title: Refusal of Vitamin K by Parents of Newborns: A Survey of the Better Outcomes Through Research for Newborns Network.
abstract: To survey newborn clinicians in the United States regarding the frequency of intramuscular (IM) vitamin K refusal by a parent, reasons for refusal, and approaches of clinicians to refusals.
  
  
  
  An electronic survey was administered to the clinician site representative (nursery director or designee knowledgeable about site-specific nursery policies) at all newborn nurseries in the Better Outcomes through Research for Newborns (BORN) network of newborn nurseries.
  
  
  
  Of 92 BORN sites, 85 (92%) respondents completed the survey. Frequency of IM vitamin K refusal during the past 5 years was reported as increased by 52% of respondents, unchanged by 42%, and 6% did not know. Reported frequencies of refusal of IM vitamin K was weekly (9%), a few times a month (31%), once a month (13%), once every 3 to 4 months (20%), once or twice a year (26%), or never (1%). The overall distribution of the reported frequencies of refusal differed among regions in the United States (higher in the West and the South; P < .05). Reported reasons for refusal by parents included perceptions of parents that the injection was unnecessary, lack of knowledge about vitamin K deficiency bleeding, and concern about preservatives. Approaches to refusal included attempts to educate parents, enlisting support from community clinicians, a state mandate, and prescription of oral vitamin K.
  
  
  
  Respondents from a national sample of newborn nursery clinicians reported an increase in refusal of IM vitamin K in the past 5 years with regional variation. Approaches to refusals need further investigation to determine effectiveness.
authors.affiliation: Department of Pediatrics, Yale University, New Haven, Conn. Electronic address: Jaspreet.Loyal@yale.edu.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Loyal
authors.affiliation: Department of Pediatrics, University of Washington, Seattle.
authors.forename: James A
authors.initials: JA
authors.lastname: Taylor
authors.affiliation: Department of Pediatrics, Oregon Health & Science University, Portland.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Phillipi
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.affiliation: Academic Pediatric Association, McClean, Va.
authors.forename: Niramol
authors.initials: N
authors.lastname: Dhepyasuwan
authors.affiliation: Department of Pediatrics, Yale University, New Haven, Conn.
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Shapiro
authors.affiliation: Department of Pediatrics, Yale University, New Haven, Conn.
authors.forename: Eve
authors.initials: E
authors.lastname: Colson
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D009725:Nurseries, Hospital; D010290:Parents; D011795:Surveys and Questionnaires; D016312:Treatment Refusal; D014481:United States; D014812:Vitamin K / Q000627:therapeutic use*; D006475:Vitamin K Deficiency Bleeding / Q000517:prevention & control*
chemical_list: D000933:Antifibrinolytic Agents; D014812:Vitamin K
keywords: BORN network; vitamin K refusal