An 11-day-old baby died from vitamin K deficiency bleeding after her parents chose oral drops instead of the routine newborn injection, ProPublica reported.

Gwen Biesenbach was taken to a New Braunfels, Texas, emergency department in August 2023, after her umbilical cord stump began bleeding. Her parents, Stephanie and Eric, had opted against the vitamin K shot at birth, believing oral drops would protect her.

The emergency department doctor, Nicole Malouf, tried seven methods to control the bleeding over nearly three hours. Gwen eventually received a vitamin K injection from the ambulance team at 3:45 a.m., before being transferred to a hospital in San Antonio. Her condition continued to deteriorate, and she died shortly after 9 a.m.

An autopsy listed vitamin K deficiency bleeding as the cause of death.

Vitamin K Helps Newborns Form Blood Clots

Vitamin K is essential for producing proteins that help blood clot. Newborns naturally have low levels because only small amounts cross the placenta, while breast milk contains relatively little vitamin K.

Without enough of the vitamin, babies can develop vitamin K deficiency bleeding (VKDB), which may cause bleeding beneath the skin, in the digestive system or inside the brain. It can occur during the first six months of life, even after an apparently healthy start.

The US Centers for Disease Control and Prevention (CDC) says babies who do not receive the injection at birth are 81 times more likely to develop VKDB. The shot reduces the risk of late VKDB to fewer than one case per 100,000 infants.

Oral Drops Do Not Offer the Same Protection

The CDC recommends a single intramuscular vitamin K injection for newborns, which can be given within six hours of birth. Oral vitamin K is not the recommended method in the US because it is less reliable: some babies may not absorb the drops properly or may spit them up, and doses can be missed. Cases of vitamin K deficiency bleeding have also been reported in babies given oral drops.

The injection is not a vaccine. It is a dose of vitamin K that helps prevent a rare but potentially fatal bleeding disorder.

Gwen's parents told ProPublica they had researched alternatives and believed the drops would protect their daughter. Medical experts cited in the investigation said oral regimens are less reliable, partly because doses may be missed or poorly absorbed.

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Texas Medical Board Found Failures in Emergency Care

The Texas Medical Board also investigated Gwen's emergency care. It found that Malouf failed to recognise that the infant had a life-threatening vitamin K-dependent bleeding disorder, that the emergency department did not have vitamin K injections available and that she failed to transfer Gwen immediately to a regional paediatric referral hospital. The board also found that Malouf had failed to quantify the amount of blood Gwen had lost.

The board ordered Malouf to complete 24 hours of continuing medical education. She neither admitted nor denied the allegations but agreed to abide by the board's final order.

Malouf told ProPublica she believed she had done everything possible with the resources available. She said the emergency department now stocks the injection.

Vitamin K Deficiency Bleeding Can Have Few Warning Signs

The CDC warns that many babies with VKDB show no warning signs before a serious bleed occurs. Possible warning signs include unexplained bruising, bleeding from the nose or umbilical cord, paleness, irritability, feeding difficulties and a bulging soft spot on the head.

Unexplained or persistent bleeding in a newborn requires urgent medical attention. The CDC identifies the vitamin K injection at birth as the most effective way to prevent the condition.

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