Parents Who Refuse Neonatal Vitamin K Prophylaxis Are More Likely to Refuse Childhood Immunizations

Deborah Lehman, MD

In Canada, more parents are declining intramuscular vitamin K prophylaxis and this decision correlates with vaccine refusal.

Intramuscular administration of vitamin K at birth prevents late vitamin K deficient bleeding, and parental refusal of prophylaxis has rare but devastating consequences (NEJM JW Pediatr Adolesc Med Dec 4 2013). Researchers examined parent refusal rates, patient characteristics, and compliance with subsequent immunization in a retrospective review of all infants born in Alberta, Canada, between 2006 and 2012.

Most (99.3%) of the 282,378 infants received intramuscular vitamin K and 0.4% received oral vitamin K. During the 6-year period, the refusal rate rose significantly from 0.21% to 0.32%. Factors associated with vitamin K refusal included delivery at home or birthing center and delivery by a midwife (4.9, 3.5, and 8.4 times higher than delivery at hospitals and by physicians, respectively). Mothers who delivered vaginally without epidurals had a significantly higher refusal rate than those who delivered vaginally with epidurals. Nonimmunization rates in infants who did and did not receive vitamin K were about 5% vs. 75% for DTaP-IPV-Hib, meningococcal, and pneumococcal primary series and 20% vs. 85% for MMR and VZV vaccines. At age 15 months, children who did not receive neonatal vitamin K prophylaxis were 15 times more likely to have not received any childhood vaccinations than children who did receive vitamin K.

Citation(s):

Sahni V et al. Neonatal vitamin K refusal and nonimmunization. Pediatrics 2014 Sep 15; 134:497.