title: Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance.
abstract: 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.
authors.affiliation: Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA. lauren.marcewicz@gmail.com.|Centers for Disease Control and Prevention, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA. lauren.marcewicz@gmail.com.|Department of Veteran's Affairs, Atlanta VA Medical Center, Palliative and Supportive Care, 149 Ridley Lane, Decatur, GA, 30030, USA. lauren.marcewicz@gmail.com.
authors.forename: Lauren H
authors.initials: LH
authors.lastname: Marcewicz
authors.affiliation: Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA.|Tennessee Department of Health, Nashville, TN, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Clayton
authors.affiliation: Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA.|Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maenner
authors.affiliation: Centers for Disease Control and Prevention, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Odom
authors.affiliation: Centers for Disease Control and Prevention, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
authors.forename: Ekwutosi
authors.initials: E
authors.lastname: Okoroh
authors.affiliation: Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Christensen
authors.affiliation: Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
authors.forename: Alyson
authors.initials: A
authors.lastname: Goodman
authors.affiliation: Tennessee Department of Health, Nashville, TN, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Warren
authors.affiliation: Tennessee Department of Health, Nashville, TN, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Traylor
authors.affiliation: Tennessee Department of Health, Nashville, TN, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Miller
authors.affiliation: Tennessee Department of Health, Nashville, TN, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Jones
authors.affiliation: Tennessee Department of Health, Nashville, TN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Dunn
authors.affiliation: Tennessee Department of Health, Nashville, TN, USA.|Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.affiliation: Centers for Disease Control and Prevention, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
authors.forename: Althea
authors.initials: A
authors.lastname: Grant
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013714:Tennessee; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data; D014812:Vitamin K / Q000494:pharmacology / Q000627:therapeutic use*; D006475:Vitamin K Deficiency Bleeding / Q000188:drug therapy
chemical_list: D014812:Vitamin K
keywords: Vaccine hesitancy; Vitamin K; Vitamin K deficiency bleeding; Vitamin K prophylaxis