Refusal of neonatal vitamin K injections: antivaccine déjà vu all over again

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As prolific as I am, I have actually slowed down. Long time readers know this, as I used to have a post up seven days a week and sometimes two or more in a day. These days, I’ve made it a rule that I don’t post on weekends (except if something really catches my eye and I can’t control the blogging itch until Monday), and I almost never post more than once a day on weekdays. Heck, of late I’ve even been known to miss a weekday every now and then without even recycling posts from my not-so-super-secret other blog. It’s good, as I was a bit insane back then.

What I’m talking about is an article that appeared a week ago in Mother Jones by my old ScienceBlogs fellow blogger Chris Mooney. Now Chris and I might have had our differences over the years, but more often than not he’s right on, and even when we disagree we’re usually not so far apart that the gap is unbridgeable. In any case, a week ago, Chris published an article entitled Babies Are Getting Brain Bleeds—Are Vaccine Fears to Blame?, where he described a problem:

In May, the Tennessean reported on a truly shocking medical problem. Seven infants, aged between seven and 20 weeks old, had arrived at Vanderbilt University’s Monroe Carell Jr. Children’s Hospital over the past eight months with a condition called “vitamin K deficiency bleeding,” or VKDB. This rare disorder occurs because human infants do not have enough vitamin K, a blood coagulant, in their systems. Infants who develop VKDB can bleed in various parts of their bodies, including bleeding into the brain. This can cause brain damage or even death.

There is a simple protection against VKDB that has been in regular medical use since 1961, when it was recommended by the American Academy of Pediatrics: Infants receive an injection of vitamin K into the leg muscle right after birth. Infants do not get enough of this vitamin from their mother’s body or her milk, so this injection (which is not a vaccine, but simply a vitamin being delivered via a shot) is essential, explains pediatrician Clay Jones on the latest installment of the Inquiring Minds podcast (stream below). It’s also quite safe.

Mooney’s article was based largely on information supplied to him by a pediatrician, Clay Jones, who also happened to blog at my not-so-super-secret other blog about the efficacy and safety of neonatal vitamin K injections for preventing brain bleeds, in a post from last year entitled Separating Fact From Fiction in the Not-So-Normal Newborn Nursery: Vitamin K Shots… and an installment of the Inquiring Minds podcast. The long version is in Clay’s post, but the short version is that newborn infants are considered universally deficient in vitamin K because of poor transfer of the vitamin across the placenta, immaturity of the liver leading to decreased storage capability and inefficiency at using available vitamin K, and deficiency of vitamin K in breast milk. In addition, the gut of the newborn, which starts out sterile, doesn’t significantly contribute to vitamin K levels for several weeks. (Vitamin K is actually synthesized by bacteria in the intestines and then absorbed.) The primary function of vitamin K is in clotting, where it’s a cofactor necessary for the activity of several enzymes involved in the clotting cascade. Indeed, the mechanism by which the anticoagulant drug warfarin (Coumadin) is by blocking the conversion of inactive precursors into active vitamin K, which is why vitamin K is used to reverse the the effects of Coumadin, and patients are told to avoid foods rich in vitamin K.

Without supplementation, babies are at risk for a potentially life-threatening complication known as vitamin K-deficient bleeding (VKDB). It primarily occurs in breastfed babies who didn’t receive an intramuscular dose of vitamin K as a newborn. There are two forms, an early form that occurs in the first week of life with an incidence of 0.25% to 1.7%) and a late form (late VKDB) that occurs between 2 and 12 weeks of age. It is this late form that tends to be associated with brain bleeding. Worse, VDKB can occur in perfectly healthy babies spontaneously (i.e., no obvious trauma is necessary), and it can range in severity from mild to life-threatening. Bleeding commonly manifests itself as skin bruising, bleeding from the mucus membranes, bleeding at the umbilical cord stump, and, worst of all, bleeding into the brain. Although the risk of late VKDB in babies who don’t receive prophylaxis is low (4.4 to 7.2 per 100,000 children not receiving vitamin K prophylaxis, according to Clay), intramuscular vitamin K is virtually 100% protective, and oral vitamin K supplementation doesn’t work nearly as well, so much so that some countries who had previously switched from recommending intramuscular vitamin K to recommending oral supplementation switched back to intramuscular injection after they noted a spike in cases of VKDB. Moreover, the intramuscular vitamin K injection is about a safe an intervention as you can imagine. Even though the incidence of late VKDB without prophylaxis is very low, the consequences are so devastating and the prophylaxis is so safe and effective that it makes perfect sense to recommend it.

Whether vaccine fears or not are responsible for the increase in parents refusing the vitamin K injection for their newborns is unclear. The wag in me wants to point out that it’s probably not fear of vaccine that’s driving this phenomenon. After all, most antivaccinationist or vaccine-averse parents love vitamins, given the prevalence of “natural medicine” among those who tend to distrust vaccines. Rather, I tend to believe that it’s a similar phenomenon, the fear of injections driven by the naturalistic fallacy that assumes that an injection of “synthetic” vitamin K is somehow “unnatural” and therefore inferior or dangerous, that drives rejection of the vitamin K injection. However, a lot of the same fallacies that drive vaccine rejectionism drive vitamin K rejection. A great example of this comes from someone whom we’ve met before.

I’m referring to a woman named Megan from a woo-infused website LivingWhole.org. We first met Megan, who brags about being a naturopath, Certified Natural Health Educator, Registered Power Yoga Instructor, writer, and stay-at-home mama, when she wrote a mind-bogglingly ignorant antivaccine screed that later disappeared because Megan confused criticism for persecution and harassment. An example of the sort of pseudoscience Megan regularly lays down is her “classic” post, Dear parents, are you being lied to?, which is still periodically pops up on Facebook and Twitter. Regular readers here will have no problem deconstructing its many…issues.

Cut from the same cloth is her post from yesterday, Synthetic vitamin K shot for my baby? No thanks. The article declares its dedication to pseudoscience from the very first paragraph, but the second one is where the nonsense starts:

The about four babies who get vitamin K deficiency bleeding (VKPD) out of the four million babies born in the United States each year? That’s not due to the medications women take while pregnant, trauma women and babies suffer during a modern childbirth, early cord-cutting, the low levels of gut bacteria infants have because we wipe it out with antibiotics, infant circumcision, or the hep B vaccination given to your babe during its first 12 hours of life to “protect” it against a disease that’s transferred via sex and dirty needles. It’s just a coincidence that one of the many possible adverse reactions of all infant vaccines includes encephalitis, which coincidentally can cause hemorrhaging.

That’s right. Right off the bat, Megan is trying to insinuate that it’s the neonatal hepatitis B vaccine that causes VKPD, not vitamin K deficiency. Based on what evidence? None, of course! Not surprisingly, she zeros in like the proverbial woo-infused laser beam on just the brain bleeds, which are uncommon, ignoring the other forms of bleeding due to VKPD, which are much more common, with an incidence between 0.25%–1.7%. She also keeps claiming that there is little evidence for the efficacy of the neonatal vitamin K shot. The American Academy of Pediatrics would beg to differ, pointing out that it’s been the standard of care since 1961. When faced with the ill-informed opinion of a naturopath and “natural” mother (or father) and the opinion of a major medical society based on evidence, guess which one I’ll lend a lot more credence to.

None of this stops our Megan, who dives further and further into bad science. If early VDKB to her is caused by the hepatitis B vaccine right after birth, then what could possibly be causing late VDKB, which is what causes the the highest risk of intracranial hemorrhage. One wonders, one does… Actually, one doesn’t. Megan is as predictable as she is medically ignorant:

But what else happens between 2 and 12 weeks that could cause a hemorrhage? Breastfeeding in and of itself does not and cannot cause trauma that induces bleeding. Let’s see what can:

Between four and twelve weeks, we give babies twelve vaccines including a second dose of Hep B, and two doses of DtaP, IPV, Hib, and PCV, all of which can cause vasculitis and brain encephalitis that can induce a hemorrhage. Our children also get two doses of a live rotavirus vaccine that can shed, infect others, and cause hemorrhagic enteritis and thrombocytopenic purpura (a bleeding disorder). Have you read your child’s vaccine inserts?

Forget “Late-onset VKPD” (vitamin K deficiency bleeding). Let’s call it “Late-onset VIB” (vaccine-induced bleeding). When these babies get sick from their vaccinations, we then put them on antibiotics, which wipe out their gut flora hindering their ability to synthesize vitamin K from breast milk leaving them at risk for an uncontrollable bleed.

Yes, indeed. It has to be vaccines, too! But, then, you knew that that’s what it had to be, given Megan’s history. Never mind that she has not one shred of evidence to support this hypothesis. Like many antivaccinationists, she’s good at tying together disparate observations without having the scientific background to realize that what she is doing is complete and utter nonsense. I’ve discussed before what this sort of speculation reminds me of, but first I’ll give you another example of it:

You know what else “synthetic vitamin K” enthusiasts don’t understand? The thought that babies (and all animals for that matter) have lower levels of vitamin K at birth for a beneficial, protective, reason. I’m just going to throw these “common sense-based” thoughts out there but let’s consider them:

First, in order to absorb vitamin K we have to have a functioning biliary and pancreas system. Your infant’s digestive system isn’t fully developed at birth which is why we give babies breast milk (and delay solids) until they are at least 6-months-old, and why breast milk only contains a small amount of highly absorbable vitamin K. Too much vitamin K could tax the liver and cause brain damage (among other things). As baby ages and the digestive tract, mucosal lining, gut flora, and enzyme functions develop, baby can process more vitamin K. Low levels of vitamin K at birth just…makes…sense.

Secondly, cord blood contains stem cells, which protect a baby against bleeding and perform all sorts of needed repairs inside an infant’s body. Here’s the kicker, in order for a baby to get this protective boost of stem cells, cord-cutting needs to be delayed and the blood needs to remain thin so stem cells can easily travel and perform their functions. Imagine that, baby has his/her own protective mechanism to prevent bleeding and repair organs…that wasn’t discovered until after we started routinely giving infants vitamin K injections.

Megan thinks she is brilliantly synthesizing medical knowledge about vitamin K on the “just makes sense” model. I’m surprised, but relieved, that she didn’t invoke some sort of reason based in evolution. Still, I’m amazed at the turn Megan managed to make in invoking cord blood stem cells, and the alleged shortage of them due to premature clamping of the umbilical cord, as the “real reason” why low vitamin K in the newborn is adaptive, so that these stem cells can do what it is they do. Again, of course, there is no good evidence to support her speculations. How Megan comes to the remarkable conclusion that low vitamin K is natural and allows stem cells to prevent bleeding and “repair organs” is a brilliant example of the Dunning-Kruger effect, in which Megan relates diverse observations to each other without understanding the context of those observations or even the basic science that makes her conclusions from them incredibly implausible. To her they just “make sense”; so they must be right. Never mind whether they make sense from a scientific standpoint. It’s the sort of thing that the crews at antivaccine blogs like The Thinking Moms’ Revolution and Age of Autism routinely do do when they string together all sorts of scientific studies and observations willy nilly into a narrative that sounds compelling to a non-scientist but that scientists scoff or laugh at because they have a deep understanding of the actual science that provides them with an exquisite BS detector.

One other myth about vitamin K shots is that they cause childhood leukemia, and Megan hits this one as well. She cites studies that are over 20 years old, ignoring the mass of evidence since then that has shown that vitamin K injections are not associated with childhood cancer. As Clay pointed out, this question was thoroughly investigated after those small studies, and no association was found. Moreover, more recent science on the pathophysiology of childhood leukemia weakens the plausibility of a link to neonatal vitamin K injections, given that newer evidence strongly suggested a prenatal origin to the cancer. Megan even hits the package insert for vitamin K injections the same way that antivaccinationists mine the package inserts for rare adverse reactions to vaccines, leading her to wax fearful about rare anaphylactic reactions and the “toxicity” of aluminum, the latter of which can only reach toxic levels after prolonged intravenous administration, not a single intramuscular dose.

In the end, Megan pontificates:

When it comes to my children, I err on the side of biology, evidence, caution, and common sense. Whether you believe in God or biology, I don’t think either messed up, and the “data” hasn’t shown otherwise. Who’s with me?

Given that Megan is wrong on just about everything about vitamin K injections, her appeals to “biology” and “common sense” notwithstanding, the answer to that question should be crickets chirping.