Factors Associated With Refusal of Intramuscular Vitamin K in Normal Newborns

Pediatrics. 2018 Aug;142(2):e20173743. doi: 10.1542/peds.2017-3743.

Abstract

Background and objective: Refusal of intramuscular (IM) vitamin K administration by parents is an emerging problem. Our objective was to assess the frequency of and factors associated with refusal of IM vitamin K administration in well newborns in the United States.

Methods: We determined the number of newborns admitted to well newborn units whose parents refused IM vitamin K administration in the Better Outcomes through Research for Newborns network and, in a nested patient-control study, identified factors associated with refusal of IM vitamin K administration by using a multiple logistic regression model.

Results: Of 102 878 newborns from 35 Better Outcomes through Research for Newborns sites, parents of 638 (0.6%) refused IM vitamin K administration. Frequency of refusal at individual sites varied from 0% to 2.3%. Exclusive breastfeeding (adjusted odds ratio [aOR] = 3.4; 95% confidence interval [CI]: 2.1-5.5), non-Hispanic white race and/or ethnicity (aOR = 1.7; 95% CI: 1.2-2.4), female sex (aOR = 1.6; 95% CI: 1.2-2.3), gestational age (aOR = 1.2; 95% CI: 1.1-1.4), and mother's age (aOR = 1.05; 95% CI: 1.02-1.08) were significantly associated with refusal of IM vitamin K administration. Refusal of the administration of both ocular prophylaxis and hepatitis B vaccine was also strongly associated with refusal of IM vitamin K administration (aOR = 88.7; 95% CI: 50.4-151.9).

Conclusions: Refusal of IM vitamin K by parents of newborns is a significant problem. Interventions to minimize risks to these newborns are needed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Infant, Newborn
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Parents / psychology*
  • Treatment Refusal / psychology*
  • Treatment Refusal / trends*
  • United States / epidemiology
  • Vitamin K / administration & dosage*
  • Vitamin K Deficiency Bleeding / epidemiology
  • Vitamin K Deficiency Bleeding / prevention & control*
  • Vitamin K Deficiency Bleeding / psychology
  • Young Adult

Substances

  • Vitamin K