Newborn IM Vitamin K Refusal Rates and Parental Reasoning in an Academic Well Baby Nursery

Background:

Since 1961, the American Academy of Pediatrics (AAP) has recommended a single intramuscular dose of Vitamin K be administered to all infants within 6 hours of birth to prevent vitamin K deficiency bleeding (VKDB), previously known as hemorrhagic disease of the newborn (Hand and Noble 2022). However, despite its proven safety profile, there has been a marked increase in parental refusal nationwide, ranging from 0-3.2% in large academic centers (Loyal et al 2018). This presents multiple challenges to public health including increased risk of early, classic, and late VKDB and subsequent morbidity and mortality (Marcewicz et. al., 2017).

Objectives:

We aim to quantify the rate of IM vitamin K prophylaxis refusal at our academic children's hospital over a 1-year period and changes in refusal rate broken down over the two six-month periods. In addition, we are looking to identify the most common reasons given by parents for refusing IM vitamin K for their newborns. Lastly, we plan to identify differences in approach by physicians when discussing and educating hesitant parents on vitamin K, which can be used for a future quality improvement initiative.

Methods:

Here, we performed a retrospective chart review for all babies born between February 15, 2023 and February 15, 2024 who were discharged from the well-baby nursery at Robert Wood Johnson University Hospital in New Brunswick, NJ. We then gathered information on the rate of refusal and reasons given by parents for this decision. Lastly, we performed a subgroup analysis for each of the newborn nursery attendings.

Results:

18 out of 2038 newborns who met the inclusion criteria, or 0.88%, did not receive IM vitamin K due to parental refusal. There was an increase in the rate of vitamin K refusal between the first and second six-month intervals from 0.67 to 1.10%, but it was not statistically significant (p= 0.305, Chi-squared). Per chart review, the five most common reasons for their decision provided by families were: unspecified (8/18), refusing all routine newborn medications, vaccinations or prophylaxis (5/18), wanting to wait until PCP appointment to discuss (2/18), wanting to give PO rather than IM dose (2/18), and unaware vitamin K is not a vaccine (1/18). A subgroup analysis performed for each of the newborn nursery attending physicians did not identify statistically significant differences in refusal rate for each, however key differences in documentation of the patient encounter as well as counseling process with parents were identified.

Conclusions:

Data from a 1-year period at our institution showed rates of VKDB prophylaxis refusal consistent with those of past nationwide studies and meta-analyses (Isennock 2023). However, inconsistencies in education and documentation for parents who are initially hesitant have been identified. The information in this study will form the basis for a future quality improvement study aimed at reducing vitamin K refusal rates and providing parents with evidence-based, internally consistent counseling.

No relevant conflicts of interest to declare.