title: Declining newborn intramuscular vitamin K prophylaxis predicts subsequent immunisation refusal: A retrospective cohort study.
abstract: OBJECTIVE
  Low rates of childhood immunisation are linked to outbreaks of infectious disease. Identifying and addressing barriers to immunisation may lead to improved immunisation rates. Immunisation and newborn vitamin K prophylaxis have many similarities. We aimed to investigate whether parents who decline newborn vitamin K are also more likely to decline subsequent childhood immunisations.
  
  
  METHODS
  We undertook a retrospective cohort study, examining the relationship between vitamin K administration and immunisation uptake by parents of babies born over a 2-year period (January 2010-December 2011) in Dunedin, New Zealand (NZ). Both written and electronic data from a single birthing unit and the NZ National Immunisation Register (NIR) were analysed to ascertain the relationship between declining newborn vitamin K prophylaxis and subsequent immunisation uptake.
  
  
  RESULTS
  Records for 3575 babies were examined. Ninety-two per cent of infants received intramuscular, and 5% received oral vitamin K. An increased risk ratio for non-immunisation of 14.1 (95% confidence interval 7.8-25.9) for babies whose parents declined vitamin K was identified. Receiving oral vitamin K was also associated with subsequent non-immunisation, with a risk ratio of 3.5 (95% confidence interval 1.7-7.3).
  
  
  CONCLUSIONS
  Parents who decline newborn vitamin K are more likely to decline immunisation for their child. These parents, as well as those that elect for oral vitamin K, are a small but easily identifiable group to whom additional education about the benefits of immunisation could be offered. This is especially pertinent at a time when there is a resurgence of immunisation preventable diseases.
authors: Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: Helen
authors: H
authors: Bernhardt
authors: Department of Women's and Child Health, University of Otago, Dunedin, New Zealand.
authors: David
authors: D
authors: Barker
authors: Department of Women's and Child Health, University of Otago, Dunedin, New Zealand.
authors: David M
authors: DM
authors: Reith
authors: Department of Women's and Child Health, University of Otago, Dunedin, New Zealand.
authors: Roland S
authors: RS
authors: Broadbent
authors: Department of Women's and Child Health, University of Otago, Dunedin, New Zealand.
authors: Pamela M
authors: PM
authors: Jackson
authors: Department of Women's and Child Health, University of Otago, Dunedin, New Zealand.
authors: Benjamin J
authors: BJ
authors: Wheeler
mesh_terms: D003657:Decision Making; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand; D010290:Parents / Q000523:psychology*; D012189:Retrospective Studies; D016312:Treatment Refusal; D014611:Vaccination / Q000706:statistics & numerical data*; D014812:Vitamin K / Q000008:administration & dosage*
chemical_list: D014812:Vitamin K
keywords: immunisation; neonate; prophylaxis; vaccine; vitamin K