In MIDIRS Midwifery Digest vol 7 no 3, the following article is discussed.
Hansen KN, Ebbesen F.  Neonatal vitamin K prophylaxis in Denmark: 3 years' experience with oral administration during the first three months of life compared with one oral administration at birth.  Acta Paediatrica, vol 85, no 10, Oct 1996, pp 1137-1139.
MIDIRS had constructed a graph showing the incidence of late vitamin K deficiency bleeding in communities where babies are offered no vitamin K at birth, and in communities with a range of different prophylactic policies.  This graph shows two regimens which virtually eliminate the problem: 1 mg IM at birth, and 1 mg by mouth weekly for three months.  The table also shows that with the German regimen of 1 mg my mouth at 1,2 and 3-6 weeks, there is an incidence of 32/1,200,000, significantly reduced from no prophylaxis, but still occurring.
In the Danish study, there were 6 babies with late vitamin K deficiency bleeding in the group of about 134,500 who received a single dose of 1 mg vitamin K orally at birth.  One of these babies died, and three of the others were severely handicapped.  Before the hemorrhages they were healthy and all were exclusively breastfed.  All had in fact received the oral prophylaxis single dose.  Bleeding occurred 3-7 weeks after birth.  Among 163,000 babies given the newer, long-term oral regimen there had been no reported cases of vitamin K deficiency bleeding, a significant reduction.
In Norway we use the 1 mg IM at birth routinely and about one family in a thousand questions it, usually from a desire to avoid an injection as the first event in the baby's life.  We do not withhold vitamin K if the mother is planning not to breastfeed, and since 99% of women initiate breastfeeding it is pretty automatic.  My research into what other alternatives we have when parents want effective prophylaxis without injections led me to the info I posted.  There is a lot of good material in MIDIRS on the topic for those who are interested.
I still would like to see research on the true vitamin K content in milk when mothers practice clockless, schedule-less, limitless bf from birth.  It will be impossible to determine how much of this vitamin K the baby gets, because all our babies are already injected with it so their blood levels are sky high.  But we could perhaps refute the notion that breast milk is deficient!
Or maybe we will come up with a way to determine safely which babies are at risk for late vit K deficiency bleeding and just give them the prophylaxis.
BTW, the vitamin source for A and D, which are the only supplements recommended to babies of all ages here is cod liver oil, not made by formula manufacturers.  We are way up north and cod liver oil is a cultural tradition.  It is also nearly impossible to achieve vitamin D toxicity by taking cod liver oil.  I found a literature review explaining why when I was searching for my phone a few weeks ago.  It was written by Rune Blomhoff, a professor at the Institute for Nutritional Research, U of Oslo.  Industrially produced supplements of vitamins A and D are water soluble, and 10 times as toxic as the normal fat soluble vitamins in their natural form in cod liver oil.  The vitamins added to milk or to formula are water soluble.
For the record, I own no stock in any cod liver oil refineries.  But I take my teaspoon a day all year!
Rachel Myr [log in to unmask]

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