# Evidence Based Birth — Research Notes (Vitamin K + Eye Ointment) Pulled from the Evidence Based Birth® YouTube channel (Dr. Rebecca Dekker, RN, PhD) on 2026-06-28. 333 videos on the channel; these are the ones directly relevant to our two decisions. Transcripts captured from the videos' captions, then summarized here. Not medical advice — confirm with our provider. --- ## VITAMIN K ### "The Latest Evidence on Vitamin K and a New EBB Article Update" — most current https://www.youtube.com/watch?v=k7JO39hJ4WA **Why babies need it:** All newborns are born with low vitamin K and get little through breast milk. If levels drop too low (varies baby to baby, can't be predicted), blood can't clot → Vitamin K Deficiency Bleeding (VKDB). Three types: early (day 1, linked to mom's meds), classic (days 2–7), and **late (weeks 3–8, the dangerous one — >half of cases are brain bleeds)**. **Effectiveness, head to head (rate of late VKDB per 100,000):** - **Injection:** ~0–0.4. Single dose, slow-release, most reliable. - **2 mg oral regimens (completed):** ~0–0.9. Nearly as good as the shot. - **Old 1 mg ×3 oral regimen:** ~2.6. Noticeably worse. - **Single oral dose at birth only:** ~1.4–6.4. Poor. - Takeaway: a *completed 2 mg regimen* is nearly comparable to the shot; the gap in older data came from low doses and **missed doses**. **The two best-evidence oral regimens (both get late VKDB under 1 in 100,000):** 1. **German/Swiss 3-dose:** 2 mg at birth (with first feeding) · 2 mg at day 4–6 · 2 mg at week 4–6. 2. **Danish weekly:** 2 mg at birth, then 1 mg every week for 3 months (good for exclusively breastfed babies; also protects the rare baby with undiagnosed gallbladder disease). **US product reality:** There is **no FDA-approved oral vitamin K for infants** in the US. What exists: an FDA adult 5 mg tablet (inaccurate to split for a 1–2 mg dose) and the FDA injection. Some parents use a non-FDA **supplement** (~0.5 mg vitamin K1 per drop → 4 drops = 2 mg), sold without FDA approval, so dosing accuracy isn't third-party verified and can vary bottle to bottle. **Confirm the exact product + schedule with our provider.** **Absorption tips:** Vitamin K is fat-soluble — give it **with a feeding**, and make sure baby doesn't spit it up within ~1 hour (re-dose if they do). **All doses are necessary** — incomplete regimens are where oral "fails." ### Supporting videos - "Free Video Lesson 3: Best Oral Vitamin K Regimen for Newborns" — https://www.youtube.com/watch?v=FCNh0N9yg5E - "Free Video on Vitamin K: Lesson 1" — https://www.youtube.com/watch?v=PGAAC9t83xc - "Evidence on Vitamin K Deficiency Bleeding" — https://www.youtube.com/watch?v=SVKSbv02bYY **When injection is the smarter call (even if planning oral):** prematurity/low birth weight; any liver/gallbladder/cholestasis or malabsorption (e.g. chronic diarrhea); instrumental/traumatic delivery, bruising, or planned surgery incl. circumcision; mom on warfarin or seizure meds in pregnancy; repeated antibiotics; or if we can't reliably complete the full oral schedule. --- ## ERYTHROMYCIN EYE OINTMENT ### "Free Video Lesson 2: Erythromycin Eye Ointment for Newborns" (recorded 2014, updated 2020) https://www.youtube.com/watch?v=I-gyfgOAYj0 (also covered in the class video https://www.youtube.com/watch?v=o1H8EJby7-Y) **What it's for:** A topical antibiotic to prevent *ophthalmia neonatorum* (newborn pink eye), specifically the dangerous form from **gonorrhea** passed during birth — which, untreated, blinds ~3% of affected babies. Gonorrhea is often symptomless, so a mother can carry it unknowingly. It is weak against chlamydia and doesn't cover other bacteria well. **Why many countries don't do it routinely:** England, Australia, most of Europe, and Canada use **screen-and-treat** instead — test every pregnant person for gonorrhea/chlamydia, treat them and partners, and treat the baby's eyes only if an infection actually appears. This works when there's good prenatal-care access and fast treatment available. **Current US guidance is split:** - **AAP (2018 Red Book):** *no longer recommends universal use*; calls for re-evaluating state mandates; favors screening + treatment. Says ointment is still appropriate where gonorrhea is widespread and screening/treatment rates are low. - **USPSTF (2019):** reaffirmed giving it to *all* newborns — mainly because ~6% of US pregnant people get little/no prenatal care (up to ~20% in some areas), so screen-and-treat misses people. **Practical notes:** - Erythromycin can cause **temporary blurred vision** (can interfere with the first bonding hour); not painful like the old silver nitrate. - **~1 in 4 gonorrhea cases is now resistant** to erythromycin. Povidone-iodine drops are cheaper and possibly more effective but **not available in the US**. - If declining, **check state law** — some US states mandate it; a signed refusal/waiver may be required. Parents have organized to change some of these laws. **Bottom line for us:** Declining is well-supported *when mom screened negative for gonorrhea/chlamydia, we're low-risk, and we have fast access to care* — which we do. Keep the threshold to accept it **low** if anything is uncertain. **It becomes "obvious" — we want it (or treatment):** mom's STI screening is positive, incomplete, or unknown; prolonged rupture of membranes or signs of maternal infection in labor; or baby develops eye redness/swelling/discharge (an active infection needs *systemic* antibiotics, not just ointment). --- ## Adjacent EBB videos (not our decisions, but on the channel if useful later) - "Ethics and Evidence on Circumcision" — https://www.youtube.com/watch?v=uQKSME2lXjI - "Evidence on Newborn Baths and Screening for Low Blood Sugars" — https://www.youtube.com/watch?v=IKScawcJix8 - "Ask Me Anything about Group B Strep" — https://www.youtube.com/watch?v=HGxH8EkARsI - "Uncovering the Facts about Private Cord Blood Banking" — https://www.youtube.com/watch?v=K5LpJFZB1Mg - "Evidence on Doulas" — https://www.youtube.com/watch?v=s2xrpfn-mi4