Neonatal Vitamin K Refusal and Nonimmunization

Abstract

BACKGROUND: Neonatal Vitamin K prophylaxis is an effective intervention for reducing vitamin K deficiency bleeding. A recently published report of parental refusal of vitamin K prompted an investigation of the prevalence and characteristics of this group, and exploration of whether these same parents were likely to subsequently refuse immunization for their children. METHODS: We conducted a retrospective population-based cohort study of all infants born in Alberta between 2006 and 2012 by using linkage of administrative health data. Risk factors for vitamin K refusal were determined by using Poisson regression. The association between vitamin K refusal and nonimmunization was assessed using relative risk. RESULTS: Among the 282 378 children in the cohort, 99.7% received vitamin K and 0.3% declined. Midwife-assisted deliveries were more likely to be associated with vitamin K refusal compared with physician-attended delivery (risk ratio 8.4, 95% confidence interval [CI] 6.5–11.0). Planned home delivery (risk ratio 4.9, CI 3.8–6.4) or delivery in a birth center (risk ratio 3.6, CI 2.3–5.6) were more likely to result in decline of vitamin K compared with hospital delivery. Vitamin K refusal was associated with a 14.6 (CI 13.9–15.3) higher relative risk of having no recommended childhood vaccines at 15 months. CONCLUSIONS: This is the first population-based study to characterize parents who are likely to decline vitamin K for their infants and whose children are likely to be unimmunized. These findings enable earlier identification of high-risk parents and provide an opportunity to enact strategies to increase uptake of vitamin K and childhood immunizations.

Perinatal influences on the uptake of newborn Vitamin K prophylaxis – a retrospective cohort study

“…14 The main reason for this difference between countries is perhaps seen in the more than two-fold increase in oral vitamin K in our cohort. It is, however, reassuring that 97% of parents overall consented for some form of vitamin K prophylaxis.…”

“…Further study is needed to confirm this. However, this was seen in the Canadian setting, 14 where those opting for a planned home birth were about five times more likely to decline vitamin K.…”

Examination of a prenatal syphilis screening program, Alberta, Canada: 2010–2011

“…16,17 This may be due to women who choose midwifery care having alternative beliefs regarding health care interventions, as evidenced by recent literature showing decreased vaccination rates and neonatal vitamin K prophylaxis among children born to women who sought midwife care. 18,19 This trend might also be due to midwifery's principles of encouraging informed choice for independent decision making. 20,21 Women using midwives in our cohort were older, and less likely to be First Nations, single and in the lowest income quintile than women not using midwives.…”

Are Pediatricians Complicit in Vitamin K Deficiency Bleeding?

“…In a Canadian cohort, 0.3% of children did not receive vitamin K owing to parental refusal. 2 Incidence of vitamin K refusal in the United States is unknown but likely varies by geography, delivery clinician, and delivery setting.…”

“…A different study showed increased likelihood of vitamin K refusal among those who chose midwife delivery, suggesting a role for targeted prenatal counseling by trusted providers who care for those most likely to decline it. 2 The second question central to this case is whether clinicians should offer or support oral vitamin K. We know oral vitamin K preparations used in Europe are effective in prevention of classic VKDB, but they are less effective in prevention of late VKDB. 24 In the United States, oral preparations include vitamin K intravenous solution, compounded vitamin K tablets, and a mail-order liquid preparation.…”