Parents’ Knowledge and Perceptions Regarding Vitamin K Prophylaxis in Newborns

Eventov‐Friedman, Smadar; Vinograd, Orit; Ben-Haim, Maggie; Penso, Sara; Bar‐Oz, Benjamin; Zisk-Rony, Rachel Yaffa

doi:10.1097/mph.0b013e318279e509

Cited by 21 publications

(27 citation statements)

References 16 publications

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“…3 A one-time, prophylactic intramuscular (IM) injection of vitamin K at birth, recommended by the American Academy of Pediatrics (AAP) since 1961, had virtually eliminated this serious disease of newborns. 1 Recently, there have been increasing numbers of reports of parents refusing the vitamin K injection for their newborns in the United States 4–9 and an increase in the number of reports of infants with VKDB. 4,8 …”

mentioning

confidence: 99%

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network

Loyal

Taylor

Phillipi

et al. 2017

Academic Pediatrics

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Objective To survey newborn clinicians in the United States regarding the frequency of intramuscular (IM) vitamin K refusal by a parent, reasons for refusal, and approaches of clinicians to refusals. Methods An electronic survey was administered to the clinician site representative (nursery director or designee knowledgeable about site-specific nursery policies) at all newborn nurseries in the Better Outcomes through Research for Newborns (BORN) network of newborn nurseries. Results Of 92 BORN sites, 85 (92%) respondents completed the survey. Frequency of IM vitamin K refusal during the past 5 years was reported as increased by 52% of respondents, unchanged by 42%, and 6% did not know. Reported frequencies of refusal of IM vitamin K was weekly (9%), a few times a month (31%), once a month (13%), once every 3 to 4 months (20%), once or twice a year (26%), or never (1%). The overall distribution of the reported frequencies of refusal differed among regions in the United States (higher in the West and the South; P < .05). Reported reasons for refusal by parents included perceptions of parents that the injection was unnecessary, lack of knowledge about vitamin K deficiency bleeding, and concern about preservatives. Approaches to refusal included attempts to educate parents, enlisting support from community clinicians, a state mandate, and prescription of oral vitamin K. Conclusions Respondents from a national sample of newborn nursery clinicians reported an increase in refusal of IM vitamin K in the past 5 years with regional variation. Approaches to refusals need further investigation to determine effectiveness.

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confidence: 99%

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network

Loyal

Taylor

Phillipi

et al. 2017

Academic Pediatrics

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“…VKDB can be severe, and may present as spontaneous intracranial or gastrointestinal hemorrhage (Zipursky 1999; Sutor et al 1999; Winckel et al 2009). Although there currently is no active surveillance of VKDB or prophylaxis administration in the United States (U.S.), U.S. and foreign medical literature seems to have noted an increase in both parental refusal of vitamin K prophylaxis and VKDB in the past few years (Schulte et al 2014; Woods et al 2013; Eventov-Friedman et al 2013). …”

Section: Introductionmentioning

confidence: 99%

Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance

Marcewicz

Clayton

Maenner

et al. 2017

Matern Child Health J

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Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011–2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.

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“…22 Looking beyond our scenario, clinicians who care for newborns may need to ally with obstetric clinicians to inform expectant parents about newborn preventive health measures. In a recent study, 69% of expectant parents did not know the purpose for vitamin K, 23 indicating a need for education and counseling before delivery. 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.…”

Section: Melissa Weddle MD Mph Commentsmentioning

confidence: 99%

Are Pediatricians Complicit in Vitamin K Deficiency Bleeding?

et al. 2015

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The American Academy of Pediatrics recommends that all newborns receive a single dose of intramuscular vitamin K to prevent vitamin K deficiency bleeding. How should the clinician respond when parents decline vitamin K? Although vitamin K deficiency bleeding can have devastating sequelae, they are uncommon; therefore, parents are generally allowed to decline vitamin K after counseling is provided. When parents ask for a vitamin K preparation of unproven effectiveness, should the clinician honor that request? To address these questions, we present a case of a healthy newborn whose parents declined intramuscular vitamin K and requested an oral preparation. Two general pediatricians discuss the medical and ethical issues these situations pose, and the parents describe their experience.

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Parents’ Knowledge and Perceptions Regarding Vitamin K Prophylaxis in Newborns

Abstract: There is a need to provide expecting parents with information regarding safety, utility, and benefits of VK prophylaxis.

Cited by 21 publications

References 16 publications

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network

Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network

Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance

Are Pediatricians Complicit in Vitamin K Deficiency Bleeding?

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