5 Things Neonatologists Should Know About Vitamin K Deficiency5 Things Neonatologists Should Know About Vitamin K Deficiency https://pediatricsnationwide.org/wp-content/uploads/2022/07/AdobeStock_48244950-1024x683.jpg 1024 683 Mary Bates, PhD Mary Bates, PhD https://secure.gravatar.com/avatar/c6233ca2b7754ab7c4c820e14eb518c8?s=96&d=mm&r=g
- March 06, 2023
- Mary Bates, PhD
Vitamin K prophylaxis is safe and effective. Why are more parents refusing it, and what can be done?
In a new perspective paper in the Journal of Perinatology, researchers from Nationwide Children’s say that vitamin K prophylaxis is an essential component of newborn care and yet, parental refusal of the intervention is on the rise. What should neonatologists know?
A dose of vitamin K can prevent a life-threatening disease that causes bleeding in otherwise healthy infants. Newborns are at risk for vitamin K deficiency bleeding (VKDB), which has long been recognized as a significant cause of morbidity and mortality in infants. The disease may manifest as bruising, gastrointestinal bleeding, or even intracranial hemorrhage.
Since 1961, the American Academy of Pediatrics has recommended a single intramuscular dose of vitamin K for newborns shortly after birth. This intervention effectively prevents VKDB.
Certain states, including New York, Oregon and Maine, have enacted mandates that require any health care professional to provide vitamin K prophylaxis at birth. The impact of these mandates on parental acceptance of vitamin K administration at birth is not known.
Despite its safety and efficacy, parental hesitancy of vitamin K prophylaxis is a growing problem, and it reflects a larger mistrust of the medical establishment. Although most newborns in the United States receive vitamin K at birth, parental hesitancy about this intervention is increasing.
“The increasing rates of vitamin K hesitancy mirror the distrust that we are seeing of the medical profession as a whole by some subsets of our society,” says Timothy Rogers, MD, a neonatology fellow at Nationwide Children’s and lead author of the paper. “We are now seeing increased rates of vaccine-preventable illnesses, and I think the rise in vitamin K hesitancy and cases of VKDB go hand in hand with that.”
Vitamin K hesitancy tends to be related to concerns about child welfare and conflicts with parental beliefs and values. Some parents cite concerns about potential harm from the injection or preservatives contained in the medication, despite a lack of empirical evidence. Parents’ personal beliefs are another reason for vitamin K refusal, especially among parents expressing the desire for a more “natural” approach to child rearing and distrust of the medical field as a whole.
Oral vitamin K administration is not as effective. An oral regimen of vitamin K might appear to be a satisfactory alternative for some hesitant parents. However, studies suggest that while oral regimens provide some protection against VKDB compared to no prophylaxis, they do not eliminate the risk as effectively as intramuscular injection of vitamin K.
Communication can build a bridge between parents and health care providers. Neonatologists need to be aware of the common objections to vitamin K prophylaxis, as well as strategies for approaching hesitant parents.
“The most important thing is a discussion of parental beliefs, including identifying why they are hesitant, and then working to alleviate those fears,” says Dr. Rogers.
Co-author Pablo Sánchez, MD, a principal investigator in the Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s, adds that these beliefs should be addressed before birth.
“We have to make sure that the health care professional who has the most contact with the expectant mother, whether that is the obstetrician, a pediatrician, a nurse, a midwife or a doula, is aware of the benefits of vitamin K administration and the risks of refusal,” he says.
Rogers TP, Fathi O, Sánchez PJ. Neonatologists and vitamin K hesitancy. Journal of Perinatology. 2023. Doi: 10.1038/s41372-023-01611-w.
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