title: Reasons for Refusal of Newborn Vitamin K Prophylaxis: Implications for Management and Education.
abstract: OBJECTIVE
  The American Academy of Pediatrics recommends intramuscular (IM) vitamin K prophylaxis for all newborns to prevent vitamin K deficiency bleeding. Given the serious implications of late-onset vitamin K deficiency bleeding, our objective was to examine factors influencing parents' decisions to refuse IM vitamin K prophylaxis.
  
  
  METHODS
  Parents intending to refuse IM vitamin K prophylaxis at delivery were recruited from 5 community hospitals, 1 academic medical center, and 2 birthing centers in a single Southeastern state. Participants completed a written survey including demographics, birth and parenting decisions (eg, breastfeeding), and open-ended questions about their vitamin K information sources, concerns, and knowledge of risks.
  
  
  RESULTS
  The incidence of refusal was highest at the birthing centers. Fifty-four parents intending to refuse IM vitamin K completed the survey. Most were white (78%), over age 30 (57%), and college graduates (65%). All reported intention to exclusively breastfeed. Most refused hepatitis B vaccine (90%) and erythromycin eye ointment (77%). The most common source of information was the Internet (70%). Concerns included synthetic or toxic ingredients (37%), excessive dose (28%), and side effects (24%). Eighty-three percent of parents reported awareness of risks associated with vitamin K refusal. However, only 6 parents (11%) decided to accept IM prophylaxis.
  
  
  CONCLUSIONS
  This study provides an understanding of the concerns, mindset, and information sources used by parents refusing IM vitamin K. Educating parents about the importance of IM prophylaxis should begin in the prenatal period and must address concerns parents identify on the Internet.
authors.affiliation: Department of Pediatrics and.
authors.forename: Harvey James
authors.initials: HJ
authors.lastname: Hamrick
authors.affiliation: Pediatric Teaching Program, Cone Health, Greensboro, North Carolina; and.
authors.forename: Elizabeth Kaye
authors.initials: EK
authors.lastname: Gable
authors.affiliation: Department of Pediatrics and.
authors.forename: Emily Hruska
authors.initials: EH
authors.lastname: Freeman
authors.affiliation: Department of Pediatrics and.
authors.forename: Laurie Louise
authors.initials: LL
authors.lastname: Dunn
authors.affiliation: Department of Pediatrics and.
authors.forename: Sarah Pritchett
authors.initials: SP
authors.lastname: Zimmerman
authors.affiliation: Department of Pediatrics and.
authors.forename: Molly Moriarty
authors.initials: MM
authors.lastname: Rusin
authors.affiliation: Department of Pediatrics and.
authors.forename: Olivia Reid
authors.initials: OR
authors.lastname: Linthavong
authors.affiliation: Mission Health, Asheville, North Carolina.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Wright
authors.affiliation: Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Leslie Ann
authors.initials: LA
authors.lastname: Moss
authors.affiliation: Department of Pediatrics and asheley@unc.edu.
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D018890:Chemoprevention / Q000379:methods / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D008297:Male; D010290:Parents / Q000193:education / Q000523:psychology; D063046:Patient Medication Knowledge / Q000379:methods*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States; D014812:Vitamin K / Q000008:administration & dosage*; D006475:Vitamin K Deficiency Bleeding / Q000517:prevention & control*
chemical_list: D000933:Antifibrinolytic Agents; D014812:Vitamin K