Vitamin K refusal for newborns linked to non-immunization

1. Parents who used a midwife to deliver their child and those who delivered at home or in a birthing center were at a significantly increased risk of refusing to provide their newborn with vitamin K prophylaxis.

2. Children who did not receive vitamin K prophylaxis at birth had an increased risk of non-immunization at age 15 months old.

Evidence Rating Level: 2 (Good)

Study Rundown: Administration of vitamin K to newborns has been established as an important intervention in preventing vitamin K deficiency bleeding. This study focused on the prevalence of parental refusal of vitamin K, the factors associated with refusal, and if refusal was linked to decline of recommended childhood vaccinations. Vitamin K was received by 99.7% of all babies born in Alberta, Canada during the study period. Using a midwife and having the birth at home or in a birthing center increased the risk of vitamin K prophylaxis refusal. Children who did not receive vitamin K were also 15 times more likely to be unvaccinated at 15 months of age. Results of this study are supported by its large size but may not be generalizable to other areas where midwifery practices and standards vary. Ultimately, these findings may aid physicians in identifying and providing guidance to parents who may refuse vaccinations for their children.

Click to read the study, published today in Pediatrics

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Study Author, Dr. Shannon MacDonald, PhD, talks to 2 Minute Medicine: University of Calgary, Department of Pediatrics.

“Many clinicians have presumed that all children receive vitamin K at birth, given that it is a safe and highly effective prophylactic for a rare but very serious outcome for infants. The recent MMWR report on 4 infants with VKDB has caused us to rethink this assumption and prompted our research team to investigate the frequency of vitamin K refusal. The good news is that a very small proportion (0.3%) in our population-based study refused vitamin K. However, there appeared to be a slight increase in this trend. Refusal was more common among mothers who delivered at home and/or with midwives, and many went on to refuse immunizations for their children. The significance of these findings to clinicians is two-fold. First, if a physician knows that their patient is planning a midwife-attended and/or home birth they should be providing anticipatory guidance regarding the value of vitamin K. Second, increased awareness of this issue should prompt physicians to be more aware of VKDB as a differential diagnosis and prompt them to provide extra guidance and resources regarding immunization to parents who refuse vitamin K for their infants.”

In-Depth [retrospective cohort study]: A total of 214 061 live births in Alberta, Canada were studied from 2006 to 2012. Vitamin K administration data were obtained from the notice of birth for each delivery, and immunization (DTaP-IPV-Hib, meningococcal and pneumococcal conjugates, MMR, and varicella) records were obtained from the provincial immunization repository. Vitamin K was not given to 0.3% of births due to parent refusal, and there was a significant increase in refusal over the study period (0.21%-2006 to 0.39%-2012, P <.001). Parents utilizing a midwife, rather than a physician, were at 8.43 times greater risk of refusing vitamin K for their child (P <.001). Births that took place at home or at a birth center, rather than in a hospital, increased the risk of vitamin K refusal by 3.58 and 4.92 times, respectively (P <.001 for both). Vaginal deliveries without use of an epidural were also linked to greater risk of refusal when compared to vaginal births with an epidural and to cesarean deliveries (P <.001 for both). Children who did not receive vitamin K prophylaxis were at 14.58 times increased risk of being unvaccinated at 15 months of age than children who did (95% CI 13.9-15.3).

Image: PD

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