Neonatal vitamin K refusal and nonimmunization

Pediatrics. 2014 Sep;134(3):497-503. doi: 10.1542/peds.2014-1092. Epub 2014 Aug 18.


Background: Neonatal Vitamin K prophylaxis is an effective intervention for reducing vitamin K deficiency bleeding. A recently published report of parental refusal of vitamin K prompted an investigation of the prevalence and characteristics of this group, and exploration of whether these same parents were likely to subsequently refuse immunization for their children.

Methods: We conducted a retrospective population-based cohort study of all infants born in Alberta between 2006 and 2012 by using linkage of administrative health data. Risk factors for vitamin K refusal were determined by using Poisson regression. The association between vitamin K refusal and nonimmunization was assessed using relative risk.

Results: Among the 282378 children in the cohort, 99.7% received vitamin K and 0.3% declined. Midwife-assisted deliveries were more likely to be associated with vitamin K refusal compared with physician-attended delivery (risk ratio 8.4, 95% confidence interval [CI] 6.5-11.0). Planned home delivery (risk ratio 4.9, CI 3.8-6.4) or delivery in a birth center (risk ratio 3.6, CI 2.3-5.6) were more likely to result in decline of vitamin K compared with hospital delivery. Vitamin K refusal was associated with a 14.6 (CI 13.9-15.3) higher relative risk of having no recommended childhood vaccines at 15 months.

Conclusions: This is the first population-based study to characterize parents who are likely to decline vitamin K for their infants and whose children are likely to be unimmunized. These findings enable earlier identification of high-risk parents and provide an opportunity to enact strategies to increase uptake of vitamin K and childhood immunizations.

Keywords: health education; immunization; vitamin K.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alberta / epidemiology
  • Cohort Studies
  • Female
  • Humans
  • Immunization / psychology*
  • Infant, Newborn
  • Male
  • Parents / psychology*
  • Population Surveillance*
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Treatment Refusal / psychology*
  • Vitamin K / administration & dosage*
  • Vitamin K Deficiency Bleeding / epidemiology
  • Vitamin K Deficiency Bleeding / prevention & control
  • Vitamin K Deficiency Bleeding / psychology*


  • Vitamin K