Trends in and Documentation of Refusal of Common Routine Newborn Interventions: 2013-2019

Area of Science:

• Neonatal care
• Public health
• Pediatric medicine

Background:

• Refusals of essential newborn interventions like intramuscular vitamin K, ocular prophylaxis, and hepatitis B vaccine persist.
• Intramuscular vitamin K refusal heightens the risk of severe vitamin K deficiency bleeding in infants.
• Current trends in refusal rates and the adequacy of clinical documentation for these refusals are not well understood.

Purpose of the Study:

• To analyze trends in refusal rates for intramuscular vitamin K, ocular prophylaxis, and hepatitis B vaccine.
• To evaluate the documentation practices of clinicians regarding intramuscular vitamin K refusal.
• To assess documentation completeness during birth hospitalization and subsequent emergency department visits.

Main Methods:

• Chart review of livebirths across five well newborn units from 2013 to 2019.
• Analysis of refusal rates and documentation of intramuscular vitamin K non-administration.
• Examination of documentation at birth hospitalization, before invasive procedures, and during emergency department visits up to six months of age.

Main Results:

• Intramuscular vitamin K refusal rates saw a slight increase (0.4% of livebirths), while ocular prophylaxis refusal was 2.4%.
• Hepatitis B vaccine birth dose refusal decreased significantly from 16.1% to 8.7%.
• Documentation of intramuscular vitamin K refusal was inconsistent (49.8% in discharge summaries), with several infants undergoing procedures or visiting the ED without documented prophylaxis status.

Conclusions:

• Refusal rates for intramuscular vitamin K and ocular prophylaxis remain low, with increased hepatitis B vaccine uptake.
• Significant gaps exist in the clinical documentation of intramuscular vitamin K refusal.
• Improved documentation practices are crucial during birth hospitalization, before invasive procedures, and in emergency settings to ensure infant safety.