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

Abstract

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.

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

“…13 Other than reports from single centers, there is a paucity of quantitative information about temporal changes in the frequency of refusal of intramuscular vitamin K, but there is a perception among clinicians that the frequency is increasing. 7 In a 2014 report from the National Center for Health Statistics, the percentage of outof-hospital births in the United States increased from 1.26% in 2011 to 1.36% in 2012, continuing an increase that began in 2004. 8 Among out-of-hospital births in the Parent' s perception that intramuscular vitamin K is not necessary (53%); parents desired natural birthing process (36%); concern about preservatives or ingredients (19%); concern about adverse reactions (14%); concern about harmful effect of pain for infant (11%); concern about dose being too high (11%); concern that injection causes cancer (8%); concern about potentially overwhelming infant' s immune system (1%)…”

“…We identified 9 original articles on reasons for intramuscular vitamin K refusal by parents. 3,4,7,8,[16][17][18][19] Details on data collection and results are shown in Table 1. There were 3 major categories of reasons for refusal of intramuscular vitamin K by parents of newborns.…”

“…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.…”

Newborn Vitamin K Prophylaxis: A Historical Perspective to Understand Modern Barriers to Uptake

“…28,45 Ensuring awareness of the serious risks appears essential, with researchers in a recent study from the United States finding that .69% of parents cited a lack of awareness of importance as a reason for vitamin K prophylaxis refusal. 46 Interestingly, there are also health professional factors associated with refusals of vitamin K prophylaxis. In a recent study in which researchers examined health professionals' attitudes toward vitamin K prophylaxis in New Zealand, it was found that 100% of the doctors surveyed thought vitamin K should be given to all infants, compared with 55% of the surveyed midwives.…”

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

“…2,3 Despite this, rates of parental refusal of vitamin K for their newborn are on the rise. [4][5][6] The rationale behind parental vitamin K refusal is multifactorial and can include mistrust of the medical establishment. 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.…”