Sorry for bringing this up again, and as I have just zoomed through 11
digests in an hour, I did not note all the names of previous posters on this
topic.

The Norwegian health authorities require midwives to offer (and recommend
acceptance of) Vitamin K prophylaxis to all newborns, either as a single
injection or as an oral solution which must be given several times over the
course of the first week of life.  I should add that midwives are present at
all births here except the one in a thousand that is unattended entirely,
and are the lead professional at about 80% of births.

The research available has shown that the oral treatment is not as effective
as the IM injection unless it is repeated weekly for three months.  We do
not ask about intended feeding method, and indeed, would still be required
to offer and recommend Vit. K if the baby was to be artificially fed.
Actually, we don't ask about intended 'feeding method', ever.  Imagine that!
If a mother is planning not to BF she tells us that, but it doesn't change
the procedure on Vitamin K.  (We don't always react professionally to this
info either, unfortunately, but that is a different story.)  For those of
you who may not be aware of it, our BF initiation rate is about 99% or more,
and continuation rate at three months seems to be at least 80%.  So the
artificially fed baby is not the norm by any means.

Since breastfed babies have little E.coli in their guts, they don't produce
much of their own Vitamin K.  As someone pointed out, the research showing
lower concentrations of Vit. K in BF babies is from a time when early feeds
were limited in frequency and especially duration, and it was not common for
babies to get colostrum the first 12 hours anyway.  The problem is how to
set up a study to examine Vit.K concentrations in babies breastfed ad lib
from birth, since it would be hard to randomize anyone NOT to get Vitamin K
these days.

As someone else pointed out, if babies had contact with more of their
mothers' gut flora during birth they might have just the safety net they
need in order to make Vitamin K themselves.  All that disinfection and
draping is just another example of us thinking we can go the Creator one
better, and what CAN S/He have been thinking of, putting the birth canal
down THERE, anyway?!

Being somewhat nervous by nature, I think there is a stronger case for
babies born with forceps or vacuum extractors to get Vitamin K, as they are
at higher risk for traumatic hemorrhage in the first days post partum, as
are pre-term babies and babies of mothers who take certain prescription
drugs.

We don't know why a small number of babies get late-onset hemorrhagic
disorder up to three months after birth, but we do know that this is
eliminated by the Vitamin K prophylaxis, and since the condition has a high
mortality rate it is hard to justify changing the current recommendations.
It would be great if we found a way to identify at-risk babies so we could
stop treating all the others.  Until then, we have to rely on the current
evidence.  For informed and skeptical parents there is always the option of
signing a waiver and not having the baby given any Vitamin K.

For the record, we absolutely never recommend using formula to help the
baby's Vitamin K status.

Rachel Myr
Kristiansand, Norway

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