Posts Tagged: child health

Hyperemesis Gravidarum – The Aftermath

When you’ve survived Hyperemesis Gravidarum, you hold your baby and thank God that you made it, and that your baby made it, and that you’re both  alive. You survived. Then you kind of forget about it, or try to, at least, while you get on with feeding your baby, changing her and learning to be a mother. You kind of assume that Hyperemesis Gravidarum is gone, and you hope that that’s the end of it.

I did, both times.

And for Ameli it was. She’s suffered no ill fate from this ghastly condition. I assumed the same would be true for her sister, born two and a half years later. But things were different. During my pregnancy with her I was already running on depleted supplies, and the sickness was worse, and when I started throwing up blood at 10 weeks, I went on medication because by 12 I couldn’t get out of bed without fainting. That’s not an ideal way to look after an almost two year old.

The medication I was on – Ondansetron, also known as Zofran – wasn’t specifically tested in pregnancy and my doctor wasn’t happy about giving it to me, but I showed him information about it being used for Hyperemesis Gravidarum in the US, and he agreed. He prescribed three tablets a day, but I took one in the morning so that I could eat something at least, which would carry me through the day. Anecdotal evidence mentioned incidence of deformities and I didn’t want to take any chances.

Aviya was born at home in water at 42+5, a perfect baby girl.

At 10 months and 8 days she rolled off a bed, but seemed okay. She was a bit cranky for a few days and cried whenever we tried to pick her up, but on investigation she seemed totally fine. (My mother is a remote areas nurse practitioner, and my brother is a medical student, so they should know.)  At 10 months and 10 days she took her first step on Christmas day, but even so… something wan’t right.

I finally took her to Perth’s Children’s Hospital where they said that she had broken something – her clavicle or scapula, I can never remember. We treated it, and went about our business. After all, we were in Perth for my mother, who was dying of cancer.  I never thought much of it again, only fearing for Aviya’s health whenever my mother commented on a blue ring around her mouth, saying that I had to get her heart checked out when I got back to England.

Months passed, we found ourselves back in England, trying to find a normal life again. Ameli started back at  nursery, Aviya was running around, engaging in the world, doing the things that one year’s olds do. Her first tooth appeared, and then her second tooth appeared and as happens with these things, so did her third and fourth. Our girl was doing great.  Until one day I had a piercing pain in my nipple as she tried to nurse!

Her tooth had chipped! No, not chipped broken! It looked like a vampire fang! I felt awful! How could I not have noticed a fall that did that to her tooth! We went to the dentist and had it filed down, a traumatic experience for her, for sure.  Not a week later, guess what? Her second tooth did the same. Broken! I was glad her arm had broken in Australia and not England. At least there’s no medical record of it here. I mean, a broken bone and two broken teeth? I know what I’d be thinking.

Well, we took her to the dentist again, and again with the third tooth and again for the fourth. And again, and again. It was only when we discovered two abscesses in her mouth that the dental staff started to take it very seriously. They were going to put her on a waiting list for our area’s special care unit, but an hour later I got a call to say they were going to  transfer her to a hospital in London to be seen sooner.

Then the guilt sets in. The dentist said I should stop breastfeeding because that’s what’s causing the tooth decay (but not for the other teeth in her mouth?) Clearly, I’ll not be taking the advice to wean.

We brush her teeth, but probably not long enough.

Maybe I feed her the wrong things.

But no.

A bit of reading, and it turn out that – anecdotally of course – HG babies often have weaker enamel on their first four teeth due to malnutrition in the mother (or something like that).  She loses these teeth now, but her adult teeth should be fine. With removing them, however, there may be problems with her teeth descending as the ‘tunnel’ for them isn’t there. So she won’t lose her front teeth either. There’ll be nothing for the memory box.

But there’s maybe more.

While reading about all this, I found something else, slightly more alarming: again anecdotally, of course, but there are a number of babies who had  Ondansetron/Zofran who also developed heart problems – thinking about my mother’s comments about the blue ring.

Well. Nothing’s proven. But it’s a worry.

So my little girl has her first ever course of antibiotics for the abscesses. 

And we wait.

We wait for the GP appointment for the referral for the scan or whatever they do for her heart. Then we wait for the referral for her dental surgery. Then we wait and see what else life throws our way.

And whatever else Hyperemesis Gravidarum takes.

Did you have Hyperemesis Gravidarum? How has it affected your child or your life since having a child?

Does A Newborn Need Additional Vitamin K?

(Q16 on the birthplan: Would I like my baby to be given a vitamin K injection?)

During my pregnancy with Ameli, I learned everything I could about everything pregnancy and birth related! I wrote a book full of notes, typed it all up and kept it with my birth plan so that if I had to have a justification for my decisions at any point, I’d have it on hand. I was blessed with an amazing midwife who didn’t even question my choices, so I never needed them, but here are my notes on Vitamin K… maybe you’ll find them useful. These notes formed the basis of my decision and are only intended to provide reference materials to start you off on your own research.

Vitamin K is routinely given because:

“The problem of bleeding into the brain occurs mainly from 3 to 7 weeks after birth in just over 5 out of 100,000 births (without vitamin K injections); 90% of those cases are breastfed infants because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.”Linda Folden Palmer, DC in International Chiropractic Pediatric Association Newsletter September/October 2002 Issue

Vitamin K may be needed when:

  • Premature clamping of the umbilical cord deprives babies of up to 40% of their natural blood volume, including platelets and other clotting factors
  • The use of vacuum extractor or forceps causes bruising or internal bleeding, which uses up the baby’s available clotting factors
  • Antibiotics are used in the birth, as they inhibit the baby’s generation of clotting factors.
  • C-Section

There are alternatives to a vitamin K shot:

For breastfed infants, an oral vitamin K preparation (Konakion MM) given in 3 doses of 2mg at birth, 7 days, and 30 days of life results in higher plasma vitamin K concentrations than a single injected dose at birth (although my current midwife doesn’t agree with this statement). The preparation must be Konakion MM, which contains lecithin and glycocoholic acid; vitamin K require emulsification and the presence of bile salts for its absorption.

For formula fed infants, formula contains enough vitamin K that no supplement should be necessary.

Arguments against the routine use of vitamin K – three main observations (Falcao):

Vitamin K1 Injection (Phytonadione Injectable Emulsion, USP) (10 mg/mL)

Nature seems to go to a lot of trouble in regulating the baby’s vitamin K levels: the level at birth gradually rises over the eight days following birth to a higher level. It is almost as if nature very specifically wants the baby to have a specific level of clotting factors at birth, followed by a higher level of clotting factors a week after the birth.

This may be related to the fact that in a physiological birth, where the baby gets all the blood from the placenta, the baby’s blood is a little thicker; this is especially true in the 72 hours following birth, since the babies naturally become a little dehydrated until the mother’s milk changes to a higher volume flow, so the blood is thicker.

There has been some association between vitamin K injection and childhood leukaemia. (Parker) Theoretical observations are that precise levels of vitamin K are required to regulate the rate of cell division in newborns and that excessive levels of vitamin K disrupt this regulatory process, thus increasing the possibility of leukaemia and other childhood cancers. (While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely1,2.The most current analysis of six different studies suggests it is a 10% or 20% increased risk. This is still a significant number of avoidable cancers.3)

Follow up research indicated that the leukaemia might have been related to mercury used to preserve the vitamin K solution. Further research in 2003 found that there was no definitive link between childhood leukaemia and Vitamin K, but also that ‘small effects cannot be ruled out’.

Research shows that babies who contract meningitis are more likely to die if they have higher clotting factors. It’s not clear whether this is due to genetic factors or whether it applies to all babies who receive vitamin K. ( I can’t find any actual links to this research, despite it being mentioned all over the web!)

The warning label on Vitamin K injections is pretty scary too:

Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of Phytonadione. Typically these severe reactions have resembled hypersensitivity or anaphylaxis, including shock and cardiac and/or respiratory arrest. Some patients have exhibited these severe reactions on receiving Phytonadione for the first time. The majority of these reported events occurred following intravenous administration, even when precautions have been taken to dilute the Phytonadione and to avoid rapid infusion. Therefore, the INTRAVENOUS route should be restricted to those situations where another route is not feasible and the increased risk involved is considered justified.

Dangers of excess Vitamin K:

When a baby is born gently, without any intervention, antibiotic, or trauma, and no apparent bruising, and is breastfed, there is no need for Vitamin K. Administering vitamin K to these babies – especially if they are formula fed – can lead to excess Vitamin K, which in turn may lead to newborn jaundice.

Signs Suggesting Need for Vitamin K after birth:

  • bleeding from the umbilicus, nose, mouth, ears, urinary tract or rectum
  • any bruise not related to a known trauma
  • pinpoint bruises called petechiae
  • black tarry stools after meconium has already been expelled
  • black vomit
  • bleeding longer than 6 minutes from a blood sampling site even after there has been pressure on the wound
  • symptoms of intracranial bleeding including paleness, glassy eyed look, irritability or high pitched crying, loss of appetite, vomiting, fever, prolonged jaundice.

(This list is written by Jennifer Enoch. Midwifery Today. Issue 40.)

Natural alternatives:

Keep the umbilical cord attached until it stops pulsing. Do not cut it prematurely, as average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. (As Vitamin K doesn’t cross the placenta, this should make no difference to Vit K levels, but will help with iron levels etc.)

When breastfeeding (or just before starting), make sure to eat plenty of leafy greens or take a vitamin K supplement – vitamin K does not cross the planceta in pregnancy, but does enter breast milk in feeding. Anti-acids (used for heartburn) decrease the absorption of Vitamin K in the body – bare this in mind if you have lots of indigestion during pregnancy and be sure to increase with Vitamin K intake from around 38 weeks of pregnancy, as this will help prevent against haemorrhaging too.

Nettles are rich in Vitamin K – made into a tea you’ll get everything you need. Otherwise try a Nettle soup.

Conclusion:

My conclusion on this sensitive matter, based on the information available to the public and its potential impact on my own family, is thus:

Nature says a baby doesn’t need large amounts of Vitamin K, but that delayed cord clamping and the transfer of oxygenated blood gives the child enough resources to cope with the effects of a ‘normal’ birth. If the mother has been consuming Vitamin K in some form or another, it will immediately begin transferring through her colostrum, which is rich in Vitamin K and breastmilk and by eight days of age, baby will have the ‘right’ amount of Vitamin K (and since formula is fortified with vitamin K, formula fed babies shouldn’t require it at all) – since the disease it is meant to prevent doesn’t tend to occur until between 3 and 7 weeks I personally question the need for the injection.

At the same time, bleeding kills almost 2 in 10,000 babies, and this is the closest I could find to statistics as to deaths from the injections ** although we know that they have occurred. It says so on the label.  So really, the conclusion is inconclusive.

Every parent has to make their own decisions on this, but for me and mine, we’ve decided against vitamin K injections unless something in the birth necessitates it. We’ve also decided to follow natural alternatives, such as breastfeeding and a high maternal Vitamin K intake and to keep a close eye on the signs of bleeding as described above. 

** The FDA database contained a total of 2236 adverse drug reactions reported in 1019 patients receiving vitamin K by all routes of administration. Of the 192 patients with reactions reported for intravenous vitamin K, 132 patients (69%%) had a reaction defined as anaphylactoid, with 24 fatalities (18%%) attributed to the vitamin K reaction. There were 21 patients with anaphylactoid reactions and 4 fatalities reported with doses of intravenous vitamin K of less than 5[emsp4 ]mgs. For the 217 patients with reactions reported due to vitamin K via a non-intravenous route of administration, 38 patients had reactions meeting the definition of anaphylactoid (18%%), with 1 fatality (3%%) attributed to the drug.

 

References:

 

L. Parker et al., “Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study,” BMJ (England) 316, no. 7126 (Jan 1998): 189-93.

 

S.J. Passmore et al., “Case-control studies of relation between childhood cancer and neonatal vitamin K administration,” BMJ (England) 316, no. 7126 (Jan 1998): 178-84.

 

E. Roman et al., “Vitamin K and childhood cancer: analysis of individual patient data from six case-control studies,” Br J Cancer (England) 86, no. 1 (Jan 2002): 63-9

Further Reading: 

 

Five Great Things About Breast Milk

Breastmilk has been touted as the wonder drink. We’ve all heard how good it is for babies, and we all know that babies who have been breastfed are said to be healthier, less obese as children, and less fussy eaters than formula fed babies. We also know that breastfeeding is good for mothers. It reduces the risk of breast cancer, helps with wait loss and can help prevent post partum depression.

Even so, I am often surprised by the things that people don’t know about breastmilk. Here are a few of my favourites:

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