Tag: vitamin K shot

Don’t Skip Your RhoGAM Shot

I’m kind of shocked that I am having to write about warning folks to not skip their RhoGAM shot.

“Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery.”

ACOG on Prevention of Rh D Alloimmunization

Unfortunately, like with the vitamin K shot, in addition to trying to scare new moms away from getting vaccines, they also tell them to skip their RhoGAM shot.

What is RhoGAM?

RhoGAM (RhIg) or anti-D immune globulin is not a vaccine.

A RhoGAM shot can help prevent hemolytic disease of the newborn and fetus.
A RhoGAM shot can help prevent hemolytic disease of the fetus and newborn.

It is a prescription immune globulin shot that is given to some pregnant and post-partum women to prevent Rh (Rhesus) immunization, which can lead to hemolytic disease of the fetus and newborn if you get pregnant again.

RhoGAM was approved by the FDA in 1968.

RhoGAM Questions and Answers

If you have been educated about RhoGAM on the Internet and are thinking about skipping your RhoGAM shot, it might be time for a little more research:

  1. What is hemolytic disease of the fetus and newborn (HDFN)? It is not to be confused with vitamin K deficiency bleeding, which can be prevented with a vitamin K shot. Also known as erythroblastosis fetalis, HDFN occurs when a mother develops antibodies against her baby’s own red blood cells and destroys them, leading to anemia, jaundice, and edema. In severe cases, this can be life-threatening and the baby can develop hydrops fetalis.
  2. Why would a mom develop these antibodies against her own baby’s blood in the first place? Since a baby’s blood type is determined by both their mom and dad’s blood type, it is easy to see how it might be different than moms. This usually isn’t a problem, after all, a mother’s immune system doesn’t usually attack any other cells of the placenta or her baby (immune tolerance of pregnancy) that might be “foreign.” Unfortunately, it is not uncommon for a baby’s blood and “foreign” red blood cells to mix with mom’s blood, which could trigger antibodies to form.
  3. How does a baby’s blood mix with mom’s blood? Doctor’s have long known that while mixing is not common during a women’s pregnancy, it can commonly occur when she gives birth, explaining how Rh disease used to kill 10,000 babies each year in the United States. It doesn’t take trauma, a procedure (amniocentesis or chorionic villus sampling), or a difficult delivery for a baby’s blood cells to leak into a mother’s bloodstream. It can just happen. Mixing can also happen after a miscarriage, an ectopic pregnancy, or an induced abortion. Simply trying to turn a baby from the breech to a head-down position before delivery (external cephalic version procedure) leads to fetal-maternal hemorrhage in 2 to 6% of cases.
  4. Who needs to get a RhoGAM shot? It is hopefully clear already that not everyone is at risk to develop Rh immunization and so not everyone needs RhoGAM. Some folks can safely skip their RhoGAM shot, but only because it would never have been recommended for them in the first place. You only need RhoGAM if your baby’s blood type might be different than yours, specifically the Rh D antigen of the blood  and if you (mom) are Rh D negative (Rh-negative). Why don’t we worry about the ABO part? While an ABO incompatibility can also cause hemolytic disease of the newborn, it is usually much more minor. Why don’t we worry if you are Rh-positive and the baby is Rh-negative? If your baby is Rh-negative, then he or she wouldn’t have any Rh antigens on their red blood cells to make antibodies against.
  5. What is the chance your baby will be Rh-positive? It depends. And is actually more complicated than people think. If dad is Rh-positive, he can be either +/- or +/+, because there are two alleles for the Rh gene and Rh-positive is dominant. So if mom is Rh-negative (she can only be -/-), then their baby could either be +/- or -/-, so has at least a 50% chance of being Rh-positive. On the other hand, if dad is definitely +/+, then there will be a 100% chance that the baby will be Rh-positive. If you are confused now, then you don’t want to think about how two Rh-positive parents can have a Rh-negative baby!
  6. When will I get my RhoGAM shot? The current guidelines are to get a RhoGAM shot at around the 28th week of pregnancy to prevent Rh sensitization for the rest of the pregnancy; within 72 hours after the delivery of an Rh-positive infant; after a miscarriage, abortion, or ectopic pregnancy; or after amniocentesis or chorionic villus sampling.
  7. Can I skip my RhoGAM shot? You can skip your RhoGAM shot if you are already Rh sensitized (because it’s too late and RhoGAM won’t help for any future pregnancies) or if you are Rh-positive.  You will know if you are already Rh sensitized because a blood test is done to check for Rh antibodies. When paternity is certain (you know who the father is), and the father is Rh-negative, you can also skip the shot you would get at 28 weeks.  You can also skip your RhoGAM shot if your baby is Rh-negative.
  8. How do you know if you are already Rh sensitized? Moms who are Rh-negative get an antibody screen to see if they have Rh antibodies when they are 28 to 29 weeks pregnant.
  9. Why do some women seem to safely skip their RhoGAM shot and have a healthy baby? Like with skipping a vitamin K shot or with skipping or delaying vaccines, the risk of a baby developing hemolytic disease of the fetus and newborn isn’t 100%, so these parents who skipped their RhoGAM shot gambled and got lucky their baby wasn’t harmed.
  10. But don’t they do it differently in other countries? Yes. In the UK, they routinely give all Rh-negative mothers either one dose of RhoGAM at 28-30 weeks or two doses, one at 28 weeks and another at 34 weeks. New mums will also get a shot after their baby is born if their baby is Rh-positive.

Don’t skip your RhoGAM shot if it has been recommended. If you do, you will have a 13-16% chance of becoming Rh sensitized, which can affect your next pregnancy.

RhoGAM Myths

But your OB/Gyn doctor gives you RhoGAM, so why is a pediatrician writing about it?

Because getting RhoGAM prevents hemolytic disease of the fetus and newborn. If you ever see, or hopefully just read about a baby with hydrops fetalis, you will understand why pediatricians don’t want you to skip anything just because of something you read on the Internet, especially myths like:

  • RhoGAM is a vaccine – not true. RhoGAM is made of antibodies. And while it is a blood product, it is extensively screened and tested for infections. Of course, you shouldn’t skip any of your pregnancy vaccines either, like your flu or Tdap vaccines.
  • RhoGAM contains mercury – not true. RhoGAM is thimerosal free.
  • You only need RhoGAM if you have been in a car accident – not true, at all. Again, even in a normal pregnancy, with a “gentle birth,” there can be mixing of blood. And it doesn’t take a lot of blood mixing. As little as 0.1ml of blood (keep in mind that a teaspoon is 5ml) can trigger Rh sensitization.
  • hemolytic disease of the fetus and newborn is easily treatable – not true. While it might be true for more minor ABO blood incompatibilities, it is not true for Rh disease. If a baby develops hydrops fetalis, they might need intrauterine fetal blood transfusions and an early delivery. After they are born, babies with hydrops fetalis will likely need blood transfusions (because of severe anemia), exchange transfusions (because of extreme levels of jaundice), medicines to manage heart failure, phototherapy, and will likely be on a ventilator to help them breath. And even in a modern NICU, babies with hydrops fetalis still die.
  • everyone is offered a RhoGAM shot as part of a Big Pharma profit ploy – not true. RhoGAM is only given to moms who are Rh-negative, and since 85% of people are Rh-positive, most are never offered RhoGAM.
  • you can just wait to see if you want to get the shot later – not true. If you are Rh-negative and skip the pregnancy dose, waiting until your baby is born to see if they are Rh-positive, you may have already become sensitized. Mixing of blood occurs during pregnancy in at least 12% of cases and that is not just with car accidents, procedures, or trauma. Before RhoGAM started to be used during pregnancy, instead of just after, almost 2% of moms still became sensitized. Although that might seem like a small number, when you consider that almost 4 million babies are born in the United States each year, it ends up being a lot of babies at risk for HDFN if moms start skipping their RhoGAM shots.
  • you can just skip the shot if you don’t want any more kids – not true. Want if you change your mind and decide you do want more kids or have a “happy accident.”
  • there are natural ways to prevent Rh-sensitization – not true.
  • Rhogam causes serious side effects – not true. Rhogam is safe and doesn’t cause autism or any of the other serious side effects that you might see listed on sites trying to scare you away from getting your shot.
  • “First time mothers do not need it. A dose at 28 weeks is unnecessary unless a test shows sensitization has already occurred.” – ridiculously untrue, but I included it to show what kind of advice you will find on some websites. First time mothers definitely could need it, if they are Rh-negative, so that they don’t become sensitized, and if they are already sensitized, a dose isn’t going to help them!

Again, don’t skip your RhoGAM shot.

What To Know About Getting a RhoGAM Shot

There is no reason to skip your RhoGAM shot if it has been recommended for you during or after your pregnancy.

More About Deciding To Get A RhoGAM Shot

That Black Box Warning on Vitamin K Shots

Vitamin K is not a vaccine, but some parents who plan on skipping or delaying their baby’s vaccines, also choose to skip this shot.

Vitamin K Shots

Given soon after a baby is born, a vitamin K shot is the most effective way to prevent both early onset and late onset vitamin K deficiency bleeding.

“The vitamin K injection is also a supposed safeguard in case your car is involved in a car wreck on the way home from the hospital or birthing center with newborn in tow.”

The Healthy Home Economist on why you should Skip that Newborn Vitamin K Shot

Although vitamin K deficiency bleeding has never been very common, it is often fatal, and it has been known for almost 125 years that it is caused by a temporary lack of vitamin K in newborns and younger infants.

Can’t you just give babies oral vitamin K to prevent this bleeding?

While oral vitamin K can prevent early onset vitamin K deficiency bleeding, which might start from birth to when a baby is about two weeks old, it won’t prevent late onset bleeding, even if you give the recommend three doses on schedule over two months (as they do in some countries). Babies with late onset vitamin K deficiency bleeding might not have symptoms until after they are two weeks old, or as late as 5 or 6 months old, and it can only be prevented with a vitamin K shot.

Can’t you just avoid dropping your baby or getting into a car wreck if you skip the vitamin K shot?

While you will hopefully do that anyway, the truth is that we don’t know why some infants with vitamin K deficiency bleeding develop bleeding in their brains, as it usually isn’t any kind of big trauma.

In 2013, seven babies over a period of eight months had early and late vitamin K deficiency bleeding at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville.

Three of them required surgery to remove clots “out of their head” and may “have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”

I don’t think any of them were dropped or were involved in car accidents on the way home from the hospital or birthing center.

All had refused to get their baby a vitamin K shot.

Why Do Parents Refuse Vitamin K???

So why do some parents choose to skip their baby’s vitamin K shot?

There are no toxic ingredients in your baby's vitamin K shot.
There are no toxic ingredients in your baby’s vitamin K shot.

Some parents simply think their baby doesn’t need it, especially if they have an uncomplicated, “gentle birth” at home. Of course that has nothing to do with whether or not your baby develops vitamin K deficiency bleeding days or weeks later. It also doesn’t matter whether or not you plan on getting your baby boy circumcised, although your pediatrician probably won’t do the circumcision if you skip the shot.

Other parents are worried about a possible link to leukemia and childhood cancer, an improbable link that was refuted way back in the 1990s.

And still others are worried about the mercury content of vitamin K shots. Or they are worried about other supposed “toxins” in the shot, that it is a synthetic version of vitamin K, or that the dose is too high.

“There is no evidence to suggest that the small amount of benzyl alcohol contained in Vitamin K1 Injection (Phytonadione Injectable Emulsion, USP), when used as recommended, is associated with toxicity.”

Vitamin K Package Insert

Why are they worried about these things?

Mostly because someone on the Internet told them to be worried about them, even though vitamin K shots are safe, are free of mercury and any other toxins you might really need to be concerned about, and the dose of synthetic vitamin K your baby gets in the shot will not cause an overdose.

Or they might be worried that their baby might get up to 100mcg/L of aluminum with each shot. Of course, since they are only getting 0.5ml with the shot, that only equals about 0.05mcg of aluminum! Although it is an extremely tiny amount, why is it even in there? It is not working as an adjuvant as some would propose (again, vitamin K is not a vaccine), but rather is likely just a byproduct of the manufacturing process. And you can be assured that your baby can quickly, and safely eliminate the small amount from their body.

“…several countries have reported a resurgence of late VKDB coincident with policies promoting the use of orally administered prophylaxis, even with multiple-dose regimens.”

AAP on Controversies Concerning Vitamin K and the Newborn

The shot (which works) is certainly safer than going to a compounding pharmacy for oral vitamin K (which won’t work to prevent all cases of late-onset vitamin K deficiency bleeding).

That’s right – oral vitamin K for babies isn’t even available in the United States.

That Black Box Warning on Vitamin K Shots

And then there is the black box warning in the package insert for vitamin K.

The package insert for vitamin K does include a black box warning, although these severe reactions are extremely rare in newborns who get a vitamin K shot to prevent vitamin K deficiency bleeding.
The package insert for vitamin K does include a black box warning, although these severe reactions are extremely rare in newborns who get a vitamin K shot to prevent vitamin K deficiency bleeding.

Why is it there?

It was found that people could have severe, life-threatening allergic reactions (anaphylaxis) if they got a large dose of vitamin K too rapidly through an IV. This type of dose would usually be given to patients with significant bleeding who were being treated with anticoagulants (anticoagulant reversal).

“Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1.”

Jamie N Brown on Characterizing the Severe Reactions of Parenteral Vitamin K1

This is not what happens when babies get their vitamin K shot though, although there is one non-fatal case report of anaphylaxis after a baby in Turkey got a vitamin K shot in 2014.

There are nearly 4 million births in the United States each year.

Almost all of them get a vitamin K shot very soon after they are born.

And yet there are no reports of anaphylaxis in the United States.

There are isolated case reports of anaphylaxis in newborns to other things, including antibiotics, hepatitis B immunoglobulin, total parenteral nutrition (TPN), and atracurium (used in anesthesia) – but not to vitamin K shots.

“Therefore the INTRAVENOUS and INTRAMUSCULAR routes should be restricted to those situations where the subcutaneous route is not feasible and the serious risk involved is considered justified.”

Vitamin K Black Box Warning

That’s why most parents don’t skip getting their baby a vitamin K shot. Or they come to regret the decision if they do.

“What it comes down to is that giving your child a shot of Vitamin K at birth is a small price to pay, especially when the cost of rejecting the shot can be severe brain injury and death. I can’t change what happened to Olive, but I can try to prevent it from happening to another baby.”

Olive’s Story

For most parents, avoiding the serious risk of vitamin K deficiency bleeding justifies their baby getting a vitamin K shot.

And that’s why vitamin K deficiency bleeding is so rare these days – at least among those babies whose parents didn’t choose to skip their vitamin K shot.

What To Know About That Black Box Warning on Vitamin K Shots

For most parents, avoiding the serious risk of vitamin K deficiency bleeding easily justifies their decision to get their baby a vitamin K shot, despite the presence of a black box warning.

More About That Black Box Warning on Vitamin K Shots

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Don’t Skip Your Baby’s Vitamin K Shot

Most parents understand and expect that their baby will get a vitamin K shot when they are born and before they leave the hospital.

It helps prevent bleeding from vitamin K deficiency.

Vitamin K for Babies

Leave the formula samples at the hospital, but don't leave without your baby's vitamin K shot.
Leave the formula samples at the hospital, but don’t leave without your baby’s vitamin K shot.

Newborns have been routinely getting vitamin K shots since at least since 1961.

While it was well known that newborns could suffer from hemorrhagic disease of the newborn (the old name for vitamin K deficiency bleeding) since 1894 (thanks to Dr. Charles Townsend), it wasn’t until later that it was connected to a temporary lack of vitamin K in newborns and younger infants. This occurs because:

  • vitamin K doesn’t pass through the placenta well, so your baby doesn’t build up a good supply during pregnancy
  • breast milk is a poor source of vitamin K, even if the breastfeeding mother eats well and takes supplements, so your baby isn’t able to quickly build up a good supply after she is born
  • babies have a mostly sterile gut and are not born with the bacteria in their intestines that can make vitamin K
  • some clotting factors need vitamin K to work

Although vitamin K deficiency bleeding was never very common, before newborns began it get vitamin K shots, it did affect from 1.7% (classic onset disease) to 7 in 100,000 newborns (late onset disease).

Since many of these bleeds were fatal, even though they were rare, no one thought that there was a benefit to being low in vitamin K and getting a vitamin K shot wasn’t controversial. At least not until a 1992 paper suggested that vitamin K shots could be associated with childhood cancer. That soon led some parents to refuse their babies vitamin K shots for a short time, at least until the link was refuted.

In 1996, a student called for the ‘End of the Vitamin K Brouhaha:’

“Because hemorrhagic disease of the newborn can be life-threatening but preventable, the studies by von Kries et al and Ansell et al should allay our fears and doubts about the dangers of administering intramuscular vitamin K immediately after birth. It seems that hemorrhagic disease of the newborn can be completely eradicated without the threat of leukemia and childhood cancer as a side effect.”

And the vitamin K brouhaha did seem to end.

The Vitamin K Controversy

It came back though.

In addition to holistic and natural parenting groups, there are some who are against vaccines who are also against vitamin K shots.

This is surprising to many people, as those who oppose giving babies vitamin K are often the same folks who push many other types of vitamins, including megadoses of vitamin C, vitamin B12 shots, and extra vitamin D.

Vitamin K Misinformation

So why do some parents skip giving their new baby a vitamin K shot?

It is possible that in doing their research, they have been mislead by some of the misinformation about vitamin K that you commonly find on the internet.

This includes claims that:

  • there is mercury and other toxic ingredients in the vitamin K shots (the truth is that neither mercury or thimerosal nor any other heavy metals are used as a preservative in vitamin K shots and all of the other ingredients are safe too)
  • vitamin K shots cause cancer (the truth is that they don’t and an early study that suggested they did was later refuted many times)
  • babies don’t need extra vitamin K (the truth is that some do though and it is typically impossible to identify them, except maybe for babies born to mothers taking certain medications, mostly seizure medicines, that put them at extra risk of early vitamin K deficiency bleeding)
  • babies start making enough vitamin K when they are 8 days old (the truth is that some babies don’t, especially those with liver disease and other disorders that might interfere with the absorption of fat soluble vitamins)
  • babies did fine before we started giving them vitamin K shots (the truth is that some died, which is why we started giving vitamin K in the first place)
  • you can just give babies oral vitamin K instead of a vitamin K shot (the truth is that oral vitamin K doesn’t work to prevent all cases of late onset vitamin K deficiency, which is also deadly)
  • only boys who get a circumcision need vitamin K (the truth is that we don’t know why some infants with vitamin K deficiency bleeding develop bleeding in their brains, as it isn’t usually any kind of big trauma, so it doesn’t have to be something like a circumcision or a fall or whether you delivered vaginally or by C-section, etc. In fact, late onset bleeding can occur up to 12 weeks, and sometimes as long as 6 months, after a baby is born!)
  • there must be a benefit to having low vitamin K levels when we are born, otherwise God wouldn’t have made us this way (even if this were somehow true, it doesn’t negate the fact that some babies die from their low vitamin K levels…)

Just as with vaccine preventable diseases, since vitamin K deficiency is now rare (because most parents make sure their babies get a vitamin K shot), it is easy for parents to be misled by this type of misinformation.

Bad Advice about Vitamin K

According to the American Academy of Pediatrics, vitamin K deficiency bleeding “is most effectively prevented by parenteral administration of vitamin K.”

That’s the vitamin K shot.

While early (birth to 2 weeks) vitamin K deficiency bleeding can be prevented with either oral vitamin K or a vitamin K shot, late onset (2 to 12 weeks) vitamin K deficiency bleeding is best prevented with a vitamin K shot.

Some people didn’t get the message though, advising parents to skip the vitamin K shot against all standard medical advice:

  • Dr. Mercola still warns parents about the ‘jab with a syringe full of vitamin K.’
  • Sarah Pope at the Health Home Economist tells parents to ‘Skip that Newborn Vitamin K Shot’
  • 28 percent of parents who delivered at local private birthing centers in Tennessee had recently declined the vitamin K shot

So what are the consequences of this kind of non-standard, non-evidence based advice?

They are much as you would expect when dealing with a potentially life-threatening condition – a rise in vitamin K deficiency bleeding in newborns and infants.

Among the recent cases of early and late vitamin K deficiency bleeding include:

  • seven babies over eight months in  2013 at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, including three who required surgery to remove clots “out of their head” and who may “have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”
  • a 5-week-old in Florida with late onset vitamin K dependent bleeding. The youngest of 6 children, none of whom had been given vitamin K, the baby had a seizure and stopped breathing after developing two brain hemorrhages.
  • a 3-week-old in Indiana with late onset vitamin K dependent bleeding who was born in a birthing center and whose “parents signed a waiver to forego vaccination and prophylactic therapies,” and required an emergency craniotomy to evacuate braining bleeding, prolonged intubation, and difficult to control seizures
  • a 6-week-old in Illinois with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and developed brain bleeding and swelling, seizures, a DVT, and who was hospitalized for 10 days
  • a 6-week-old in South Texas with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and died after developing brain bleeding and seizures
  • an infant in Australia who had not been given a vitamin K shot as per her mother’s birth plan and  died of late vitamin K deficiency bleeding (at 33 days of life)
  • another infant in Australia who is in critical condition after his parents refused a vitamin K shot
  • infants in Germany, Switzerland, Denmark, and the Netherlands who have suffered from vitamin K deficiency bleeding while receiving oral vitamin K, often because their parents refused a vitamin K shot

Tragically, most parents who refuse vitamin K shots also refuse other potentially life-saving medical interventions, including getting a hepatitis B vaccine and even getting erythromycin eye ointment. And many go on to refuse all childhood vaccines.

On the bright side, the great majority of parents do allow their newborn babies to receive vitamin K when they are born. One study found that only 0.3% of parents refused vitamin K.

What To Know About Vitamin K Shots for Babies

The bottom line is that vitamin K shots are a safe way to prevent vitamin K deficiency bleeding. This is no good reason to skip this shot for your baby.

More Information About Vitamin K Shots for Babies

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