Baby Pea: a controversy is born

In the event of a person being unable to take medical responsibility for themselves – regardless of whether they are minors or not, or even if they are conscious – it is the next of kin that take the decision of what medical treatment to allow.

But what happens when medical authorities argue that the same next of kin are not acting in the best interest of the patient?

This issue came to the forefront this week with the case now referred to as “Baby Pea” (somewhat ambiguously, given the existence of a similar name for a child abuse case in the UK).

In the Malta case, the parents last week found themselves stripped of parental rights over their newborn baby, so that the hospital could provide treatment for a stomach infection and to administer a vitamin K injection, that prevents intracranial haemorrhage in newborn babies.

The parents, David Ellul and Marissa Bose, did not want the child to be administered with the vitamin K injection because of a possible link of the supplementation with leukaemia or other cancers: a danger they learnt of through the Internet.

Ellul and Bose are believers in “healthy living”. When their baby daughter was due to be born, the couple wanted to attempt a home birth, but when complications arose and after one full day in labour, the couple turned to Mater Dei hospital where the baby was eventually born by C-section.

Vitamin K supplements are routinely administered to newborns to prevent a rare disease causing blood haemorrhage in the brain. But the parents refused, as they were made aware of possible links between the injected vitamin supplement and the development of childhood leukaemia and other cancers.

Though their wishes were respected to start with, but when blood stains were seen in the baby’s vomit, doctors recommended flushing of the infant’s stomach.

Following some unrest between parents and hospital staff, the parental rights were stripped from the couple by the law courts for so long as the infant could be treated, having the stomach flushed and being administered with the vitamin K supplement.

Parental rights

Without entering the merits of medical arguments on both sides, MaltaToday sought to obtain a legal perspective on the issue.

Lawyer Dr Jose Herrera argues from a legal standing, the Attorney General can be called upon whenever there is any doubt that a patient is not receiving treatment necessary for survival.

“In Malta the Attorney General has the moral and legal obligation to defend the citizens of the state, or anyone visiting the state, and bring the case to the attention of the Court of Voluntary Jurisdiction in order to preserve the rights of the person involved.”

He said that the Attorney General can be alerted to the case by other members of the family – a concerned grandparent – or by medical professionals concerned for the health of that particular patient.

A case two years ago, involving the child of a Jehovah’s Witness was taken to the Court of Voluntary Jurisdiction by the Attorney General, when the child needed to have a blood transfusion.

Jeovah’s Witnesses oppose the practice of blood transfusion on religious grounds. Due to the parent’s religious background, they refused to approve of the treatment as it would (according to their faith) automatically deny her the right to eternal life.

However their concerns were overruled and the court ordered treatment as it was deemed a life-saving operation.

Such altercations between parents, relatives and medical authorities are in fact most common among religious communities which oppose certain medical treatments on religious grounds.

Vitamin K supplementation to newborns

The vitamin K supplement given to Baby Pea is routinely administered to newborns to prevent, or slow, bleeding into the brain in the first few weeks of life. Vitamin K promotes blood clotting and is present in very low levels in the foetus and the newborn.

This type of brain haemorrhage may occur in the first three to seven weeks of life, though it is very rare affecting 5 in every 100,000 babies. Ninety percent of these are breastfed as milk formula is supplemented with unnaturally high levels of vitamin K. Nursing will increase the infant’s level of vitamin K, though very gradually.

Up to 40% of cases of intracranial bleeding result in permanent brain damage or even death.

Controversy surrounds the administration of vitamin K through injection as it has been shown to affect the rate of cell division. It is possible that abnormally high levels of vitamin K can lead to cell division getting out of hand causing some forms of cancer.

A number of studies have been conducted proving links between the increase in vitamin K levels by 20,000 times the level of newborns and increasing incidences of cancer, though other studies have shown no significant link. More recent studies have shown that the link between vitamin K injections and any forms of cancer are slight if any exist at all.

Low oral doses have been given to newborns in liquid forms at 200 micrograms for five weeks, totalling 1 milligram, showing less adverse consequences.

Supplementation of the mother has not shown increases in the foetus’ levels of vitamin K therefore supplementation is necessary once the baby is born. However, supplementation of the nursing mother will increase vitamin K levels in breast milk that will in turn be passed on to the newborn.

The cause of bleeding is usually a result of malfunction of the liver, which prohibits the liver making blood-clotting agents from vitamin K. Therefore added vitamin K helps the situation.

Infants are at a higher risk if their mother was exposed to drugs, alcohol or anti-epileptic medications. This rare bleeding disorder has been found to be highly preventable through an injectable dose of vitamin K. Difficult childbirth, such as a breech birth or one that requires the use of foreceps also put the child at further risk to vitamin K deficient haemorrhaging.

Unfortunately brain haemorrhages may occur in babies without any prior warning or risk factor therefore it is impossible to treat only newborns that have any associated risk. In a study conducted in the UK out of 80,000 births 60 to 80 babies will suffer a bleed, 15 to 20 babies will suffer a bleed to the brain, 4 to 6 babies will die from a bleed to the brain and 10 to 20 babies will remain brain damaged as a result of the bleeding.