BACKGROUND: Late vitamin K deficiency bleeding (VKDB) manifests at 2 weeks–6 months of age, primarily as intracranial hemorrhage; risk increases without vitamin K prophylaxis. Reported incidence is 4.4–7.2 cases/100,000 births among infants without prophylaxis. During 2013, four VKDB cases were reported in Nashville (25/100,000 births). We investigated to determine the rates and predictors of vitamin K refusal.
METHODS: We examined the 2013 birth cohort at a Nashville children’s hospital (Hospital A) and 5 freestanding birthing centers (over-representing birthing centers) to identify vitamin K refusers, determine refusal rates, and perform a vitamin K knowledge survey. We randomly sampled births from Nashville’s largest obstetrics hospital (Hospital B) for vitamin K nonreceipt rates during 2011–2013.
RESULTS: We identified 104 vitamin K refusers at Hospital A (rate: 2.7%) and 83 at 5 birthing centers (rate: 28%; range: 15%–83%). Vitamin K nonreceipt rates at Hospital B were 3.2% (95% confidence interval [CI]: 1.3–6.5) in 2013, 3.7% (95% CI: 1.4–8.0) in 2012, and 2.3% (95% CI: 0.6–6.1) in 2011. Of 102 vitamin K refusers surveyed, 47 (46%) responded; 31/47 (66%) identified bleeding as a risk of refusing prophylaxis. The leading reasons for refusal were desire for a natural birthing process (43%) and believing prophylaxis was unnecessary (43%). Hepatitis B vaccine and erythromycin eye ointment were also refused by 65% of respondents.
CONCLUSIONS: Vitamin K refusal rates varied appreciably between Hospital A and birthing centers; a consistent proportion of newborns at Hospital B did not receive vitamin K. The majority of vitamin K refusers surveyed also refused several other preventive care measures. Health care providers should discuss risk of VKDB with parents early in pregnancy.