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Medications

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After your baby is born, your baby will receive two medications within one hour of birth, vitamin K injection and an antibiotic eye ointment. Vitamin K is an intramuscular injection given to babies after birth to aide in blood clotting and to prevent a condition known as Vitamin K Deficiency Bleeding (VKDB). VKDB, once called Hemorrhagic Disease of the Newborn, is a rare, but life-threatening bleeding disorder that occurs in a newborn during the first few days or weeks of life and is caused by a deficiency in vitamin K. Since the introduction of vitamin K injection, VKDB has declined dramatically. Unfortunately, because of the low amounts of vitamin K in breast milk, exclusively breastfed infants are at higher risk for VKDB.

Below are some common signs of VKDB:

  • Bruising
  • Bleeding from the mouth, nose, ears, umbilicus, or puncture sites. 
  • Blood in the urine, stool, or vomit.
  • Poor appetite
  • Difficulty breathing
  • Lethargy
  • Vomiting 
  • Irritability or agitation
  • Bulging fontanel (soft spot)
  • Seizures
The intramuscular route provides the best protection against VKDB and is the preferred route for vitamin K administration. Oral doses of vitamin K can be given; however, some studies have shown a failure in the prevention of VKDB with orally administered vitamin KWhen given orally, three doses are necessary. There are a variety of treatment regimens that are utilized globally, most of which administer three doses of oral vitamin K at specific intervals within the first two months of life. Oral vitamin K requires multiple doses and compliance has been an issue. Ensuring all three doses are given as prescribed is very important. If infant vomits within an hour of taking the medication, another dose is needed.
 
Erythromycin eye ointment is given after birth to prevent serious eye infections and blindness in infants who are born to mothers with gonorrhea or chlamydia, both of which are sexually transmitted diseases that can go unnoticed in the infected mother. Since erythromycin is a broad-spectrum antibiotic and works on many different types of bacteria, it is the usual drug of choice.
 
Most state have laws that mandate the administration of one or both of these medications. It has become a popular trend to refuse the above prophylactic medications because of the controversies surrounding their use. To learn more about theses controversies, click the links below:
As the parent, most states (except New York) allow you the option to opt out giving your baby either medication. A signed informed consent form will be needed and will be supplied by your birthing facility. Here is an example of a refusal consent form (pdf).  It is important to educate yourself on the risks of not getting these medications. 
 
Hepatitis B vaccine is another medication that is given to newborns before leaving the birthing facility. Parents must sign a consent form prior to the administration of the vaccine. This is a great time to discuss the vaccines benefits and risks with your baby's healthcare providers. If you decline the hepatitis B vaccine in the hospital, your baby can be vaccinated in your pediatrician’s office.
 
Here are some resources to help you become familiar with the above medications:

The Academy of Pediatrics now recommends that all infants be given daily vitamin D supplements to prevent a condition called rickets. The new recommended dose is 400 IU (international units) per day starting in the first couple of days of life. Read our article Vitamin D Supplements to learn more.

 

How to Clean Your Baby's Nose With a Bulb Syringe
 
Sources:
American Academy of Pediatrics (2003). Controversies Concerning Vitamin K and the Newborn. PEDIATRICS; Vol. 112 (1); pp. 191 -192.
Buck, M. (2001). Vitamin K for the Prevention of Bleeding in Newborns. Pediatr Pharm. 7(10) 
Center for Disease Control: Conjunctivitis (Pink Eye) in Newborns 
Dharmendra J Nimavat, MD, FAAP . Hemorrhagic Disease of Newborn  
Mabry-Hernandez, I. & Oliverio-Hoffman, R. Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. AHRQ Publication No. 10-05146. August 2010. 
New Zealand Medicines and Medical Devices Safety Authority: Vitamin K Prophylaxis in the Newborn
Stanford School of Medicine: Guidelines for Vitamin K Prophylaxis
Tres Lunas Midwifery: Vitamin K Waiver of Liability
 

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