Characterizing Vitamin K Refusal in Term Hospital-Born Infants in Minnesota, 2015-2019

Area of Science:

• Neonatal care
• Public health
• Pediatric medicine

Background:

• Clinician perceptions suggest an increase in prophylactic vitamin K refusal among newborns.
• Actual incidence and at-risk populations for vitamin K refusal remain largely unknown.
• This study addresses the need to quantify vitamin K refusal rates and identify associated demographic factors.

Purpose of the Study:

• To determine the incidence of prophylactic vitamin K refusal in newborns.
• To characterize maternal-newborn dyads with higher rates of vitamin K refusal.
• To inform targeted interventions for increasing vitamin K acceptance.

Main Methods:

• Retrospective analysis of newborn data from 2015-2019 across multiple institutions.
• Collection and analysis of maternal-newborn dyad and community characteristics (language, religion, insurance).
• Univariable and multivariable logistic regression models were used to identify factors associated with refusal.

Main Results:

• The incidence of vitamin K refusal increased from 0.9% in 2015 to 1.6% in 2019 (P < .0001).
• Factors associated with increased refusal included female sex, exclusive human milk feeding, higher parity, midwife-assisted delivery, public insurance, and Russian language.
• Specific religious groups, such as Pentecostal (7.0%) and Baptist (3.3%), showed higher refusal rates.

Conclusions:

• Prophylactic vitamin K refusal incidence rose significantly in Minnesota hospital-born infants from 2015-2019.
• Populations with public insurance and those exclusively human milk-feeding, along with specific linguistic and religious communities, demonstrated higher refusal rates.
• Targeted community engagement and conversations are recommended to improve prophylactic vitamin K acceptance.