Factors Associated With Refusal of Intramuscular Vitamin K in Normal Newborns

Loyal, Jaspreet; Taylor, James A.; Phillipi, Carrie A.; Goyal, Neera K.; Wood, Kelly E.; Seashore, Carl; King, Beth; Colson, Eve R.; Shabanova, Veronika; Shapiro, Eugene D.

doi:10.1542/peds.2017-3743

Cited by 27 publications

(30 citation statements)

References 17 publications

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“…1 This response was partly due to an increase in the number of reports of parents who refuse intramuscular vitamin K for their newborns and a concomitant increase in reports of newborns with vitamin K deficiency bleeding (VKDB), a serious and potentially life-threatening condition, in recent years in the United States and other countries. [2][3][4][5][6][7][8][9][10][11][12] Newborns have low reserves of vitamin K, putting them at risk for VKDB. VKDB may present in the first week of life (classic VKDB) with bleeding from the gastrointestinal tract and/or from the umbilicus.…”

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Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review

Loyal

Shapiro

2020

Hospital Pediatrics

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In 2019, the American Academy of Pediatrics made public education about intramuscular vitamin K administration at birth a public health priority, partly in response to reports of refusal of intramuscular vitamin K by parents of newborns that led to vitamin K deficiency bleeding (VKDB). We reviewed the literature on the frequency of, reported reasons for, and factors associated with refusal of intramuscular vitamin K, incidence of VKDB in newborns who did not receive intramuscular vitamin K, and use of oral vitamin K to prevent VKDB. Without prophylaxis, estimates of the incidence per 100 000 births of VKDB range from 250 to 1700 for early VKDB and from 10.5 to 80 for late VKDB. The frequency of refusal of intramuscular vitamin K by parents ranged from 0% to 3.2% in US hospitals, up to 14.5% in home births, and up to 31.0% in birthing centers. Reported reasons for refusal were concern of harm from the injection, a desire to be natural, and a belief in alternative methods of prophylaxis. Parents who refused intramuscular vitamin K were more likely to refuse immunizations. Many different regimens were used for orally administered vitamin K; it is not clear which is best, but all are less effective than intramuscular vitamin K. VKDB is rare but can result in either neurologic sequelae or death. In addition to continued surveillance of the frequency of both refusal of intramuscular vitamin K and VKDB, a renewed focus on education of and collaboration with parents is needed to address this major public health threat.

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Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review

Loyal

Shapiro

2020

Hospital Pediatrics

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“…At the California site, there are ∼1550 live births per year with a vitamin K refusal rate of ∼1.3%. 9 At the Connecticut site, there are ∼4000 live births per year with a vitamin K refusal rate of ∼0.2%. 9 At the Iowa site, there are ∼2400 live births per year with a vitamin K refusal rate of ∼0.8%.…”

Section: Sample and Settingmentioning

confidence: 99%

“…9 At the Connecticut site, there are ∼4000 live births per year with a vitamin K refusal rate of ∼0.2%. 9 At the Iowa site, there are ∼2400 live births per year with a vitamin K refusal rate of ∼0.8%. 9 Inclusion criteria for survey respondents were clinicians who cared for newborns in the newborn nursery and/or the NICU.…”

Section: Sample and Settingmentioning

confidence: 99%

“…9 At the Iowa site, there are ∼2400 live births per year with a vitamin K refusal rate of ∼0.8%. 9 Inclusion criteria for survey respondents were clinicians who cared for newborns in the newborn nursery and/or the NICU. This included physicians, nurse practitioners, advanced practice registered nurses, and physician assistants.…”

Section: Sample and Settingmentioning

confidence: 99%

“…7 This same sentiment is a major driving force behind the refusal of routine childhood vaccinations with studies revealing that parents who refuse IM vitamin K are more likely to refuse routine vaccinations and other forms of newborn prophylaxis such as the hepatitis B vaccine and erythromycin ointment for their child. 8,9 In the setting of increasing rates of IM vitamin K refusal in the United States, oral vitamin K has become an attractive alternative among parents. Oral vitamin K has been and continues to be used in other countries but has not been studied in the United States.…”

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confidence: 99%

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Oral Vitamin K Prophylaxis in Newborns: A Survey of Clinician Opinions and Practices

Cheng

Loyal

Wood

et al. 2020

Hospital Pediatrics

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The majority of newborns in the United States receive intramuscular (IM) vitamin K for prophylaxis against vitamin K deficiency bleeding (VKDB). Oral vitamin K is less effective than IM vitamin K in preventing VKDB but is widely used in Europe and by some in the United States when parents refuse IM vitamin K for their newborn. Our aim was to assess the practices, opinions, and knowledge of newborn clinicians regarding oral vitamin K prophylaxis when parents refuse IM vitamin K. METHODS: We conducted an electronic survey of newborn clinicians from 3 academic medical centers in California, Iowa, and Connecticut. Descriptive statistics and x 2 tests were performed. RESULTS: Of 160 newborn clinicians at 3 sites, 110 (69%) completed the survey. Of respondents, 58 (53%) believed the incidence of IM vitamin K refusal is increasing and had prescribed or recommended oral vitamin K at least once. Regarding knowledge, 32 (28%) and 23 (20%) respondents did not know whether oral vitamin K decreases the risk of early-and late-onset VKDB, respectively. There were no significant differences in opinions, knowledge, or practices across institutions or practice settings (NICU, well-newborn nursery, or both) (P. .05). CONCLUSIONS: Our study findings suggest that newborn clinicians may lack knowledge about the effectiveness of oral vitamin K in preventing VKDB. More information is needed about oral vitamin K regimens and outcomes of newborns who receive oral vitamin K.

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Caring for the Normal Newborn

Stanojević

2021

Perinatology

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Factors Associated With Refusal of Intramuscular Vitamin K in Normal Newborns

Abstract: Refusal of IM vitamin K by parents of newborns is a significant problem. Interventions to minimize risks to these newborns are needed.

Cited by 27 publications

References 17 publications

Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review

Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review

Oral Vitamin K Prophylaxis in Newborns: A Survey of Clinician Opinions and Practices

Caring for the Normal Newborn

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