Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance

Matern Child Health J. 2017 May;21(5):1079-1084. doi: 10.1007/s10995-016-2205-8.


Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011-2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.

Keywords: Vaccine hesitancy; Vitamin K; Vitamin K deficiency bleeding; Vitamin K prophylaxis.

MeSH terms

  • Adult
  • Birthing Centers / organization & administration
  • Birthing Centers / statistics & numerical data
  • Female
  • Humans
  • Infant, Newborn
  • Male
  • Parents / psychology*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Tennessee
  • Treatment Refusal / psychology*
  • Treatment Refusal / statistics & numerical data
  • Vitamin K / pharmacology
  • Vitamin K / therapeutic use*
  • Vitamin K Deficiency Bleeding / drug therapy


  • Vitamin K