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

Some Minnesota clinicians perceive that the incidence of prophylactic vitamin K refusal is increasing, yet the actual incidence and which populations are most likely to refuse is unknown. Our objective is to identify the incidence of vitamin K refusal and to characterize the maternal-newborn dyads with increased refusal rates.

This retrospective multi-institution study analyzed vitamin K refusal in newborns born from 2015 to 2019. Maternal-newborn dyad delivery and community characteristics (language, religion, population size) were collected and analyzed by univariable and multivariable logistic regression.

Among 102 451 term infants, 1.3% did not receive intramuscular vitamin K. Refusal increased from 0.9% in 2015 to 1.6% by 2019 (P < .0001). In multivariable analysis, factors associated with increased likelihood of refusal included female sex (odds ratio [OR] 1.22, 95% CI 1.09-1.36), exclusive human milk feeding at hospital discharge (OR 3.46, 95% CI 2.87-4.17), parity greater than 0 (OR ranging from 1.32 [95% CI 1.13-1.54] for parity of 1, to 3.70 [95% CI 2.80-4.90] for parity of 4), having a midwife at delivery (OR 1.70, 95% CI 1.45-2.01), public insurance (OR 1.84, 95% CI 1.60-2.12), and Russian language (OR 4.92, 95% CI 2.90-8.35). Some religious identities had higher refusal rates (ie, Pentecostal 7.0%, Baptist 3.3%).

In a cohort of Minnesota hospital-born infants, the incidence of vitamin K refusal increased between 2015 and 2019. We identified large populations (eg, public insurance, exclusive human milk feeding) and smaller discrete communities (eg, Russian, Pentecostal) with opportunities for increasing prophylactic vitamin K acceptance through targeted community conversations.