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Midwifery Collective of Ottawa
Client Information Sheet
Vitamin K and Erythromycin eye prophylaxis
There are two medications that are offered to the baby shortly after the birth, one is vitamin k and the
other is erythromycin eye prophylaxis. Vitamin K:
Vitamin k is a factor used in blood clotting. We form vitamin k from the bacteria in our gut, however,
baby's guts are sterile and it takes up to three weeks for them to colonize the gut with bacteria and to
begin making their own vitamin k. Only small amounts of vitamin k are able to cross the placenta or to
come through breast milk. During these few weeks the baby is vulnerable to abnormal bleeding
because they do not have this clotting factor. The bleeding can be life threatening as it can be internal
and even into the brain. Vitamin k deficiency bleeding is rare, so it is likely that some other risk factor is
present that makes a baby vulnerable. We know that babies whose mothers take anti-epileptic
medication, and babies with liver problems are at increased risk, but this does not account for all cases,
so we offer all parents the option of giving their babies a synthetic version of vitamin k by injection into
the thigh within a couple of hours of the birth.
If we do nothing, the risk of vitamin k deficiency bleeding (VKDB) is 0.25% to 1.7% in the first week and
4.2 to 7.2 cases per 100,000 from 7 days to 12 weeks(1) If we give the injection of vitamin K, VKDB is
practically eliminated except in cases of malabsorption.
If you opt to not give the injection and your baby develops vitamin k deficiency bleeding, the treatment
is to give vitamin k. Signs of vitamin k deficiency bleeding include bleeding from the belly button and
bruising easily. More severe bleeding or bleeding into the brain will have more severe symptoms;
however, there may not be early warning signs.
If you opt to have vitamin k, the major risks are bleeding at the site of the injection similar to when you
have blood taken. Pressure with sterile gauze stops this bleeding quickly. There is also a small risk of
infection at the injection site. We clean the site with alcohol first to minimize this risk. The medication is
a synthetic version of the vitamin K our bodies produce natural y.
An alternative to the intramuscular injection is to give the IM dose orally. This is not as effective and
there is evidence that the effect is of a shorter duration. Even giving repeat oral doses at 2 and 4 weeks
of age do not have the same efficacy as the intramuscular route.(1,2) The community standard is to offer
Erythromycin Eye Prophalaxis
Erythromycin eye prophylaxis is an ointment put into the baby's eyes to prevent infection caused by
chlamydia and gonorrhea from the mother.(3) It is possible for the mother to have an asymptomatic
infection (meaning you can be infected but not aware). This is why we offer routine screening for
chlamydia and gonhorrea in early pregnancy during the booking visit. If there is transmission to the
baby during the birth, it can cause blindness. The erythromycin is an antibiotic (broad spectrum) meant
to prevent this infection. It is a public health law to give eye prophylaxis to all newborns with or without
the parent's consent.(4). The refusal of eye prophalaxsis is expected to be reported to public health,
however this is not routinely done in our community.
The administration of the eye ointment does not seem to cause babies any distress or side effects,
however, it will blur the vision. For that reason, we defer the administration of this medication for a
couple of hours. The reason for this is that babies have a quiet alert state after they are first born which
is an optimal bonding time. Their eyes are open and they are looking around. This is also a crucial time
to initiate breastfeeding. This state lasts about 2 hours, so we usually defer the giving of medications to
the baby to the end of this time. At this point the baby is often ready to go to sleep and the blurred
vision becomes less of an issue.
After the birth, prior to giving medications we ask if you have any questions and whether you consent to
us giving the medications or not.
1. Canadian Pediatric Society Position Statement: Routine administration of vitamin K to
newborns, Paediatr Child Health 1997;2(6):429-31. Reaffirmed: Jan 30 2012
2. AMERICAN ACADEMY OF PEDIATRICS: Policy Statement: Controversies Concerning Vitamin K
and the Newborn. Pediatrics. 2003 112(1pt1):191-192. Reaffirmed May 2009
3. Canadian Task Force of the Periodic Health Examination. Prophylaxis for gonococcal and
chlamydial opthalmia neonatorum. CMAJ 1992;147(10):1449-53.
4. Health Promotion and Protection Act, 1990). Communicable Diseases – General, R.R.O. 1990,
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