Reasons for Refusal of Newborn Vitamin K Prophylaxis: Implications for Management and Education

Abstract

This study provides an understanding of the concerns, mindset, and information sources used by parents refusing IM vitamin K. Educating parents about the importance of IM prophylaxis should begin in the prenatal period and must address concerns parents identify on the Internet.

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

“…In our study, almost one-third of infants born in birthing centers did not receive the vitamin K injection. This finding is also similar to that of a recent study in North Carolina, which found a higher rate of vitamin K refusal at birthing centers than hospitals (Hamrick et al 2016). Variation in frequency of vitamin K refusal by delivery site may be due to inherent differences in the philosophies of parents who choose alternatives to delivering in hospitals, or may reflect the attitudes of providers at such facilities and the education they provide to parents.…”

“…In our study, 31% of infants born at birthing centers in Tennessee did not receive vitamin K, compared with 10.7% of infants born at birthing centers in Alberta (Sahni et al 2014), and 4.34 and 8.33% at two birthing centers in North Carolina (Hamrick et al 2016). As in the other studies, rates of refusal for hospital births are low; however, in the Nashville area, rates of refusal are near 3%, which is nearly 10 times higher than the 0.2% refusal rate in Alberta (Sahni et al 2014).…”

“…However, it was unclear whether the majority understood that the duration of risk for infants extends to 6 months of age, that this bleeding could be severe and life-threatening, or that this risk is increased among children who are exclusively breastfed (Zipursky 1999; Sutor et al 1999; Winckel et al 2009). Indeed, in the North Carolina study, which was substantially smaller than ours (n = 54), while a majority of parents understood that there was a risk for bleeding, only a few understood that this could be life-threatening (Hamrick et al 2016). …”

“…As in the other studies, rates of refusal for hospital births are low; however, in the Nashville area, rates of refusal are near 3%, which is nearly 10 times higher than the 0.2% refusal rate in Alberta (Sahni et al 2014). Rates of refusal at hospitals in the North Carolina study varied, with most hospitals having a rate less than 1%; the highest rate of refusal was 3.15% and occurred at a community hospital with an established system of oral vitamin K administration (Hamrick et al 2016). Reasons for the apparent regional variation in vitamin K refusal are unclear, but there may be hospital- or locality-specific explanations, such as counseling by a particular local provider, a well-developed alternative medicine network, or the availability of particular processes or medications.…”

Why do parents decline newborn intramuscular vitamin K prophylaxis?

“…One recent study used a survey to ask parents about their concerns regarding vitamin K and where they got their information from. The most common source of information for parents was the internet and the most common concerns were centred on synthetic or perceived toxic ingredients in the formula, excessive dose and side effects 14. However, no other studies have undertaken in-depth interviews with parents.…”