If you plan to give birth in the US, you will need to make your first healthcare-related decision about your newborn not long after your little one arrives. A vitamin K shot and erythromycin—an antibiotic eye ointment—are routinely given to all newborns within the first few hours of life as a ‘standard of care’. A standard of care is a treatment or course of action given by a provider for a particular condition or patient scenario.
Newborn medications may be a hot topic if you are preparing a birth plan. Making a decision about vitamin K and erythromycin feels different than deciding to breastfeed or requesting delayed cord clamping.
As a labor & delivery and postpartum nurse for nearly 10 years, I spend much of my time educating patients and their families so they can make evidence-based and confident health-related decisions for themselves and their baby.
Here’s what you need to know about the newborn vitamin K shot and erythromycin eye ointment at birth.
What is vitamin K’s role in the human body?
Vitamin K is a fat-soluble vitamin that is essential for the clotting of blood. There are two forms of vitamin K. K1 is present in green leafy vegetables while K2 is produced by our gut flora. If you’re bleeding, your body will initiate the ‘clotting cascade’, an intricate dance of proteins and enzymes that result in the clotting of blood. Vitamin K is necessary for the creation of the proteins in the cascade. Without vitamin K, you risk bleeding to death.
Related: Do I need to give my baby vitamins? A dietitian weighs in
Why is vitamin K supplemented in newborns?
Shortly after birth, almost all infants born in a hospital receive an intramuscular injection of vitamin K, usually given as a shot in their thigh. This is not a vaccine—but a large dose of the vitamin. This standard of care practice began in 1961.
Only minimal amounts of vitamin K are transferred from the placenta to the developing fetus. Breast milk also contains very low levels of vitamin K, making exclusively breastfed infants at special risk for deficiency. Low stores and limited incoming supply of vitamin K puts newborns at high risk for vitamin K deficiency bleeding (VKDB). Preterm infants have a higher risk of VKDB due to the immature liver and blood systems.
Without vitamin K, an infant’s body cannot clot and cannot stop bleeding. VKDB can occur between 24 hours and six months of life. Symptoms can range from bruising to bleeding in the brain (intracranial hemorrhaging) in 30-60%of cases.
Studies have shown that vitamin K preventative injections produce a significant reduction of classic (two days to one week) and late-onset (one week to six months) VKDB. This injection can stop a preventable disease in your baby.
Are there alternatives to a vitamin K injection?
In recent years, controversies have surrounded vitamin K injections and parental refusal has become more common.
Currently, in the U.S., there are no FDA-approved oral vitamin K regimens for infants.
Some European countries do give approved oral vitamin K drops as an alternative. Generally, three different doses are given at different timeframes, from birth to three months. Studies have failed to show that oral vitamin K is comparable to the injection at preventing late-onset VKDB. However, oral vitamin K has been shown to decrease the risk of classic VKDB.
No parent wants to think about their newborn child being in pain from an injection immediately after birth. Yet, it is important to understand the purpose of vitamin K injections at birth. If you have concerns, be sure to talk to your birth care provider or your child’s pediatrician.
Related: I’m a nutritionist—these are my 5 favorite prenatal vitamins
What is ophthalmia neonatorum (ON)?
Ophthalmia neonatorum (ON) is eye conjunctivitis—also known as pink eye—an infection that occurs within the first four weeks of life.
While there are numerous reasons for infection, vaginal bacteria from delivery is the most common. Gonorrhea is the most significant and dangerous infection that can be acquired during the infant’s journey out of the womb. Untreated gonorrhea has a 30% to 50% transmission rate to the newborn. Gonococcal ON (GON) infections can cause corneal scarring and blindness.
Why is erythromycin eye ointment given at birth?
Erythromycin eye ointment is given as a preventative treatment for GON. The creamy ointment is spread across the conjunctiva—the outer covering of the white part of the eye—and will leave the infant eye’s looking ‘goopy’ until the ointment is absorbed. No known side effects have been observed.
Like vitamin K injections, this preventative medication is given as a standard of care. Because not all pregnant people receive prenatal care, gonorrhea infections can be asymptomatic and the effects on an infant can be devastating and rapid.
Are there alternatives to erythromycin eye ointment?
No evidence-based or FDA-approved alternatives to erythromycin eye ointment are available at this time.
It’s important to note also that the standard of care that has been established has virtually eliminated GON.
All pregnant people are tested for and if needed, treated for gonorrhea as a standard of prenatal care. If a pregnant patient comes to Labor & Delivery without a test result, they will be tested and treated if necessary. If you have been tested and know that you do not have an active STD, then the risk of transmitting the infection to your infant is a nonissue.
Additionally, babies born by C-section without previous breaking of water have an incredibly low risk of infection.
OK with your baby getting the eye ointment? You can ask the nursing staff to wait on the administration of the eye ointment until after infant bonding. This is general practice in mother- and baby-friendly hospitals, where skin-to-skin, breastfeeding and the sacredness of the golden hour are paramount.
A note from Motherly: The vitamin K shot and newborn eye ointment
Vitamin K injections and erythromycin eye ointment are the current standard of care in medicine. Evidence has shown that the benefits of preventative treatment outweigh the risks. However, if you are hesitant as a parent, it is important to speak to your provider, share your concerns and review the evidence. Everyone, including you, is completely invested in the well-being of your baby.
Imbrescia K, Moszczynski Z. Vitamin K. Updated 2022 Jul 11. In: StatPearls. Treasure Island (FL): StatPearls Publishing.
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