1985.)

In an April 7, 2003 Policy Statement, the American Academy of Pediatrics now recommends that “all infants, including those who are exclusively breastfed, have a minimum intake of 200 International Units (IU) of vitamin D per day beginning during the first two months of life … because adequate sunlight exposure is not easily determined for a given individual.”

In an April, 17, 2003 Press Release La Leche League International responds saying, “Exclusively breastfed healthy, full-term infants from birth to six months who have adequate exposure to sunlight are not at risk for developing vitamin D deficiency or rickets. Rickets occurs because of a deficiency in sunlight exposure, not because of a deficiency in human milk.”

Another option, is to begin supplementation for you, rather than your baby. It has been found that by giving 60 mcg of Vitamin D each day to the mother, the levels of this vitamin in her milk will raise substantially within a period of two weeks (Hollis, 1983.) Do not take Vitamin D in amounts exceeding the recommended daily allowance, because it could cause high (and possibly toxic) levels of this vitamin to be excreted into your milk.

Most likely, your physician has recommended supplementing your infant to comply with the recommendations of the Canadian Pediatric Academy. They recommend supplementation of 10mcg per day or 400 IU of Vitamin D each day for infants. In contrast, the NIH Subcommittee on Nutrition During Lactation (1991) recommended supplementation of Vitamin D only in those breastfed babies whose moms have inadequate Vitamin D intake, and who are not regularly exposed to sunlight. The amount they have recommended for these infants is 5 to 7.5 mcg of Vitamin D per day.