title: Neonatal vitamin K refusal and nonimmunization.
abstract: 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.
authors.affiliation: Alberta Health Surveillance and Assessment, Edmonton, Alberta, Canada;
authors.forename: Vanita
authors.initials: V
authors.lastname: Sahni
authors.affiliation: Alberta Health Surveillance and Assessment, Edmonton, Alberta, Canada;
authors.forename: Florence Y
authors.initials: FY
authors.lastname: Lai
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada smacdon@ualberta.ca.
authors.forename: Shannon E
authors.initials: SE
authors.lastname: MacDonald
mesh_terms: D000416:Alberta / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007114:Immunization / Q000523:psychology*; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology*; D011159:Population Surveillance; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D016312:Treatment Refusal / Q000523:psychology*; D014812:Vitamin K / Q000008:administration & dosage*; D006475:Vitamin K Deficiency Bleeding / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*
chemical_list: D014812:Vitamin K
keywords: health education; immunization; vitamin K