130: Vitamin K at Birth: The Tiny Injection Social Media Got Wrong

In this episode, Afif and Anne take a deep dive into vitamin K at birth and the growing wave of misinformation surrounding it online. They explore why newborn babies are naturally low in vitamin K, how clotting works, and what vitamin K deficiency bleeding (VKDB) actually is. The discussion covers the differences between intramuscular and oral vitamin K, why the injection remains the most reliable protection, and the devastating consequences VKDB can have, including brain bleeding and death. Along the way, they unpack some of the most common myths circulating on social media, from claims about “toxins” and cancer to misconceptions around breastfeeding and “natural” birth. As always, the episode combines evidence-based medicine with honesty, humour, and practical conversations about how healthcare professionals and parents can navigate fear, risk, and misinformation together. Learn more about your ad choices. Visit megaphone.fm/adchoices

Transcript

SPEAKER_00 0:01

This show is part of the Head Stuff Podcast Network.

SPEAKER_01 0:15

Welcome to the Baby Tribe. I'm your host, Afi Felkafash, Neo Neptologist, pediatrician, and lactation consultant, and my co-host is Anne Deharty, obstetric anesthesiologist. Today's episode is about vitamin K at birth. Now, vitamin K is not glamorous, it doesn't trend well, it has no celebrity spokesperson and no Instagram carousel, but vitamin K matters. All newborn babies are born with low vitamin K stores. Vitamin K is needed to activate clotting factors, and without enough of it, babies can develop vitamin K deficiency bleeding or VKDB. That bleeding can happen in the gut, from the umbilical stump, after procedures, or most worryingly, inside the brain. Although VKDB is rare because of vitamin K prophylaxis, when prevention succeeds, the disease disappears from public memory, and then the intervention starts to look unnecessary. So in this episode, we want to do three things explain the physiology clearly, take a look at what VKDB actually does to babies, and unpack the misinformation that is leading some parents to decline vitamin K. This is not an episode about calling parents foolish. Most parents who decline vitamin K are trying to protect their baby. The problem is that misinformation has hijacked that protective instinct and pointed it in the wrong direction. And just to remind you, this episode is for education and discussion. It's not a substitute for individual medical advice. Parents should speak to their midwife, GP, pediatrician, or neonatologist about their own baby's situation.

SPEAKER_03 1:45

Wow, you went hard there in the beginning and you went straight in. I did. A little bit of crack.

SPEAKER_01 1:50

I did.

SPEAKER_03 1:50

Bring back the bit of crack luck.

SPEAKER_01 1:52

I know, but like you're Anna's thick with me because um stop.

SPEAKER_03 1:57

I'm trying to bring back the bit of crack. Stop now.

SPEAKER_01 2:00

You are thick with me because I forgot to tell you that Faisal is thick.

SPEAKER_03 2:06

Oh my god. So I arrive from 90 years version of events. Go on.

SPEAKER_01 2:11

Yeah.

SPEAKER_03 2:11

Give it a go, Feef.

SPEAKER_01 2:13

Anne is usually late because she's a bad mother, and I do all the parenting.

SPEAKER_03 2:18

Okay, factually correct from the outset. Excellent.

SPEAKER_01 2:21

I do all the parenting, I cook the dinner for the kids, I put on the dishwasher, I feed the dog, I make sure the kids have had a good day in school. Fozzle was sick. I gave him two parsida malls and I sent him to bed. She rocks up at eight o'clock and then she's like, Did Fozzle do any study today? Half an hour later, and I was like initially, yes, and then I said, No, actually, he didn't. He's he's kind of quite sick and he's in bed, and then got really mad.

SPEAKER_03 2:46

I can't like I don't even know where to start with that entire statement from beginning to end.

SPEAKER_01 2:53

Go on. Go on, let's do a debrief.

SPEAKER_03 2:57

Oh, I'm not sure the pod is the place to start this, Afif. I mean, I'm sorry, I just forgot to tell you that he wasn't my. No, no, no. Let's go back to the Anne always comes in late from work.

SPEAKER_01 3:08

Oh, good. I hold down the house.

SPEAKER_03 3:10

I do all of this. Who carries the cognitive load, Afif? Who carries the cognitive load?

SPEAKER_01 3:17

I don't even know what that means.

SPEAKER_03 3:18

Afife, you do. Don't play dumb with me. And on the days that I'm on call and I come in late, yeah. You're you're good. You help out, you stop the place from falling down.

SPEAKER_01 3:30

Yeah, thank you.

SPEAKER_03 3:31

Yeah.

SPEAKER_01 3:31

Thank you. Yeah.

SPEAKER_03 3:32

Yeah.

SPEAKER_01 3:32

Moving swiftly on. Speaking of cognitive load, our daughter's finally finishing her exam soon. And hopefully by the time you hear this, we will be back from Amsterdam after having seen Harry Styles.

SPEAKER_03 3:44

Yeah, that'll be pretty cool. Hopefully.

SPEAKER_01 3:46

I know. Really looking forward to it.

SPEAKER_03 3:48

Yeah.

SPEAKER_01 3:49

Kind of.

SPEAKER_03 3:50

Kind of why?

SPEAKER_01 3:51

Well, I don't know the new album very well.

SPEAKER_03 3:53

Neither do I. It'll be a good show.

SPEAKER_01 3:55

Yeah, hopefully it'll be a good show.

SPEAKER_03 3:56

W weird choreography though.

SPEAKER_01 3:58

How was your week otherwise?

SPEAKER_03 4:00

I'm just tired. It was long.

SPEAKER_01 4:01

It was very long. Yeah.

SPEAKER_03 4:03

It's been a long couple of weeks, but that's okay.

SPEAKER_01 4:06

Yeah. You have been you have been late.

SPEAKER_03 4:08

Actually, I've had I've had a fairly hefty about three or four weeks between work and other obligations. That it's just been fairly hefty now.

SPEAKER_01 4:19

So how are you getting on with all the stuff I'm 3D printing for you?

SPEAKER_03 4:23

I remain to be convinced that the ginormous box in the corner that never stops running and produces tiny little things to clutter up the house is is a good idea.

SPEAKER_01 4:36

There's nothing cluttering the house.

unknown 4:37

Oh my god.

SPEAKER_03 4:38

There's just lots of little things now being left around my house. It's just it's exactly what I predicted would happen.

SPEAKER_01 4:44

Okay, what things are left around the house?

SPEAKER_03 4:47

So basically, from when I walk in the back door now through the house, there's lots of little things appearing. You know this.

SPEAKER_01 4:54

Yeah, there's a little Spider-Man sitting on my on my computer.

SPEAKER_03 4:57

Your lamp?

SPEAKER_01 4:58

Mine, oh, my dragon lamp. People love people love that dragon lamp.

SPEAKER_03 5:01

Yeah, you're printing a couple of things for Faisal.

SPEAKER_01 5:03

Yeah.

SPEAKER_03 5:04

You've printed a couple of useful things for me, I'll give you that much. And I did ask for a specific bathroom caddy thing to be printed at some stage. What did you answer when I when I said can you print that for me? You said Yes, of course. At some stage, but not now, I've got plans, is what you said.

SPEAKER_01 5:20

Well, there's a there's a print queue.

SPEAKER_03 5:22

There's a print queue. Interesting. Okay.

SPEAKER_01 5:24

Yeah, there's a print queue. There were orders that I had to fulfill.

SPEAKER_03 5:27

Okay.

SPEAKER_01 5:27

But we're finally coming at the other end of that now.

SPEAKER_03 5:30

Okay.

SPEAKER_01 5:30

There's a lull in the orders. So um yeah. So I will I shall print you whatever you need now for the bathroom. In whatever colour you need. And this time you get to pick the colour so you don't criticize the shade of blue anyway. Vitamin K.

SPEAKER_03 5:48

Yeah, we'll go back to the serious business of vitamin K. Couple of things.

SPEAKER_01 5:52

Yes.

SPEAKER_03 5:52

You had described it as like a disease, the vitamin K deficiency. Is it not something inborn that some children have more or less of rather than being actually pathology-like?

SPEAKER_01 6:02

What I described as a disease is the result of the low vitamin K levels, vitamin K deficiency bleeding.

SPEAKER_03 6:10

Okay.

SPEAKER_01 6:11

So that is different.

SPEAKER_03 6:12

All babies, or most babies to some degree, because their livers are quite immature, cannot make vitamin K or process vitamin K, isn't that right?

SPEAKER_01 6:23

Yes, you're absolutely right. So babies are generally low in vitamin K levels at birth, and there's a lot of reasons for that. Okay, the first one is it has very poor placental transfer. So it doesn't transfer from the mother.

SPEAKER_03 6:37

So it's probably one of the few things that they don't steal from us.

SPEAKER_01 6:40

Yes, exactly. Babies do not steal vitamin K from you.

SPEAKER_03 6:43

They steal all our calcium from our teeth and our bones of that, but not our vitamin K.

SPEAKER_01 6:49

Yes, and as a result, there are low hepatic stores, or there's a lot, there's not a lot of vitamin K in the baby's livers.

SPEAKER_02 6:57

Okay.

SPEAKER_01 6:57

Okay. We also make some vitamin K from the gut bacteria that are sitting in our gut.

SPEAKER_02 7:05

A microbiome.

SPEAKER_01 7:06

Yes, and babies do not have that. They have an immature gut microbiome, and as a result, they do not have enough vitamin K. Breast milk has very low vitamin K levels. And on top of that, if you are born prematurely, or if you have sluggish flow of bile in your bile chain, which some babies have, cholestasis, that will further reduce your vitamin K levels.

SPEAKER_03 7:28

I'm just sitting here listening to you wondering like evolution has biohacked so many things for us, especially related to pregnancy and related to early newborn life.

SPEAKER_02 7:38

Yes.

SPEAKER_03 7:38

How has evol why has evolution not biohacked this? Is there a benefit in any shape or form to it?

SPEAKER_01 7:44

Okay, well, I'm glad you actually brought that up because there's this narrative that is on social media that nature equates good universally, right? Um, in terms of so, for example, don't give vitamin K to unnatural, let nature deal with it.

SPEAKER_03 8:03

Yeah, but this is what I mean. Like, is there a purpose to like I can't think of a purpose that it would be beneficial for a child to have lower clotting ability than would be ideal to prevent like internal bleeding?

SPEAKER_01 8:17

You can also argue that we haven't biohacked, you know, fighting viruses without vaccines. The body's not perfect.

SPEAKER_03 8:23

Well no, we do. We've got an immune response and we've got memory and all that kind of stuff.

SPEAKER_01 8:27

Yes, we do, but it's not perfect.

SPEAKER_03 8:28

It's not perfect, no.

SPEAKER_01 8:29

No, so we need vaccines. I was just wondering about the vitamin K business.

SPEAKER_03 8:33

Like so the there is no there is nothing beneficial about having low vitamin K.

SPEAKER_01 8:39

I don't think so.

SPEAKER_03 8:40

Okay.

SPEAKER_01 8:41

Before we get into that, because that's a really important thing that I want to bring up, I want to talk about what is vitamin K deficiency bleeding.

SPEAKER_03 8:50

Yes.

SPEAKER_01 8:50

Okay.

SPEAKER_03 8:51

That was going to be my next question to run through the purpose of vitamin K in clotting.

SPEAKER_01 8:55

Okay, well, let's talk about vitamin K deficiency bleeding and what it is. What is the role of vitamin K in preventing bleeding? Because those are two important things to talk about, okay? Vitamin K deficiency bleeding is basically a tendency to bleed either after an event or just spontaneously because you have low vitamin K levels, okay? And traditionally, it has been divided into three different types: an early type that can happen within the first 24 hours, a classical type that can happen between day two to day seven, and the one that we worry about mostly is the late VKDB that can happen one week to six months. So generally that happens at home. The early one that happens in the first day of life is usually because of something in addition to the low vitamin K levels. So sometimes maternal drugs that may have been given or a critically unwell baby for whatever reason.

SPEAKER_03 9:51

What maternal drugs? Just out of interest now that you say people be wondering.

SPEAKER_01 9:55

So anticonvulsants, some of them. Okay. No TB. Yeah, and some anticoagulants.

SPEAKER_03 10:02

Okay. So if you're on your own blood thinners, okay.

SPEAKER_01 10:05

So we are specifically uh mindful of giving babies vitamin K early on in those specific situations. But all babies should get it anyway. Okay.

SPEAKER_03 10:13

If you're somebody on TB treatment, if you're somebody on blood thinners, or if you're somebody who has epilepsy, just be mindful that your baby may need it.

SPEAKER_01 10:21

Yeah, and then the classical one that happens day two to day seven is because of the low stores, low intake, and no prophylaxis.

SPEAKER_03 10:28

Okay.

SPEAKER_01 10:29

So that can happen in terms of bleeding through the umbilical stump.

SPEAKER_03 10:33

Yeah.

SPEAKER_01 10:33

That doesn't settle down. Bleeding through actually the skin, even if there's bumps and bruises from forceps or whatever, and then bleeding in your tummy, GI bleeding. And then you can vomit blood or you can poop blood.

SPEAKER_03 10:48

Bleeding from an umbilical stump is not always vitamin K deficiency.

SPEAKER_01 10:51

Yes.

SPEAKER_03 10:52

Sometimes it's just a little blood vessel.

SPEAKER_01 10:54

Yeah.

SPEAKER_03 10:55

Bleeding from a like a baby spitting up blood isn't always vitamin K deficiency. Sometimes it's from like mum's cracked nipple that they've swallowed some blood, or sometimes if they're a C-section baby or there was bleeding at the time of delivery, they've swallowed blood that way.

SPEAKER_01 11:10

Yes.

SPEAKER_03 11:11

So just not to scare monger people.

SPEAKER_01 11:13

This is an excellent point. I'm glad you brought it up. And what I'm talking about is bleeding that does not settle within a reasonable time frame. Okay. Yeah. And then the late one is the one that we worry about, is the one that happens at home. It's usually silent until it's not. Okay. And that usually happens in the brain.

SPEAKER_03 11:32

Okay. And at what day of age is that most common?

SPEAKER_01 11:36

That's the problem. It's commonest two to two to eight weeks after discharging.

SPEAKER_03 11:40

Okay, so it's a wide period of time.

SPEAKER_01 11:41

Yeah. And this this brain bleeding can happen without any warning signs.

SPEAKER_02 11:47

Yeah.

SPEAKER_01 11:47

And the babies usually present with severe lethargy or extremely pale or seizures. And one in five to a third of babies will die from this if it happens.

SPEAKER_03 12:00

But how common is it?

SPEAKER_01 12:01

Okay, we're gonna talk about how common that is.

SPEAKER_03 12:03

Yeah, because when you talk about that incidence and the severity of the outcome there, it's very scary.

SPEAKER_01 12:09

It is very scary.

SPEAKER_03 12:11

So the problem with looking at how common things are is when we have established prophylaxis and the condition becomes extremely rare because of the prophylaxis, you can't you don't know what the incidence would be if you didn't give the prophylaxis.

SPEAKER_01 12:27

And it is no longer deemed ethical to randomize.

SPEAKER_03 12:30

No, you can't because you know the benefits.

SPEAKER_01 12:32

Okay, but this is the scary thing that a lot of people do not realize. Without prophylaxis, without giving vitamin K, the incidence of the early VKDB can be up to one in 60 babies.

SPEAKER_03 12:48

That's like 1.5%.

SPEAKER_01 12:49

Yeah, it is actually really high. Yes. They quote anywhere from 0.25% up to 2% of births without prophylaxis. So it is it is quite significant.

SPEAKER_03 13:01

Now it doesn't mean that it's brain bleeding per se, but it's bleeding of some sort. Yes, these are the early bleeds.

SPEAKER_01 13:08

These are the early bleeds that usually happen outside the brain, but they can still happen in the brain. Yeah. And unfortunately, I cared for a baby that bled to death. Yes. And then the delayed one without prophylaxis, it is roughly one in fourteen to one in twenty-five thousand. So extremely rare. If you do not give prophylaxis, it is 80 times more common.

SPEAKER_03 13:29

Okay.

SPEAKER_01 13:30

So it does bring way down. It's virtually unheard of with prophylaxis.

SPEAKER_03 13:36

So you know, when you present the scary numbers like that, it seems to make sense to take the prophylaxis. But some people are hesitant because it's an intramuscular injection and they want it given orally.

SPEAKER_01 13:48

Yes.

SPEAKER_03 13:48

So what is the absorption rate like orally as compared to muscle injection? Because to be honest, nobody wants to be going around stopping a baby with a needle. Yeah. So I would assume there's some benefit to that IM injection over the oral drops.

SPEAKER_01 14:03

You're asking all the right questions, Aren't.

SPEAKER_03 14:04

It's nearly like we've got a medical degree if you've.

SPEAKER_01 14:07

I know. Before we do that, can we talk about the role of vitamin K in stopping bleeding?

SPEAKER_03 14:10

Oh, we forgot to go back and do that. Yes.

SPEAKER_01 14:12

I think that's important.

SPEAKER_03 14:13

I think that is important too.

SPEAKER_01 14:14

And I think you'll like that because you're you're a bit of a nerd and you like your homeostasis, don't you? As an anesthesia.

SPEAKER_03 14:18

I deal with bleeding every day. It is my job.

SPEAKER_01 14:20

It is your job.

SPEAKER_03 14:21

Surgeons make the holes and I stop them causing problems.

SPEAKER_01 14:24

Exactly. And now I'm actually a bit nervous because I might describe this wrong.

SPEAKER_03 14:29

Oh, I I think of it very simply. My brain breaks it down extremely simply.

SPEAKER_01 14:32

Well, let me break it down. The way I look at homeostasis, which is maintenance of normal. Yeah, maintenance of normal, preventing spontaneous bleeding. So let's say when a blood vessel is injured or when a body has a trauma or something, two main things happen. Something called early homeostasis, whereby the body needs to plug that hole very quickly. Yeah. And it does that with platelets.

SPEAKER_03 14:54

Yep.

SPEAKER_01 14:54

And some fibrin. So these are fibrous tissues that crisscross into like a mesh.

SPEAKER_03 14:58

Lattice, and then they trap the platelets and you get a plug.

SPEAKER_01 15:00

And then secondary homeostasis.

SPEAKER_03 15:02

It's kind of like how the conditioner sticks in a hair plug in your drain. It's goop.

SPEAKER_01 15:06

It's goop, exactly. But to maintain that goop and harden the goop, there are things called clotting factors that are proteins produced by the liver.

SPEAKER_03 15:14

Yes.

SPEAKER_01 15:14

And they rush to the scene and enforce that platelet plug.

SPEAKER_03 15:19

And amplify the signal.

SPEAKER_01 15:20

Vitamin K is important for activating those proteins.

SPEAKER_03 15:24

Yeah.

SPEAKER_01 15:24

So it's important in the secondary homeostasis.

SPEAKER_03 15:28

Yes.

SPEAKER_01 15:28

Without vitamin K, those proteins swim around and they do not get activated.

SPEAKER_03 15:34

Yes. The vitamin K-dependent ones. Some of them are vitamin K dependent, some of them aren't.

SPEAKER_01 15:38

A lot of them are. The important ones are. So although the liver can make those proteins, they are no good without vitamin K. It's like having a Ferrari with no wheels.

SPEAKER_03 15:47

Just sits in your driveway.

SPEAKER_01 15:48

Just sits in your driveway doing nothing. It'll look nice, but it's it's completely useless. Yes.

SPEAKER_03 15:54

Now on to IM versus oral drops.

SPEAKER_01 15:57

IM versus oral drops, okay? So what is the intramuscular injection? The intramuscular injection is a single dose given in a baby's thigh, and that acts as a depot because it replenishes deficiency in vitamin K that is present naturally at birth.

SPEAKER_03 16:15

And intramuscular injections tend to be slowly absorbed over a longer period of time. Exactly. So it gives the baby time to build up those stores.

SPEAKER_01 16:22

And it is only it's it's it really just does that until your body takes over to make enough vitamin K.

SPEAKER_02 16:29

Yeah.

SPEAKER_01 16:29

Until your microbiome gets better, until your diet is established. And then you're fine afterwards because your body and your liver begin to do their job. And it is really, really effective in dropping the incidence of the early bleeding.

SPEAKER_02 16:42

Yes.

SPEAKER_01 16:43

And as you see, it is still very effective in dropping the incidence of the late bleeds that are rarer. But if something is rare, making it even more rare is hard, if you know what I mean.

SPEAKER_03 16:53

I understand, yeah.

SPEAKER_01 16:54

Why is it better than the oral? Well, the oral medication has a few issues with it. First of all, gut absorption varies significantly. And the bioavailability, meaning how much of the drug that you ingest actually gets into your bloodstream, can be as low as 50%. Okay.

SPEAKER_03 17:12

So 50%.

SPEAKER_01 17:14

And that can be higher if the baby's not feeding well, if there's an issue with the microbiome, or if they have a sluggish bile system, because it's dependent on bile for its absorption.

SPEAKER_03 17:24

And can they not just give them two doses over a longer period of time?

SPEAKER_01 17:27

Well, that's what we do. It's usually two to three doses, depending on whether your formula or breastfeeding or depending on the jurisdiction. The problem is they are weeks apart. So people forget. Slow absorption weeks apart. So although it is somewhat effective in reducing the risk of bleeding, it is not as effective as the intramuscular injection of vitamin K.

SPEAKER_02 17:48

Okay.

SPEAKER_01 17:57

Now let's get on to the spicy bit.

SPEAKER_02 17:59

Oh, good spice.

SPEAKER_01 18:00

The unfortunate misinformation that is becoming pervasive.

SPEAKER_03 18:05

That was what I was gonna ask. Okay, so what are the naysayers objecting to?

SPEAKER_01 18:10

Just in general, I am actually getting sick and tired of how much misinformation there is on social media at the moment.

SPEAKER_03 18:18

Well, a couple of things I would say, right?

SPEAKER_01 18:20

Yeah.

SPEAKER_03 18:21

Is first of all, because you spend your time looking for this misinformation and watching this misinformation, you the algorithm will spam you with every bit of misinformation out there. Other people may not be seeing this level of misinformation because I don't. I don't get to the same degree of misinformation on my feed. So I understand that what you see may be equivalent to other people's feeds sometimes if they fall down that rabbit hole, which is terrible, but not everyone is seeing that much. So don't be maybe so afraid.

SPEAKER_01 18:54

I vehemently disagree with you.

SPEAKER_03 18:56

Okay, go for it.

SPEAKER_01 18:57

I do not spicy. I do not go seeking out that information to debunk it.

SPEAKER_03 19:02

But no, but the algorithm will present it to you because you watch it through to the end and keep moving.

SPEAKER_01 19:07

Because I'm in that space.

SPEAKER_03 19:08

And this is arguing about it.

SPEAKER_01 19:12

So my experience would be the experience of parents. When I come across a piece of misinformation, be it in a reel or a carousel, countless of parents will also send it to me at the same time.

SPEAKER_03 19:22

Okay.

SPEAKER_01 19:23

Because they come across it. And if you talk to a lot of parents, if they start searching for something or they are in a parenting space or they the algorithm figures out that they have a baby, they get bombarded. For example, I came I came across a reel today that I had to debunk. So this crazy lady, and I'm sorry she is a crazy lady, saying, Don't bother getting ultrasounds when you're pregnant. Your body will tell you if there's something wrong. It emits sound waves. We don't know what sound waves do to babies. Yes, we do. We know what sound waves do. They hit your tissues and reflect back and create an image. That's what they do. And your body will not tell you if your baby has a heart condition. Your body will not tell you if you have a placentor previa.

SPEAKER_02 20:13

I know that.

SPEAKER_01 20:14

Anyway, I'm digressing. I know. She also said, she went on, that reel was only I only debunked that part of the reel. Don't bother getting HPV vaccine. Your immunity will deal with it. It only comes and goes, it doesn't stay.

SPEAKER_03 20:25

Oh my god.

SPEAKER_01 20:27

Yes.

SPEAKER_03 20:28

Oh no. Okay. Now that you've brought it up, you started now triggering me.

SPEAKER_01 20:33

And and and Anne hundreds of thousands of views.

SPEAKER_03 20:36

Oh my god.

SPEAKER_01 20:37

Actually, and she has 3.5 million followers.

SPEAKER_03 20:41

Someone rang me the other day and said, Do you think I my kid should get the HPV vaccine? And I said, the HPV vaccine is responsible for nearly eradicating cervical cancer in Australia in one generation. It is transformative for families and it is transformative for populations. And I I really just can't see. I understand that no vaccination is 100% perfect, and I understand every decision has risks, be it going to the shop or deciding to take the HPV vaccine. But if you're reading about the risks, please, please, please read about the benefits accurately and with as much enthusiasm, please.

SPEAKER_01 21:27

So the misinformation machine that comes with vitamin K, let's talk about them. People push vitamin K as if it's a vaccine. They capitalize on the vaccine hesitancy and conflate to the fact that because it is injected, that it is a vaccine.

SPEAKER_03 21:45

What? It's a fat soluble vitamin that is in your food.

SPEAKER_01 21:49

Yes, it is not an antigen, it does not train the immune system, and it is just like he said, calling it a vaccine is like saying antibiotics are just like a sandwich because they both go through. The mouth.

SPEAKER_03 22:00

Absolutely.

SPEAKER_01 22:01

This is not to say vaccines are bad, but people are hesitant because of vaccine. Some people are vaccine hesitant.

SPEAKER_03 22:08

And some people are vaccine curious.

SPEAKER_01 22:09

Yes. Breast milk is enough, is the second one.

SPEAKER_03 22:13

It's an option, but you know, that's why we talked about like what happens with breastfed babies if they don't get supplemented and what the numbers are and stuff like that. And that's information for people to make a decision.

SPEAKER_01 22:25

And they will attack you when you say breast milk is low in vitamin K as criticism of breastfeeding. It is not.

SPEAKER_03 22:30

It's just breast milk. Breast milk is amazing. It is a magic, magic food, but nothing is perfect.

SPEAKER_01 22:37

Yes, so vitamin K is one of the few things that it doesn't reliably provide enough of in the early newborn person.

SPEAKER_03 22:42

One of the very few things.

SPEAKER_01 22:43

And that is just a fact. Okay. The other thing that people will come and say, a natural birth means the baby doesn't need it. Thus, this whole saying, natural birth, no ultrasounds, no intervention, no vitamin K, we were designed beautifully. Let nature take its course. Your body will tell you. Let's wait and see what happens. Give it when the bleed happens. A lot of the time, once the bleeding cascade starts, vitamin K will not unbleed your brain. And then the big one that people um use that came from a really badly done paper in the early 90s is that it causes cancer and increases the risk of leukemia.

SPEAKER_03 23:20

Vitamin K?

SPEAKER_01 23:21

Yes.

SPEAKER_03 23:22

But it's it's part of our like it's in everybody's body.

SPEAKER_01 23:26

Yeah. There was an old signal from a 1990 study, and unfortunately that lingered despite multiple, multiple larger scale studies that debunked that. I call bad papers and old myths the glitter of medicine. Once it's out there, it is impossible to completely get rid of.

SPEAKER_03 23:46

He hates glitter.

SPEAKER_01 23:46

I hate glitter.

SPEAKER_03 23:47

He's a glitter phobic.

SPEAKER_01 23:49

But it is impossible to clean up fully. You know, bits of glitter will pop up years later.

SPEAKER_03 23:56

If you ever want to troll a thief, send a glitter bomb to him.

SPEAKER_01 23:59

Yes, I know. And um yes.

SPEAKER_03 24:01

Now all the people who don't like you are gonna start sending glitter bombs to you.

SPEAKER_01 24:04

Yeah. And then the other myth is the dose is too high.

SPEAKER_03 24:07

It's a depot dose, so it's very slow absorption.

SPEAKER_01 24:10

Exactly. Yes, yes. It is higher than the daily recommended.

SPEAKER_03 24:14

Yeah, but it's given as a depot.

SPEAKER_01 24:16

Given as a depot, exactly. We spoke about the other myth, which is oral vitamin K is just as good. It is not. And then people will say VKDB is very rare, so the injection is unnecessary.

SPEAKER_03 24:26

It is only rare because it gets prevented.

SPEAKER_01 24:29

Yes. But these work because in the States the rate of refusal has jumped from 2.5% to 5%, so nearly doubled. And that might sound low.

SPEAKER_03 24:39

Well, what happens is the myth becomes fact the more it's repeated, and then the more it's written down, people don't check it because it's everywhere, and they assume it's just like one of those things that everyone accepts is real and true.

SPEAKER_01 24:50

Yeah, and I am now being called regularly in my medical practice to talk to parents who do not want to give intramuscular vitamin K.

SPEAKER_03 24:57

That just means that we're not getting the information out there early enough.

SPEAKER_01 25:01

Yes.

SPEAKER_03 25:01

You know, and I think parents should be able to ask those questions. I really do.

SPEAKER_01 25:05

Oh, absolutely, but often their minds are made up and it's really hard to change their minds. Yeah. Okay.

SPEAKER_03 25:11

Because what is so they're not asking, they're saying, I absolutely do not want to give it.

SPEAKER_01 25:15

Yeah, exactly. And because the biggest fear-mongering thing is that the ingredients in the IM are toxic.

SPEAKER_02 25:21

I know.

SPEAKER_01 25:22

Because here's the thing ingredients vary by formulation and country. Okay. What these fearmongerers do is that they use the chemical name to scare you, right? It has benzyl alcohol on it. Like benzyl alcohol. Why would I give my baby petrol and alcohol? You know? These are stabilizers. You see, people don't like chemical names, and those guys know this. Imagine if I came up to you and I said, Anne, here's a glass of dihydrogen monoxide.

SPEAKER_03 25:51

Water.

SPEAKER_01 25:52

There you go. Like, you know, you can you can make anything sound scary.

SPEAKER_03 25:58

You could list the components of breast milk as chemicals and people who wouldn't give it to their child.

SPEAKER_01 26:03

Absolutely. Absolutely.

SPEAKER_03 26:04

You really, really could actually.

SPEAKER_01 26:05

Yeah. I mean, like, and and remember the reel you showed me. I really think that we as doctors we need to rebrand all of these things to make them more appealing.

SPEAKER_03 26:15

There's a huge branding issue.

SPEAKER_01 26:17

I think we need to rebrand it as, you know, organic newborn clotting essence.

SPEAKER_02 26:22

Yes.

SPEAKER_01 26:23

Delivered ethically through a tiny wellness portal through the thigh.

SPEAKER_02 26:29

Yes. Into your yeah, into your baby's essence.

SPEAKER_01 26:34

Into your baby's essence. And then people will take it.

SPEAKER_02 26:36

Yes.

SPEAKER_01 26:37

It reminds me of parks and recreation where nobody was drinking water in the town.

SPEAKER_02 26:42

Yeah.

SPEAKER_01 26:43

And they were just drinking sugary drinks. Yeah. And they came up with the rebrand, H2 Flow.

unknown 26:47

Yeah.

SPEAKER_03 26:48

And everyone goes, I think I'll have some of that.

SPEAKER_01 26:51

I'll have some of that. Yeah. No, H2 Flow.

SPEAKER_03 26:53

We are so we are so marketing susceptible. Okay. That's how everything is designed.

SPEAKER_01 26:57

Yes, exactly.

SPEAKER_03 26:58

So yeah.

SPEAKER_01 26:58

Yeah. And so I think we need we need to do the big rebrand, and that's how it's going to work.

SPEAKER_03 27:03

I agree.

SPEAKER_01 27:04

Yes. But joking aside, to kind of finish up, like with all of this misinformation floating around, there are going to be parents that are worried about this. Okay?

SPEAKER_03 27:14

Yeah. And I think that's reasonable because that just means like they care enough to ask the questions. And that's they're the people that we have to sit down and have really good conversations with.

SPEAKER_01 27:22

And I think there is a communication framework that we as healthcare providers need to do better with. Okay. First of all, we need to validate their concerns. Because you know they're making these decisions based on what they have heard for the protection of their baby. They're not setting out to harm their the baby.

SPEAKER_03 27:42

No.

SPEAKER_01 27:42

And then I think it's important, as we did at the start of this episode, to explain the physiology. And then we need to explain the consequences, I think, adequately. So without it, a small number of babies, I mean one in sixty to me is not a small number of babies, but a small number of babies will bleed early. And an even smaller number of babies later on will be will bleed in a catastrophic way. Yeah. Right? One in 25,000. That's in Ireland would be two to three babies a year.

SPEAKER_02 28:12

A year, yeah.

SPEAKER_01 28:13

I know that doesn't sound as much, but it's two to three babies that do not need to.

SPEAKER_03 28:18

And again, we're talking about our incidence risk matrix kind of thing that you talk about. The even if it's rare but the consequences are monumental, it is high risk.

SPEAKER_01 28:29

Yeah, exactly. And then I think we need to be honest in comparing options. So if you do not want the intramuscular, the oral is available, it does offer some protection, but there are caveats.

SPEAKER_03 28:42

Yes.

SPEAKER_01 28:42

Okay? And we need to explain those as we run through in the episode.

SPEAKER_03 28:45

And we also don't know how the oral impacts the overall risk, then, because you don't know what the absorption is, really.

SPEAKER_01 28:52

Yeah, and it can be very variable. Yes. So I think as clinicians, we need to avoid saying things like it's completely safe, don't worry, because that is it really doesn't help. No, it doesn't help.

SPEAKER_03 29:03

And it's also not true because everything you do has some risks associated with those.

SPEAKER_01 29:08

Yeah, exactly. Um, we need to acknowledge that there can be some reactions to the intramuscular injection. There are extremely rare hypersensitivity reactions where babies can mount an allergic reaction to it. I have been in the rotunda now for 12 years. I haven't seen it once.

SPEAKER_03 29:24

Okay.

SPEAKER_01 29:25

So it is extremely rare on unbalance. It is far safer to give it than risk the one in 60 chance of your baby. Having a persistent bleed. Yeah. So, I mean, to round up the episode, I guess, vitamin K is not a vaccine, it's not a lifestyle choice, and it's not a comment on breastfeeding, birth choices, or parenting philosophy. It is a vitamin that newborn babies need because they are born with low stores, immature gut bacteria, and not enough vitamin K intake to reliably support clotting. Okay? Although VKDB is rare, it is not harmless. It can cause bleeding into the gut, after procedures, and most devastatingly, bleeding into the brain. And the late form can happen weeks after birth in a baby who looks completely well, and then by the time the baby presents with a seizure or collapse, prevention has failed. And one in five to a third of babies will die from this. What we recommend is the vitamin K injection because the most reliable protection, oral vitamin K, is better than nothing, but it's not equivalent and it does depend on repeated doses and absorption, and it can fail in babies with unrecognized liver or absorption problem. So there is a lot of misinformation about vitamin K, in addition to a lot of other things that we alluded to. So before we finish up, I want to ask people for a favor. Um, if they found this episode helpful, please share it with a parent, a midwife, a GP, um, or anybody that has heard confusing claims about vitamin K. And as always, speak to your own healthcare team about decisions for your baby.

SPEAKER_03 31:03

And just before we finish up, I just want to tell the listeners that I'm off. I'm gonna cook the dinner for the kids, I'm gonna put on a wash, I'm gonna do some housework. I've been studying all day, but I'm gonna go do that because that's what I do. And then my my most important job is actually gonna be giving a fief the cold shoulder for the evening because of that absolute farcical outburst he had at the beginning where he claimed to be doing so much. So, um, yeah, that's my job for the evening.

SPEAKER_01 31:29

I'm gonna cook a steak for me and buddy.

SPEAKER_00 31:31

Yeah, bye. This show is part of the Headstuff Podcast Network, a hub for the creative and the curious. Shows are produced in association with Headstuff and the Podcast Studios Dublin. Find out more or become a member at Headstuff Podcasts.com.