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

Abstract

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.

Belgian Consensus Recommendations to Prevent Vitamin K Deficiency Bleeding in the Term and Preterm Infant

“…Loyal et al reported that the refusal of IM vit K by parents was notably higher among home births and in birthing centers. The main reasons for refusal were: concern of pain and harm from the injection and a desire to be natural and a belief in alternative methods of prophylaxis [63]. There are many factors contributing to determine an optimal vit K administration regimen e.g., cost, accessibility, compliance, ease of use, effectiveness, contra-indication, side-effects, parental refusal, or health care organizations.…”

Vitamin K deficient bleeding and COVID-19: How are they related?

“…Thus, in the USA with nearly 4,000,000 births yearly [19] and an arbitrarily estimated incidence of 2% for lack of vitamin K administration at birth, 60-70 examples of this serious example of VKDB would be expected yearly. Notably the incidence of classic VKDB is approximately 20-fold higher than that for late VKDB [18], and thus as many as 1400 of this significant, but less serious form could be expected [18]. It can be expected, as recent experience indicates (see earlier), that clusters of cases of VKDB would occur in regions with higher proportions of births at out-of-hospital sites.…”

“…The reasons for parental decline of vitamin K have been studied worldwide, with very similar results [15][16][17][18][20][21][22][23][24][25][26][27][28]. The principal concerns generally cited are: (1) increased risk of cancer, especially childhood leukemia (not supported by available data);…”

“…Studies in New Zealand, Australia, Canada and Great Britain suggest incidences of refusal of parental vitamin K administration at birth of 1-7% [9,16,17]. Estimates for the USA range from 0-3.2% of births in hospitals, 14.5% in home births and up to 31% in birthing centers [18]. The incidence of late VKDB in the absence of vitamin K at birth ranges broadly but may be as high as 8/10,000.…”

New ways of preventing vitamin K deficiency bleeding in infancy

“…Increasingly, reports are being published of parents refusing vitamin K prophylaxis for their newborns. A number of reasons have been cited for this such as parental beliefs, mistrust in the medical profession or a lack of specific knowledge . Occasionally, healthcare providers do not offer the prophylaxis.…”