nurse_ratchet

Are there any pediatricians here? Jewish tradition dictates that circumcision be performed on the 8th day after birth. Someone told me that scientist have "proven" that clotting factors like vitamin K and thromboplastin are at their highest level only on the 8th day thus proving that this law came from God since humans at the time the Hebrew bible was written would not have known about clotting factors in the blood. I spoke to the author of the book that claims this and he could not name the source of the study he is talking about. Have any of you heard of this?

alek0

Not a pediatrician, but maybe I can help answer this.

Performing circumcision on 8th day definitely carries less risk of hemorrhage than circumcision on one day after birth in infants which have not received vit. K supplements. Though circumcision of infants is imo unethical and barbaric in any case. However, I haven't seen anywhere the claim that vit. K levels peak on the 8th day. And even if it was so, this would be no argument that "law came from God". It would be easy to empirically establish the rule, i.e. you circ. a baby right a way and it bleeds to death, you wait a couple of days and it doesn't and here is your rule.

here are some papers I've found on the topic of vit. K related coagulation factor levels after birth:

TITLE: Vitamin K1 levels and K1-dependent coagulation factors II and X in preterm and small-for-date neonates.
AUTHOR: Pietersma-de-Bruyn,-A-L; van-der-Straaten,-P-J; van-Haard,-P-M; Kuijpers,-J-C; Hamulyak,-K; Ruys,-J-H
SOURCE: Eur-J-Pediatr. 1990 Jun; 149 9: 640-4.
ABSTRACT: In 17 preterm neonates and 7 small-for-date neonates, all formula-fed, vitamin K-dependent coagulation factors II and X remained near 45% of adult values from the moment of birth until 28 days postnatally. Vitamin K1 levels, however, showed a remarkable rise from below the detection limit of 0.022 ng/ml in umbilical cord blood, to serum levels with a range of 0.99-7.29 ng/ml vitamin K1 on day 3, with a further rise on days 7 and 28 postnatally. Vitamin K1 Konakion parenterally given to a third group of four preterm neonates as a 1 mg dose resulted in very high serum levels of vitamin K1 64.08-157.10 ng/ml, but without any significant increase in plasma levels of vitamin K-dependent coagulation factors II and X, compared to the group without any extra vitamin K1. It is concluded that in healthy preterm and small-for-date neonates no correlation is seen between serum levels of vitamin K1 and plasma levels of coagulation factors II and X. After administration of 1 mg Konakion no accelerated increase is seen in coagulation factor activities.

TITLE: Vitamin K coagulation status in surgical newborns and the risk of bleeding.
AUTHOR: Najmaldin,-A; Francis,-J; Postle,-A; Griffiths,-D-M; Burge,-D-M; Karran,-S; Gollow,-I; Atwell,-J-D
SOURCE: J-Pediatr-Surg. 1993 Feb; 28 2: 138-43.
ABSTRACT: The vitamin K coagulation status in surgical newborns, who may be at increased risk of developing hypocoagulability and hemorrhage, has not previously been studied. Therefore, we measured the combined activity of the plasma vitamin K-dependent coagulation factors Thrombotest, total prothrombin, PIVKA II, plasma vitamin K1, fibrinogen, D-Dimer, and platelets in 49 newborns admitted to a neonatal surgical intensive care unit. All infants had significant pathology, and treatment involved surgery in all but two. Twenty-three infants 47% underwent surgery on two or more occasions. Intravenous or oral antibiotics were used in all patients and many received more than one course. All infants had vitamin K1 prophylaxis at birth. At day 0 date of birth, the mean Thrombotest and total prothrombin levels were 51% range, 20% to 100% and 40% range, 24% to 59%, respectively. Coagulation activity decreased on day 1 P > .1 and was followed by a graduate increase in clotting activity, reaching normal adult levels > 60% at day 5 for Thrombotest and day 24 for total prothrombin. Only three infants had a Thrombotest less than 20%. PIVKA II was detected in 20 cases 41%. However, levels were within normal limits < 0.9% in 17 of these, and between 1.0 and 4.8% in the remaining three infants. There was no relationship between elevated PIVKA levels and coagulation activity in these patients. Plasma vitamin K1 was very high, particularly in the first days of life.

TITLE: Vitamin K1 levels and coagulation factors in healthy term newborns till 4 weeks after birth.
AUTHOR: Pietersma-de-Bruyn,-A-L; van-Haard,-P-M; Beunis,-M-H; Hamulyak,-K; Kuijpers,-J-C
SOURCE: Haemostasis. 1990; 20 1: 8-14.
ABSTRACT: Vitamin K1 serum levels were assessed by means of an off-line multidimensional liquid chromatography in 18 mothers, shortly after delivery, and in their healthy term infants. Umbilical cord and venous blood samples were assayed up to 4 weeks of life. Concurrently, levels of coagulation factors II and X, antithrombin III and platelets were established. Although the detection limit of the assay was as low as 22 pg/ml, vitamin K1 concentration appeared to be still beyond that level in cord blood or in newborn serum within 30 min after birth, whereas vitamin-K-dependent coagulation factors are already at a level of 40%, without evidence for the presence of descarboxy prothrombin, in any of the investigated neonates. After 3 days, breast-fed neonates had lower vitamin K1 levels than formula-fed infants 0.76 and 1.44 ng/ml, respectively. The levels of the vitamin-K-dependent coagulation factors II and X, however, were comparable, regardless of the kind of feeding. After 28 days, breast-fed neonates had even lower vitamin K1 levels 0.49 ng/ml, while the formula-fed infants showed higher vitamin K1 levels 4.45 ng/ml. But even then, the levels of vitamin-K-dependent coagulation factors II and X were comparable, regardless of the kind of feeding. From this we conclude that the serum levels of vitamin K1 in formula-fed neonates exceed those of breast-fed infants from the moment of feeding 24 h and later without a concomitant rise in vitamin-K-dependent coagulation factors. A relationship between vitamin K1 levels and vitamin-K-dependent coagulation factors could not be established in healthy term breast-fed or formula-fed infants.

Mad Kally

Are you a registered nurse? Have you taken anatomy and physiology?

Francois Tremblay

I have to agree with alek. Even if it is true, there is no reason why primitive humans could not have concluded empirically (indirectly, of course)about "clotting factors in the blood". No doubt many babies died from this horrible and totalitarian practice before the auspicious day was found.

Peter P.

And moreover, I find it suspicious that this author, after writing a book on the matter cannot state his scientific citations. Unfortunately, this leads me, and many others, to dismiss this along the other lines of science and relgious links, IE Big Bang in the Bible, and Noah's Arc on top of a mountain in Turkey....


Peter P.

Utnapishtim

Don't forget that babies that had a history of haemophilia in their family often were not required to be circumcised. Is this from God? No it comes from human experience. Although it is interesting that the ancient Hebrews had some idea of the laws of inheritance.