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 vit… Show more
“…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.…”
Neonatal vitamin K prophylaxis is essential to prevent vitamin K deficiency bleeding (VKDB) with a clear benefit compared to placebo. Various routes (intramuscular (IM), oral, intravenous (IV)) and dosing regimens were explored. A literature review was conducted to compare vitamin K regimens on VKDB incidence. Simultaneously, information on practices was collected from Belgian pediatric and neonatal departments. Based on the review and these practices, a consensus was developed and voted on by all co-authors and heads of pediatric departments. Today, practices vary. In line with literature, the advised prophylactic regimen is 1 or 2 mg IM vitamin K once at birth. In the case of parental refusal, healthcare providers should inform parents of the slightly inferior alternative (2 mg oral vitamin K at birth, followed by 1 or 2 mg oral weekly for 3 months when breastfed). We recommend 1 mg IM in preterm <32 weeks, and the same alternative in the case of parental refusal. When IM is perceived impossible in preterm <32 weeks, 0.5 mg IV once is recommended, with a single additional IM 1 mg dose when IV lipids are discontinued. This recommendation is a step towards harmonizing vitamin K prophylaxis in all newborns.
“…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.…”
Neonatal vitamin K prophylaxis is essential to prevent vitamin K deficiency bleeding (VKDB) with a clear benefit compared to placebo. Various routes (intramuscular (IM), oral, intravenous (IV)) and dosing regimens were explored. A literature review was conducted to compare vitamin K regimens on VKDB incidence. Simultaneously, information on practices was collected from Belgian pediatric and neonatal departments. Based on the review and these practices, a consensus was developed and voted on by all co-authors and heads of pediatric departments. Today, practices vary. In line with literature, the advised prophylactic regimen is 1 or 2 mg IM vitamin K once at birth. In the case of parental refusal, healthcare providers should inform parents of the slightly inferior alternative (2 mg oral vitamin K at birth, followed by 1 or 2 mg oral weekly for 3 months when breastfed). We recommend 1 mg IM in preterm <32 weeks, and the same alternative in the case of parental refusal. When IM is perceived impossible in preterm <32 weeks, 0.5 mg IV once is recommended, with a single additional IM 1 mg dose when IV lipids are discontinued. This recommendation is a step towards harmonizing vitamin K prophylaxis in all newborns.
“…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.…”
Section: Why a Resurgence Of Late Vkdb?mentioning
confidence: 94%
“…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);…”
Section: Reasons For Refusal Of Vitamin Kmentioning
confidence: 97%
“…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.…”
“…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.…”
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