For a few years now more and more couples have birth plans in hospitals where they will give birth to let professionals know how they want the delivery to be, normally requesting that the delivery be as respected as possible, that the baby do not be separated from the mother if it is okay, among other things, being one of them, sometimes, the do not administer vitamin K intramuscularly to be the same parents who give it to the baby orally.
A few days ago we talked about the importance of administering vitamin K in infants to prevent vitamin K deficiency bleeding syndrome. Today we will explain what is the preferred route of administration, because many fathers and mothers, among which we include my wife and me, have asked the question of what is better for the baby, taking into account that if given orally you do not harm him and if you prick him As soon as you are born, you give him a good reason to start feeling bad about the world that has received him.
When vitamin K began to be taken orally
In the years 1990 and 92 Golding et al published two studies in which the administration of vitamin K to babies was related intramuscularly with the subsequent onset of childhood cancer. This relationship did not exist if it was administered orally and in some countries, such as Australia, It was decided to replace the punctured vitamin K with three oral doses of the same to be given to the baby on different days.
Two years later, however, they saw (I am still in Australia) that with this pattern the incidence of vitamin K deficiency bleeding syndrome increased and they decided to re-administer it intramuscularly. Years later, in any case (I commented in the previous entry on vitamin K), it was shown that, really, administering vitamin K intramuscularly did not increase the risk of childhood cancer.
What does the scientific evidence say
A systematic review of eleven studies conducted by Cochrane where the results obtained by the administration of vitamin K orally and intramuscularly were studied revealed that with a single dose of vitamin K IM versus a single dose of oral vitamin K, more levels were achieved. high vitamin K at two weeks and a month, while administering 3 oral doses the vitamin K levels achieved were also greater at two weeks and one month than those achieved with a single intramuscular injection.
However, it has not yet been studied how vitamin K levels (more or less elevated, depending on the route of administration) affect the child's coagulation status and, therefore, an action protocol cannot be established based on this results.
The doubt comes from other studies carried out in Europe, which showed that when 1 mg of vitamin K IM was administered at birth (in 325,000 babies) there were no cases of bleeding due to vitamin K deficiency, while in cases where it was administered orally with one dose at birth and two subsequent doses if hemorrhagic syndrome occurred in a range of 0.9 to 4.8 cases per 100,000.
What is the recommended route of administration for vitamin K
After seeing that oral vitamin K in several doses offers higher levels of vitamin K in babies, but after observing that despite this, babies who receive it orally have a higher risk of bleeding than those who receive it intramuscularly, the Ministry of Health and Social Policy (and in the absence of more evidence to clarify this issue) recommends:
Administer vitamin K in a single dose IM (1 mg) as this is the method of administration that has the best clinical results.
Already, but I prefer to give it to my baby orally to avoid the puncture
As there is the possibility of giving oral vitamin K, if the parents of a baby decide to reject the IM route can be offered orally as a second option. In this case, three doses of 2 mg will be necessary at birth, one week and one month. In the event that the baby takes exclusive breastfeeding, since it is related to the onset of late vitamin K deficiency hemorrhage syndrome, the parents will have to give him more doses.
We chose the IM route
As I said it was one of the questions we asked ourselves before giving birth, I offer you the answer to which we arrived, in case you are interested. In view of the data, we decided that it was more reliable for Guim to have the IM injection. The oral route is less traumatic, but several doses should be given at quite spaced time intervals, which can lead to forgetting, achieving worse final results and increasing risks.
On the other hand, the oral route is more "dangerous", because as every father and mother knows, babies usually regurgitate when you least expect it and leave you then in doubt as to whether to give it more or if it is not necessary.
I know that to be born and to receive a puncture in the leg a few minutes must be a real disgust, but I prefer to minimize risks and give my child a thousand kisses after the prick than to give it orally at the risk that we can not prevent bleeding (The case report, as you have seen, is very low, but not zero).
