From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Vitamin K Shot
Date: Sun, 13 Jun 1999 00:41:50 GMT

On Fri, 11 Jun 1999 22:59:01 +0100, Radha <Radha@futurecorp.co.uk>
wrote:

>I recently took my newborn to a GP for a quick 'check up'.  She
>strongly advised me to get the VK shot for my daughter and said
>that there were *no* risks/contraindictions and she had never
>heard anything 'bad' about it.
>
>This must be impossible considering the plethora of information
>available.  Do you think this was a 'line' or is she truly
>naive?

Neither.  However, I would never tell someone that there are *no*
risks for a medical intervention.  All diagnostic and therapeutic
interventions in medicine have potential risks.  The idea is to use
ones whose benefits outweigh the risks.  In this case, the benefits of
a vitamin K shot for your newborn far far outweigh the risks.

Vitamin K shots for newborns are a necessity, especially if they are
breastfed only.  Humans are born deficient in vitamin K, which is
essential for the manufacture of functioning clotting factors
(proteins in the blood that cause blood to clot and maintain the
integrity of blood vessels.)  Breastmilk, nature's perfect food for
newborns, is unfortunately also deficient in vitamin K.  Without a
vitamin K shot, babies can spontaneously bleed in the first few months
of life, and about 25-33% of them actually bleed to death.  Those who
survive can suffer brain damage due to bleeding in the brain or from
prolonged resuscitation.

Developed nations rarely see this illness anymore because
administration of vitamin K to all newborns has become routine.  I did
see a case last year because the child was born to a midwife who did
not believe in giving vitamin K.  The child nearly bled to death and
spent several days in intensive care receiving blood transfusions.

The risks of vitamin K shots are nearly negligible, which is probably
why your GP said there are none.  Formerly, large doses of a synthetic
form of vitamin K were used, which could exacerbate hyperbilirubinemia
(jaundice) and cause kernicterus, a form of brain damage caused by
excessive jaundice.  Nowadays, we use smaller doses of a natural form
of vitamin K, and this side effect is now unheard of.  There is also a
small risk of anaphylaxis (severe allergic reaction) when vitamin K
shots are given to adults, but newborns are pretty much incapable of
having anaphylactic reactions.  In the hundreds of newborns I have
seen who all received vitamin K, I have never seen a case of
kernitcterus or allergic reaction, nor has such a case been reported
recently, to my knowledge.  However, I have seen one case and there
are still plenty of reports of newborns who do not get vitamin K and
end up bleeding.

In short, you should give the vitamin K shot.  In fact, it should be
given immediately after birth and should not even be delayed until the
first checkup, even if you have a home birth, since the early form of
the hemorrhagic disease of the newborn occurs within the first week.
Most midwives give vitamin K shots -- the one in the case above was
surely an exception.

--
Jonathan R. Fox, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Vitamin K Shot
Date: Mon, 14 Jun 1999 04:14:25 GMT

On Sun, 13 Jun 1999 21:16:34 +0100, Radha <Radha@futurecorp.co.uk>
wrote:

>Sue Spence wrote:
>
>> In article <37639037.24DA7212@futurecorp.co.uk>, Radha says...
>>
>> >It would seem like a bad design for a baby to be born with a
>> >deficiency and not be able to survive with little risk without
>> >the help of an injection.
>
>> Newsflash:  People weren't "designed".  People *are*.
>
>So you think all children are somehow unable to survive without
>intervention.  That would be right.

Yes, we do think that children are unable to survive without
intervention.  They need to be dried after they're born and wrapped in
blankets, or they'll freeze to death.  They need to be fed every two
to four hours after birth or they will starve to death.  Newborn
humans are completely helpless.

We humans have somehow figured out that our babies have a better
survival if we feed them and keep them warm after they're born.  Does
this count as an intervention that might not be necessary?  Of course
not -- newborn babies are completely incapable of doing doing anything
except breathing, crying, peeing, pooping, and sucking on a nipple put
in its mouth.  Oh, and they can look you in the eyes if you hold them
close up.  Contrast that to horses, who can walk within hours after
birth.

Given that our babies do a lot better if we feed them and so on, we
have found over the millenia that some of them still die despite our
best intentions.  Using our intellect, which is one of our natural
assets, we have gradually found ways to cut infant mortality even
more.  Since we found out that the age-old habit of some infants to
bleed to death can be almost completely prevented with a simple shot
given at birth, we have some success there.  The fact that you might
think it's not such a good idea is, given the evidence, and as someone
else pointed out, equivalent to deciding you don't want to wear a
seatbelt because you fear an abdominal injury from the seatbelt, not
realizing that you are at far greater risk for more serious injury by
not wearing the seatbelt.

Why are we born deficient in vitamin K?  That is a good question.  Why
are we also one of the only mammals who can't synthesize our own
vitamin C either?  Other animals don't have to eat citrus fruits to
avoid scurvy.  It's just not fair, is it.

The answer lies in the fact that in order to evolve into the
intelligent beings we are, sacrifices had to be and could be made in
other areas.  We are not equipped with terrible claws or powerful jaws
and fangs, for example, that we can kill another animal with, and thus
we would lose in a grapple with a tiger or bear.  We lost those such
things because we have developed the intellect that allows us to build
weapons, so we can just shoot tigers and bears.  We have no fur
because we can wear clothes and build air conditioners and central
heaters.  And so on.

One drawback of our intellect is our enormous head.  If we were to
stay in the womb, then, until we were able to walk and feed ourselves
from birth, like, say, horses, our head would be too big to pass
through the birth canal.  So we have to be born much earlier in our
development.  Fortunately this is counterbalanced by the fact that our
intelligent mothers are able to figure out how to care for us, instead
of ditching us in a pile of sand like turtles do, which is why we are
here.  And beyond the intelligent mothers are intelligent scientists
who figured out even more ways to help the helpless, through
vaccinations and vitamin K shots.

Back to vitamin K.  Why are we born deficient?  Vitamin K, as well as
being necessary in the formation of functioning clotting factors, is
believed to take part in bone metabolism as well.  Some believe that
excess vitamin K delivered to the fetus interferes with limb
formation, so that the placenta has developed a protective mechanism.
This would not be so bad if human breastmilk had more vitamin K in it,
but it doesn't.  Why that is I have no clue.

You asked in another post why oral vitamin K isn't used more often.
Most comparisons have shown either an equal or lesser effect of oral
vitamin K compared to the shot.  Furthermore, oral dosing requires
redosing over the firt few months of life.  Contrast this to the
single shot given at birth, and you see that there is more opportunity
for noncompliance with the oral strategy.  And noncompliance is the
single greatest cause of therapeutic failure.  Give the shot, the
therapy is done, and there is no chance of noncompliance.

--
Jonathan R. Fox, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Vitamin K Shot
Date: 14 Jun 1999 09:15:24 GMT

In <B7175F8535FD2BA3.879B6456166F88F3.8BC9BFE71182370B@lp.airnews.net>
jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox) writes:

>The answer lies in the fact that in order to evolve into the
>intelligent beings we are, sacrifices had to be and could be made in
>other areas.  We are not equipped with terrible claws or powerful jaws
>and fangs, for example, that we can kill another animal with, and thus
>we would lose in a grapple with a tiger or bear.  We lost those such
>things because we have developed the intellect that allows us to build
>weapons, so we can just shoot tigers and bears.  We have no fur
>because we can wear clothes and build air conditioners and central
>heaters.  And so on.


   I hardly think that's the reason we have no fur.  Lennox hasn't been
around quite that long.  Even fire hasn't.

    We've got no fur because we came from the plains of East Africa a
couple of million years ago, on the other side of the rift valley,
where it's really hot and there's not much shade.  If you're going to
make your living there as a corsarial hunter and run your food down,
you'd better be able to pant really well, or sweat.  Or have an
airconditioned landrover and an icebox full of popsicles.  Hair all
over your body, if you're a larger animal that has to do endurance
running, is not an asset.

>Back to vitamin K.  Why are we born deficient?  Vitamin K, as well as
>being necessary in the formation of functioning clotting factors, is
>believed to take part in bone metabolism as well.  Some believe that
>excess vitamin K delivered to the fetus interferes with limb
>formation, so that the placenta has developed a protective mechanism.
>This would not be so bad if human breastmilk had more vitamin K in it,
>but it doesn't.  Why that is I have no clue.

  Me, either.  Perhaps our ancestors weren't quite as sanitary, and
their kids' guts got colonized with K-producing organisms a bit
earlier. Plus, not getting dropped on our heads as much as other
primates do, probably lessened our need for it.  It's much the same as
with vitamin C. There's not a lot of that in breast milk, and why not
is something of a mystery.  Iron you can understand in terms of
diarrheal death.  But why so little C?

>You asked in another post why oral vitamin K isn't used more often.
>Most comparisons have shown either an equal or lesser effect of oral
>vitamin K compared to the shot.  Furthermore, oral dosing requires
>redosing over the firt few months of life.  Contrast this to the
>single shot given at birth, and you see that there is more opportunity
>for noncompliance with the oral strategy.  And noncompliance is the
>single greatest cause of therapeutic failure.  Give the shot, the
>therapy is done, and there is no chance of noncompliance.


    Yeah, but there's the classic dilema.  If you're going to be
compliant the oral is safer.  But on average, the shot is safer, since
some people will be non-compliant.

   It's a bit the same as the old Rho-Gam problem.  If a woman is
Rh-neg and her husband is Rh-neg, she doesn't need the stuff if she's
never had sex with anyone else and been faithful to him.  Lots of money
can be saved that way.  If people never lied to their doctors, that is.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: Vitamin K Shot
Date: Tue, 15 Jun 1999 03:03:37 GMT

On Mon, 14 Jun 1999 15:46:52 +0100, Radha <Radha@futurecorp.co.uk>
wrote:
>
>"Jonathan R. Fox" wrote:
>
>> Back to vitamin K.  Why are we born deficient?  Vitamin K, as well as
>> being necessary in the formation of functioning clotting factors, is
>> believed to take part in bone metabolism as well.  Some believe that
>> excess vitamin K delivered to the fetus interferes with limb
>> formation, so that the placenta has developed a protective mechanism.
>> This would not be so bad if human breastmilk had more vitamin K in it,
>> but it doesn't.  Why that is I have no clue.
>
>Do you think it's from diet?  Probably, if someone ate VK rich
>foods and took extra VK antenatally they would provide more
>than say, the average McDonald's eater.

Well, there is no such thing as purely dietary vitamin K deficiency.
The requirements for an adult for vitamin K are so miniscule that it
would be nearly impossible for a healthy person to become deficient in
it even if he tried.  The daily intake in even the junkiest diet far
exceeds your needs.  Eating tons more vitamin K would minimally
increase the vitamin K in the breastmilk.  The milk factories simply
don't put enough in there.

Someone has put this to the test, and trials have been done where the
nursing mother mega-dosed vitamin K.  Didn't help much.  The infant
still needs supplementation directly.

>> You asked in another post why oral vitamin K isn't used more often.
>> Most comparisons have shown either an equal or lesser effect of oral
>> vitamin K compared to the shot.  Furthermore, oral dosing requires
>> redosing over the firt few months of life.  Contrast this to the
>> single shot given at birth, and you see that there is more opportunity
>> for noncompliance with the oral strategy.  And noncompliance is the
>> single greatest cause of therapeutic failure.  Give the shot, the
>> therapy is done, and there is no chance of noncompliance.
>
>Fair enough.  Does the oral administration pose less risks than
>the shot?

I would believe so, which is why if and only if an oral dosing
schedule could be devised which can be proven to have the same
efficacy as the shot, I would support the decision of a parent to do
the oral dosing.  But not because there are so many inherent risks of
the vitamin K itself from the shot, but because I would like to see
infants get less shots in general.

--
Jonathan R. Fox, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: misc.kids.pregnancy,sci.med
Subject: Re: Medical Negligence and Radha's Rant
Date: Mon, 21 Jun 1999 03:15:51 GMT

On Sun, 20 Jun 1999 21:59:04 +0100, Radha
<Radha@thumper.microboss.com.au> wrote:
>
>Happy Dog wrote:
>>
>> The responses you received were based in fact.  The medical
>> professionals posting on the topic were explaining the reasoning
>> behind the therapy.  You consider this self defence.  As if they have
>> a stake in defending a treatment they think is bogus.
>
>Oh, I don't think they think it is bogus at all but I do think there
>is a vested interest.  You do realise the medical industry is like
>any other don't you?

The medical industry is unlike any other.  Our goal is to make
ourselves as unnecessary as possible.  I would be delighted to measure
kids, give them their shots, and watch them grow, and never find
anything wrong with any of them.  I would love it if I never had
another sick visit again.  I would love to spend an entire ER shift
twiddling my thumbs rather than sewing scalps back together, giving
asthma medicines that a parent didn't bother to give, or setting a
broken bone in a kid whose mother didn't put a seatbelt on.

Your misguided implication that we give vitamin K shots because we
somehow personally profit from it is nonsense.  This is quite typical
of propagandists with an anti-medicine agenda -- to accuse physicians
of supporting a treatment because of a financial incentive when they
have no idea how the economics of such a treatment actually works.

In the case of vitamin K:  I recently gave a talk on vitamin K
deficiency in newborns, in which I presented an actual case of an
infant who nearly died because her midwife did not believe in vitamin
K.  As a rough estimate of the cost benefit of giving vitamin K, I
calculated the cost of preventing one case of hemorrhagic disease of
the newborn (HDN).  This cost was $20,400, using an estimate of 1 in
1,700 as the prevalence of HDN in infants who did not receive
prophylaxis, and the wholesale cost of one dose of vitamin K at our
institution, which is $12.00.  The hospital bill for the one patient
with HDN was $54,807.44, and was only our hospital bill -- it did not
include the bills for the outside hospital she presented to, the
fixed-wing transport to our institution where her life was saved, or
the financial and emotional burden to the parents during her hospital
stay.  Furthermore, this comparison does not account for the fact that
one in four patients who present like her die.  That cost cannot be
calculated.  Also, she was lucky and did not suffer any apparent
damage from the bleeding in her brain.  Speech therapy and wheelchairs
cost money too.

Now, don't you think, if we were all in medicine for the money, that
we would prefer instead to let them get HDN so we could make more
money off them?

Let me make it absolutely clear for all propagandists, conspiracists,
and paranoids:  I give vitamin K to newborns because I want to prevent
them from being hospitalized and possibly dying from HDN.  I don't see
one cent of the money that pays for the vitamin K.  I do see empty ICU
beds and healthy infants because of vitamin K.  Physicians do not give
vitamin K because of a financial incentive.  I know this because I am
a physician.  Non-physician anti-medicine conspiracists and
propagandists may claim otherwise, but they are ill-informed.

>Are they?  Take my example of fluoride or GM.  There is barely a
>study into the long term effects of GM.  In the US a scientsist
>released some information on links between GM and cancer in rats.
>What happened to that scientist..... mysteriously disappeared.

And you wonder why you are being called "paranoid."

>> Studies have shown that light exercise is promotes
>> cardiovascular fitness.  Do you think that a study will someday
>> refute this?
>
>I think the human body is designed to exercise so I would view this
>as common sense.  I do not think the human body is designed for
>VK injections at birth so I apply common sense to this scenario too.

The human body is designed to become dangerously coagulopathic after
birth.  Good thing some of us have the common sense to prevent this
with vitamin K.

>> You have accused the medical establishment of frequent and
>> intentional abuse.
>
>Yes.  Again, if you think a shot of this and a shot of that is
>ok than you would class these actions as abusive.  If you think
>antibiotics should be used as a precautionary measure than you
>would not consider that abuse either.

No, if you think that antibiotics in a newborn used as a precautionary
measure is abuse then you clearly demonstrate that you have absolutely
no knowledge of even the most fundamental principles of neonatology.

Let me explain something to you:  Sick newborns die.  They die very
fast.  An infant can be totally well and within hours be dead from
gram-negative sepsis with completely rotten intestines and pus for
blood.  When a newborn, especially a preterm newborn, does not appear
well, that is, has any trouble breathing, is hypothermic, or does
pretty much anything else unusual, you are abusing that infant if you
withhold antibiotics.  Antibiotics must be given immediately because
if you think you can tell which sick infant is septic and which is
not, you will soon find that when you're wrong, the infant is dead.
If you gave the antibiotics, and it turns out the infant was septic,
you've saved a life.

--
Jonathan R. Fox, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: misc.kids.health,sci.med
Subject: Re: Vitamin K. injection and Eye prophylaxis
Date: Sat, 26 Feb 2000 17:18:57 GMT

On Sat, 26 Feb 2000 03:27:26 GMT, Mike Jones <mdj6248@earthlink.net>
wrote:
>
>When our second son was born, we refused the vitamin K injection and eye
>ointment on the grounds that (a) they're not medically necessary in the vast
>majority of cases, particularly if you're not planning to circumcise, and (b)
>we wanted our son to be able to see his parents without his vision being
>blurred by eye goop or having one of his first experiences of the world be
>pain from an injection. Yes, they told CPS. We met with them, explained what
>we chose to do, why we chose to do it, gave them some references (including
>our pediatrician), and the case was dismissed.

First, vitamin K is medically necessary whether you are circumcising
or not, because the incidence of hemorrhagic disease of the newborn
(HDN), which carries a substantial mortality (25-33% in late onset
variant), is about 1 in 1,500.  This is not a small risk to take when
the prevention is simple.  And all children are at risk for HDN.
There is no "vast majority of cases" where you can conclude vitamin K
is not necessary.

Second, I have heard your argument about eye prophylaxis from parents
who claim they'd rather risk their child becoming permanently blind
just so they can "see his parents" right after birth.  They fail to
realize, however, that newborns are nearsighted and can barely see
them anyway.  What's more, if you really want, they can look at you
before the "eye goop" is put in, and after the medicine is applied, it
is mostly gone within a few hours.

--
Jonathan R. Fox, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: misc.kids.health,sci.med
Subject: Re: Vitamin K. injection and Eye prophylaxis
Date: Sun, 27 Feb 2000 14:10:14 GMT

On Sun, 27 Feb 2000 03:41:07 GMT, Mike Jones <mdj6248@earthlink.net>
wrote:

>"Jonathan R. Fox" wrote:
>
>> First, vitamin K is medically necessary whether you are circumcising
>> or not, because the incidence of hemorrhagic disease of the newborn
>> (HDN), which carries a substantial mortality (25-33% in late onset
>> variant), is about 1 in 1,500.  This is not a small risk to take when
>> the prevention is simple.  And all children are at risk for HDN.
>> There is no "vast majority of cases" where you can conclude vitamin K
>> is not necessary.
>
>I'd say that 1,499 out of 1,500 would qualify as a "vast majority of
>cases". And at birth, a baby born to a mother with proper nutrition has
>been getting vitamin K from the placenta and has a supply to last 2-3
>days. The vitamin K shot can safely be given later.

No, the placenta protects the infant from vitamin K presumably because
a relatively vitamin K deficient state is necessary for proper bone
development.  The infant is born with a relative deficiency of vitamin
K-dependent clotting factors which rapidly decline in the first few
days as the vitamin K deficiency is prolonged by the neonatal diet.

I'm not sure what you are suggesting when you say vitamin K can
"safely be given later."  Are you now saying that vitamin K is
necessary, but that it should be given later, or that it's
unnecessary, and should not be given at all?

Furthermore, according to the CDC, about 4,000,000 babies are born in
the U.S. each year.  Would you like to line up 2,700 mothers of babies
who died from HDN each year (over seven a day) and explain to them
that you didn't want their babies to have a shot when they were born,
and didn't think the risk of death was too great and didn't think it
was medically necessary?  Not to mention the many more who would be
permanently disabled (brain hemorrhaging is common in late onset HDN),
since the 1 in 1,500 is risk is for death only -- many more are
hospitalized, require blood tranfusions, and suffer brain damage.

>> Second, I have heard your argument about eye prophylaxis from parents
>> who claim they'd rather risk their child becoming permanently blind
>> just so they can "see his parents" right after birth.  They fail to
>> realize, however, that newborns are nearsighted and can barely see
>> them anyway.  What's more, if you really want, they can look at you
>> before the "eye goop" is put in, and after the medicine is applied, it
>> is mostly gone within a few hours.
>
>What is the actual risk with a healthy mother, though? The only reason
>I've ever heard for the prophylaxis is that the child can pick up an
>infection while going through the birth canal. The most common infection
>usually named is gonorrhea. If the mother has been tested and is known
>healthy, what is the rationale for the medication? As for being
>nearsighted, I'm afraid we're also those horrible sorts of people who
>insisted on having the baby with us right after birth so we could hold
>him up close to us and nurse him immediately.

"If the mother has been tested and is known healthy" is the flaw in
your logic.  There is no test reliable enough to rule out the presence
of an infection that can linger with no symptoms whatsoever when you
are risking your child's vision with it.  There is a prophylactic
treatment, however, that can prevent blindness, with no side effects
except occasional chemical conjunctivitis which resolves on its own,
and having to see the world through "eye goop" for a few hours.  Small
price to pay for a lifetime of normal vision.

Holding your baby and nursing right after birth should be encouraged
and is beneficial, as long as the baby is kept warm.  Breastfeeding
immediately promotes bonding and also stimulates the release of
oxytocin, which can shorten the duration of post-partum bleeding.
This has nothing to do with eye prophylaxis and you won't find anyone
trying to put the medication on his eyes while he's busy meeting his
parents.

--
Jonathan R. Fox, M.D.