Neonatal Vitamin K Injections

One thing I didn't think I'd be thinking about in the hours leading up to and immediately following the birth of my first child was whether or not to top up her fledgling baby body with Vitamin K (the biomolecule, not the recreational drug, as wikipedia so usefully disambiguates).

It is standard practice for Royal Prince Alfred Hospital in Sydney to provide this to newborn babies in their first hours outside the womb. The reasoning is as follows:
1) a tiny number* of babies have haemorrhagic disease of the newborn (HDN) a.k.a. vitamin k deficiency bleeding (VKDB). HDN can lead to brain haemorrhage or death in a small number of cases**
2) injecting babies with Vitamin K seems to prevent HDN
3) injecting babies with Vitamin K doesn't seem to do any harm to babies with or without HDN

On the surface of it then, there is no surprise that the Overlords of Australian Medicine decree that all babies should receive Vitamin K.

Yet when my wife and I decided that we'd like to dig a little deeper, we had no idea of the many and varied issues that lurk behind this seemingly simple and noncontroversial medical intervention.

These and other thoughts floated through mine and my wife's head
- what is the evidence, where do you get it and how do you weigh it up? are there any side effects to getting Vitamin K and what is the risk? How do they stack up with the same parameters for HDN?
- who do you trust - science? scientists? science as interpreted by public health authorities? dissenting opinions?
- public information on early childhood medical interventions is rather scanty
- somewhere (actually manywheres) out there lies the "hidden truth"
- the internet-facilitated self-education of the general public on health matters and others
- what the dickens is medical intervention all about? eradication of death? betterment of life? when is too much and when is not enough?
- what madness lies behind the word "management"? as in medical or business or natural resources management?
- why don't babies have Vitamin K if they need it so badly? Could there be (unknown) reasons babies have a low amount of Vitamin K? (nb I've seen 6 weeks and 6 months quoted as the time by which a baby builds up its own sufficient stores of Vitamin K). A study on rats by Israeli scientists tantalisingly suggests that low neonatal Vitamin K levels may be beneficial (especially if your mother's a smoker)
- the power of language e.g. VKDB assumes that no Vitamin K is the problem - as though that is the only way to cure HDN - presumably there are many other steps in the cascade of clotting events where intervention could be successful. By analogy, we could call headaches Panadol Deficiency Cranial Aches
- should we inject the Vitamin K (once, in the thigh muscle) or should we administer it orally (three doses, day 1, 6 and 28)? a study showed a link between intramuscular injections and childhood leukaemia - other studies have not. And how do we weigh up metadata (results from separate studies?)
- why the hell did we invest so much time investigating this 1 in 10,000 shot at badness, but not the myriad others that effect our lives and our baby's life? I now have in my possession a document outlining the causes of death in 0-17 year olds in NSW in 2006. Most are in the first 24 hours, and i didn't come across any due to HDN (or immunisation, or the diseases against which we immunise...). There are so many numbers out there, and who's going to analyse them?

The more you look into some things, the murkier they get.

I'd like to say we weighed up all the evidence carefully - the scientific papers, the medical brochures, the midwife run forums, the numbers... But a fair dose of emotion came into it - not that there's anything wrong with that! We came close to saying no - when the risk is so low, why intervene? We have no reason to suspect our bubba's at risk...

We chickened out in the end - what fools we'd look if little infant bled and bled and we'd done nothing! Funny how it comes down to fear - a friend once said fear is the underlying principle of society. It's just like insurance I guess. We plumped for the oral dose (why stick a needle into poor bubby's leg, plus a trace of cancer fear perhaps).

I wonder how many other parents have gone through something similar? At least a few, I'd suggest.

* the figure bandied about is 1 in 10,000, I have no idea on which population or at what time this number is based
** 1/2 and 1/5 of HDN cases respectively, again I haven't source the numbers