Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Editorial Policies
    • Open Access
  • Content
    • Current Issue
    • Online First
    • Archive
    • Topic/Program Collections
    • Blog
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Editorial Policies
    • Open Access
  • Content
    • Current Issue
    • Online First
    • Archive
    • Topic/Program Collections
    • Blog
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Review Articles

Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review

Jaspreet Loyal and Eugene D. Shapiro
Hospital Pediatrics March 2020, 10 (3) 286-294; DOI: https://doi.org/10.1542/hpeds.2019-0228
Jaspreet Loyal
Department of Pediatrics, Yale University, New Haven, Connecticut
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eugene D. Shapiro
Department of Pediatrics, Yale University, New Haven, Connecticut
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading
Download PDF

Abstract

In 2019, the American Academy of Pediatrics made public education about intramuscular vitamin K administration at birth a public health priority, partly in response to reports of refusal of intramuscular vitamin K by parents of newborns that led to vitamin K deficiency bleeding (VKDB). We reviewed the literature on the frequency of, reported reasons for, and factors associated with refusal of intramuscular vitamin K, incidence of VKDB in newborns who did not receive intramuscular vitamin K, and use of oral vitamin K to prevent VKDB. Without prophylaxis, estimates of the incidence per 100 000 births of VKDB range from 250 to 1700 for early VKDB and from 10.5 to 80 for late VKDB. The frequency of refusal of intramuscular vitamin K by parents ranged from 0% to 3.2% in US hospitals, up to 14.5% in home births, and up to 31.0% in birthing centers. Reported reasons for refusal were concern of harm from the injection, a desire to be natural, and a belief in alternative methods of prophylaxis. Parents who refused intramuscular vitamin K were more likely to refuse immunizations. Many different regimens were used for orally administered vitamin K; it is not clear which is best, but all are less effective than intramuscular vitamin K. VKDB is rare but can result in either neurologic sequelae or death. In addition to continued surveillance of the frequency of both refusal of intramuscular vitamin K and VKDB, a renewed focus on education of and collaboration with parents is needed to address this major public health threat.

In 2019, the American Academy of Pediatrics (AAP) made public education about intramuscular vitamin K administration at birth 1 of its top 10 public health priorities.1 This response was partly due to an increase in the number of reports of parents who refuse intramuscular vitamin K for their newborns and a concomitant increase in reports of newborns with vitamin K deficiency bleeding (VKDB), a serious and potentially life-threatening condition, in recent years in the United States and other countries.2–12

Newborns have low reserves of vitamin K, putting them at risk for VKDB. VKDB may present in the first week of life (classic VKDB) with bleeding from the gastrointestinal tract and/or from the umbilicus.2,12 Late VKDB presents between 2 and 12 weeks of life, and infants may present with intracranial bleeding.2,12 A 1-time, prophylactic, intramuscular injection of vitamin K administered shortly after birth that has been recommended by the AAP since 1961 virtually eliminated VKDB in the United States.2 Although prophylaxis against VKDB with intramuscular vitamin K is universally recommended for newborns in the United States, this is not the case in many other countries.

There is a growing body of literature about refusal of intramuscular vitamin K by parents of newborns and the implications of lack of prophylaxis in newborns, but many questions remain unanswered. Therefore, our objective was to review the current literature for original articles on what is known about the frequency of refusal, reported reasons and factors associated with refusal of intramuscular vitamin K, reported outcomes of newborns who did not receive intramuscular vitamin K, and use of oral vitamin K against VKDB and identify what is still unknown to better direct future research efforts.

Methods

We searched PubMed for original and relevant English-language studies on the following: the frequency of, reasons for, and factors associated with refusal of intramuscular vitamin K by parents of newborns, outcomes of those newborns, and use of oral vitamin K against VKDB that were published from January 1, 1950, through August 1, 2019. We chose 1950 as the start of our date range because we wanted to capture case reports and clinical presentations of infants with VKDB who did not receive vitamin K prophylaxis and because our institution’s database collection started in 1950. Refusal of vitamin K by parents has become a popular subject for research, with many studies having been published in recent years. We manually searched the references of relevant articles for additional studies. Our PubMed search for the frequency of and reasons for refusal of intramuscular vitamin K included the following terms: ((vitamin k[Title/Abstract]) AND newborns) AND refusal. Articles were excluded if the study was not original (eg, reviews) or if no information on either the frequency of or reasons for refusal of intramuscular vitamin K was provided in the article. For outcomes of newborns who did not receive IM vitamin K, the following terms were included in the search: ((((vitamin K deficiency bleeding[Title/Abstract]) OR hemorrhagic disease of the newborn[Title/Abstract]) AND Humans[Mesh] AND English[lang])) AND case. Articles were excluded if the primary etiology of the bleeding was not due to vitamin K deficiency or if the infant’s age at presentation was missing. For oral vitamin K regimens to prevent VKDB, the following search terms were used: (((oral vitamin K[Title]) AND prophylaxis) AND newborns) AND bleeding. Addition of the word “hemorrhage” to the search string did not yield additional studies.

Discussion

Frequency of Intramuscular Vitamin Refusal by Parents

We identified 7 original articles on the frequency of intramuscular vitamin K refusal by parents.3–6,13–15 Rates of refusal in these studies are shown in Table 1. In the hospital setting, most parents accept intramuscular vitamin K for their newborns with reported refusal rates that ranged up to 3.2%. Extrapolating a refusal rate of 3.2% to ∼6 million live births in the United States, up to 192 000 newborns could be at risk for VKDB. Investigators in Canada also reported an increase in the frequency of refusal of intramuscular vitamin K, from 0.2% to 0.4%, from 1999 to 2005.13 Other than reports from single centers, there is a paucity of quantitative information about temporal changes in the frequency of refusal of intramuscular vitamin K, but there is a perception among clinicians that the frequency is increasing.7

View this table:
  • View inline
  • View popup
TABLE 1

Frequency of Refusal of Intramuscular Vitamin K by Parents of Newborns

In a 2014 report from the National Center for Health Statistics, the percentage of out-of-hospital births in the United States increased from 1.26% in 2011 to 1.36% in 2012, continuing an increase that began in 2004.8 Among out-of-hospital births in the United States, the frequency of refusal of intramuscular vitamin K has been reported to be as high as 14.5% among home births and 31% in birthing centers.3 Using the previous estimation of 6 million live births in the United States per year and a refusal rate of 1.36%, we can expect∼81 000 out-of-hospital births per year, of which ∼12 000 to 25 000 may be at risk for VKDB if prophylactic vitamin K is not administered.

Reasons for Refusal of Intramuscular Vitamin K

We identified 9 original articles on reasons for intramuscular vitamin K refusal by parents.3,4,7,8,16–19 Details on data collection and results are shown in Table 1. There were 3 major categories of reasons for refusal of intramuscular vitamin K by parents of newborns.

Concern of Harm From the Injection

For many parents who refused intramuscular vitamin K, the perceived risk of the injection outweighed the perceived benefit. Parents reported concerns about the preservative in the injection2,4,7,8,16–20 or that pain to the infant from the injection could be harmful.3,4,7,8,16,19 Additional reported concerns were a perception that intramuscular vitamin K is a “vaccine,”7,18–20 that the dose of intramuscular vitamin K was too high,3,4,7,8,16,19,20 that there was a potential for adverse reactions to an injection,4,7,16–19 that the injection created a potential entry for germs,7 that intramuscular vitamin K causes cancer,3,4,7,8 and that intramuscular vitamin K may overwhelm the newborn’s immune system.3

Desire To Be Natural

Some parents who refused intramuscular vitamin K for their newborns desired to be more “natural” and believed that intramuscular vitamin K was unnecessary for their infants.3,4,6−8,17,19,20 Additional drivers of the desire to be natural included parents’ religious beliefs and a belief that vitamin K deficiency is to be expected for infants.3,4,8,17–20

Belief in Alternative Prophylaxis To Prevent VKDB

Some parents preferred natural sources of vitamin K, and this preference included increasing the mother’s own dietary intake of vitamin K during the pregnancy.4,20 Some parents thought that oral vitamin K was effective in preventing VKDB.16,18–20 For some parents, their beliefs or values included a strong identification with an alternative lifestyle that factored into their decision-making.8,17 This alternative lifestyle included questioning norms and not immediately accepting recommendations by physicians. In some instances, parents’ refusal of intramuscular vitamin K for their infants was a result of a lack of knowledge about the risk of VKDB to their infants and the role of intramuscular vitamin K in preventing VKDB.6,18–20

Some parents would have only considered intramuscular vitamin K in the event of a potential injury to the infant or if the birth required another intervention.8 Decisions about the refusal of intramuscular vitamin K were influenced by the opinions of other mothers or family members; statements of celebrities and health professionals, including midwives and chiropractors; as well as written information (information sheets) and Internet blogs.8,16,18–20

Factors Associated With Refusal of Intramuscular Vitamin K

Seven studies that examined the factors associated with refusal of intramuscular vitamin K are shown in Table 2. Parents who refused intramuscular vitamin K tended to refuse other preventive measures, including the hepatitis B vaccine at birth, prophylaxis against gonococcal ophthalmia, and subsequent routine vaccinations.3–5,13–15 Investigators from Canada found that refusal of intramuscular vitamin K was significantly associated with planned home births, deliveries in birthing centers, midwife-assisted deliveries, and the child subsequently not receiving any recommended childhood vaccines at 15 months of age.13 Investigators in New Zealand found that mothers with midwife-assisted deliveries, who have planned home births, and of Asian ethnicity were more likely to refuse intramuscular vitamin K for their newborns.15 The association between intramuscular vitamin K refusal by parents and midwife-assisted deliveries was replicated by investigators in Michigan.6 In a cross-sectional survey of mothers in the United States, investigators found that mothers who refused intramuscular vitamin K were more likely to be white, >30 years of age, college graduates, or breastfeeding.2 In a study of a national network of US nurseries, exclusive breastfeeding, non-Hispanic white race and/or ethnicity, female sex of the newborn, gestational age, increasing mother’s age, and refusal of ocular prophylaxis, hepatitis B vaccine, or both were associated with refusal of intramuscular vitamin K.5

View this table:
  • View inline
  • View popup
TABLE 2

Reasons for Refusal of Intramuscular Vitamin K by Parents of Infants

Outcomes of Newborns Who Did Not Receive Intramuscular Vitamin K

There were no systematic reports of the frequency of either classic or late VKDB. There are numerous case reports and case series of VKDB in infants who did not receive intramuscular vitamin K at birth.11,21–60 Most infants with VKDB were exclusively breastfeeding, and most of the case reports were from countries where administration of intramuscular vitamin K is not routine. Because administration of intramuscular vitamin K at birth became routine after the AAP recommendation in 1961, reports of VKDB in the United States are almost always associated with refusal of intramuscular vitamin K by a parent. Most case reports were of infants who had late VKDB. Signs and symptoms at the time of presentation varied widely. Infants had nonspecific findings (fussiness, poor feeding, vomiting, pallor, fever, or jaundice), signs of bleeding (blood in the stool, ecchymosis, epistaxis, hematuria, bleeding from an injection site, umbilicus, or mucosa), neurologic signs and symptoms (altered mental status, lethargy, posturing, fixed dilated pupils, bulging fontanelle, hypotonia, or seizures), or respiratory issues (increased work of breathing or cyanosis).21–58 Rarely, children with late VKDB presented with bleeding either in the vitreous of the eye or in the thymus.10,31,53 Intracranial bleeding occurred commonly in infants with late VKDB. Reported outcomes of VKDB ranged from no significant effect to severe developmental delays and death. In 40 case reports and case series, of 1486 infants with VKDB in the absence of prophylaxis, there were 305 deaths (20.5%) and 146 infants (9.8%) had significant neurologic sequelae (hemiparesis, seizures, or developmental delay). The latter number is likely an underestimate because this information was not included in some studies. Case series of >40 infants with VKDB were all published in countries outside the United States, where vitamin K prophylaxis is not routine. In case reports from the United States, of 33 infants with VKDB, 3 died (9%).

Oral Vitamin K To Prevent VKDB

We identified 7 original articles about oral vitamin K to prevent VKDB in newborns.9,61–66 Specific regimens and incidences of VKDB are shown in Table 3. The reported incidence of VKDB in infants who had received prophylaxis with oral vitamin K is shown in Table 4. For most studies, these numbers were derived from periodic surveys of clinicians and their recall about cases of VKDB, confirmation with national registries of hospital discharge diagnoses (when possible), and surveys of parents.9,61–66 Oral vitamin K is not used routinely in the United States and is not approved by the US Food and Drug Administration to use for the prevention of VKDB. In Europe, several different regimens are used, and the most effective regimen is still unclear.

View this table:
  • View inline
  • View popup
TABLE 3

Factors Associated With Refusal of Intramuscular Vitamin K

View this table:
  • View inline
  • View popup
TABLE 4

Oral Vitamin K Regimens and VKDB Cases

Regimens reported in European studies included 3-dose series of oral vitamin K (given at birth, either day 4 or week 1, and week 4),61,63 multiple-dose series (at birth and then either daily or weekly until 3 months of age),62,65 2-dose series (at birth and day 4),66 and 4-dose series (at birth and at weeks 2, 4, and 6 [in breastfed neonates]).64 The incidence of VKDB after oral vitamin K prophylaxis in these studies was up to 2.8 per 100 000. Investigators concluded that although oral vitamin K was not as effective as a single intramuscular dose, oral regimens can provide an alternative prophylaxis against VKDB in otherwise healthy newborns.

Ensuring compliance by parents is an important problem for oral regimens.61 Of parents surveyed, 93% to 94% reported compliance with the prescribed oral regimen.62,64 Investigators in the United Kingdom surveyed midwives and had a 25% response rate to an anonymous e-mail survey about the midwives’ experiences with the oral vitamin K supplement, and most respondents found oral vitamin K acceptable but expressed concerns about parents’ compliance with the regimen.65

A limitation of these large-scale, population-based studies is the potential underreporting of cases of VKDB by clinicians. Although reported compliance with prescribed oral regimens was >90% in surveys of parents, there is the potential for both recall and reporting bias. A factor contributing to good compliance was routine administration of the oral doses in the pediatrician’s office. In the United States, the availability of oral preparations of vitamin K, ability to both store and administer oral doses of vitamin K in outpatient clinics, and willingness of clinicians to perform this additional task are unknown. Despite the increased out-of-hospital births and higher rates of refusal of intramuscular vitamin K among those parents, little is known about what oral regimens, if any, are being used by US midwives in these settings. It is also unknown if and which multiple-dose regimens are being offered, how are they obtained, and if either parents or pediatric clinicians are administering the follow-up doses.

Finally, national surveillance for VKDB in these European countries is noteworthy. Regular surveys of both clinicians and hospitals and, when possible, confirmation through review of registries of both discharge diagnoses and medical records are routinely performed. No such surveillance for VKDB is done in the United States at either the national or state level.

Conclusions

Refusal of intramuscular vitamin K by parents of newborns has serious implications for the health of children. In our review, the frequency of intramuscular vitamin K refusal by parents was higher in out-of-hospital births compared with in-hospital births, and refusal of vitamin K was associated with refusal of other preventive practices, including immunizations. There is an understanding about why parents refuse intramuscular vitamin K, and there are opportunities to use this information to inform educational efforts in the public. More information about the association of vitamin K with out-of-hospital births is needed to better understand the gap and greatly improve collaboration with midwife colleagues. More information is needed on the use of oral vitamin K to prevent VKDB in the United States, and there is a need for systematic surveillance of the outcomes of newborns who do not receive intramuscular vitamin K to monitor this emerging threat to the health of newborns.

Acknowledgments

We acknowledge John Leventhal for his comments on the article.

Footnotes

  • FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

  • FUNDING: Funded in part by a Yale University Department of Pediatrics Young Investigator Award (Dr Loyal), the Clinical and Translational Science Awards Program (grant UL1 TR000142 from the National Center for Advancing Translational Sciences), and the National Institutes of Health Roadmap for Medical Research (Dr Shapiro). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. Funded by the National Institutes of Health (NIH).

  • POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

References

  1. ↵
    AAP. Elimination of non-medical vaccine exemptions ranked top priority at Annual Leadership Forum. 2019. Available at: https://www.aappublications.org/news/aapnewsmag/2019/03/16/alfresolutions031619.full.pdf. Accessed April 7, 2019
  2. ↵
    American Academy of Pediatrics Committee on Fetus and Newborn. Controversies concerning vitamin K and the newborn. American Academy of Pediatrics Committee on Fetus and Newborn Pediatrics. 2003;112(1, pt 1):191–192
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Marcewicz LH,
    2. Clayton J,
    3. Maenner M,
    4. et al
    . Parental refusal of vitamin K and neonatal preventive services: a need for surveillance. Matern Child Health J. 2017;21(5):1079–1084
    OpenUrlPubMed
  4. ↵
    1. Hamrick HJ,
    2. Gable EK,
    3. Freeman EH,
    4. et al
    . Reasons for refusal of newborn vitamin K prophylaxis: implications for management and education. Hosp Pediatr. 2016;6(1):15–21
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Loyal J,
    2. Taylor JA,
    3. Phillipi CA,
    4. et al
    ; BORN Investigators. Factors associated with refusal of intramuscular vitamin K in normal newborns. Pediatrics. 2018;142(2):e20173743
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Danziger P,
    2. Skoczylas M,
    3. Laventhal N
    . Parental refusal of standard-of-care prophylactic newborn practices: in one center’s experience, many refuse one but few refuse all. Hosp Pediatr. 2019;9(6):429–433
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Loyal J,
    2. Taylor JA,
    3. Phillipi CA,
    4. et al
    . Refusal of vitamin K by parents of newborns: a survey of the better outcomes through research for newborns network. Acad Pediatr. 2017;17(4):368–373
    OpenUrlCrossRefPubMed
  8. ↵
    1. MacDorman MF,
    2. Matthews TJ,
    3. Declercq E
    . Trends in out-of-hospital births in the United States, 1990-2012. NCHS Data Brief. 2014;144(144):1–8
    OpenUrlPubMed
  9. ↵
    1. Schubiger G,
    2. Stocker C,
    3. Bänziger O,
    4. Laubscher B,
    5. Zimmermann H
    . Oral vitamin K1 prophylaxis for newborns with a new mixed-micellar preparation of phylloquinone: 3 years experience in Switzerland. Eur J Pediatr. 1999;158(7):599–602
    OpenUrlCrossRefPubMed
  10. ↵
    1. von Kries R,
    2. Hachmeister A,
    3. Göbel U
    . Can 3 oral 2 mg doses of vitamin K effectively prevent late vitamin K deficiency bleeding? Eur J Pediatr. 1999;158(suppl 3):S183–S186
    OpenUrlCrossRefPubMed
  11. ↵
    1. Kassis KL,
    2. Wada KJ,
    3. Milton A
    . Another disease re-emerges due to parental shot refusal: case report of a fussy infant with blood in stool. J Emerg Med. 2015;49(1):e15–e17
    OpenUrlPubMed
  12. ↵
    1. Schulte R,
    2. Jordan LC,
    3. Morad A,
    4. Naftel RP,
    5. Wellons JC III.,
    6. Sidonio R
    . Rise in late onset vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth. Pediatr Neurol. 2014;50(6):564–568
    OpenUrlCrossRefPubMed
  13. ↵
    1. Sahni V,
    2. Lai FY,
    3. MacDonald SE
    . Neonatal vitamin K refusal and nonimmunization. Pediatrics. 2014;134(3):497–503
    OpenUrlAbstract/FREE Full Text
    1. Bernhardt H,
    2. Barker D,
    3. Reith DM,
    4. Broadbent RS,
    5. Jackson PM,
    6. Wheeler BJ
    . Declining newborn intramuscular vitamin K prophylaxis predicts subsequent immunisation refusal: a retrospective cohort study. J Paediatr Child Health. 2015;51(9):889–894
    OpenUrlCrossRefPubMed
  14. ↵
    1. Burke M,
    2. Bernhardt H,
    3. Reith DM,
    4. Barker D,
    5. Broadbent RS,
    6. Wheeler BJ
    . Perinatal influences on the uptake of newborn Vitamin K prophylaxis–a retrospective cohort study. Aust N Z J Public Health. 2015;39(6):573–576
    OpenUrlCrossRefPubMed
  15. ↵
    Centers for Disease Control and Prevention. Notes from the field: late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis–Tennessee, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(45):901–902
    OpenUrlPubMed
  16. ↵
    1. Miller H,
    2. Kerruish N,
    3. Broadbent RS,
    4. Barker D,
    5. Wheeler BJ
    . Why do parents decline newborn intramuscular vitamin K prophylaxis? J Med Ethics. 2016;42(10):643–648
    OpenUrlAbstract/FREE Full Text
  17. ↵
    1. Weddle M,
    2. Empey A,
    3. Crossen E,
    4. Green A,
    5. Green J,
    6. Phillipi CA
    . Are pediatricians complicit in vitamin K deficiency bleeding? Pediatrics. 2015;136(4):753–757
    OpenUrlAbstract/FREE Full Text
  18. ↵
    1. Levin R,
    2. Jung JM,
    3. Forrey L,
    4. Glick J
    . Refusal of vitamin K injection: survey of the current literature and practical tips for pediatricians. Pediatr Ann. 2018;47(8):e334–e338
    OpenUrl
  19. ↵
    1. Eventov-Friedman S,
    2. Vinograd O,
    3. Ben-Haim M,
    4. Penso S,
    5. Bar-Oz B,
    6. Zisk-Rony RY
    . Parents’ knowledge and perceptions regarding vitamin K prophylaxis in newborns. J Pediatr Hematol Oncol. 2013;35(5):409–413
    OpenUrlCrossRefPubMed
  20. ↵
    1. Volpe JJ
    . Intracranial hemorrhage in early infancy–renewed importance of vitamin K deficiency. Pediatr Neurol. 2014;50(6):545–546
    OpenUrlCrossRefPubMed
    1. Sankar MJ,
    2. Chandrasekaran A,
    3. Kumar P,
    4. Thukral A,
    5. Agarwal R,
    6. Paul VK
    . Vitamin K prophylaxis for prevention of vitamin K deficiency bleeding: a systematic review. J Perinatol. 2016;36(suppl 1):S29–S35
    OpenUrlCrossRefPubMed
    1. Cekinmez M,
    2. Cemil T,
    3. Cekinmez EK,
    4. Altinörs N
    . Intracranial hemorrhages due to late-type vitamin K deficiency bleeding. Childs Nerv Syst. 2008;24(7):821–825
    OpenUrlPubMed
    1. Doneray H,
    2. Tan H,
    3. Buyukavci M,
    4. Karakelleoglu C
    . Late vitamin K deficiency bleeding: 16 cases reviewed. Blood Coagul Fibrinolysis. 2007;18(6):529–530
    OpenUrlPubMed
    1. Behrman BA,
    2. Chan WK,
    3. Finer NN
    . Resurgence of hemorrhagic disease of the newborn: a report of three cases. Can Med Assoc J. 1985 133(9):884–885
    OpenUrlPubMed
    1. Ijland MM,
    2. Pereira RR,
    3. Cornelissen EA
    . Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005: evaluation of the current guideline. Eur J Pediatr. 2008;167(2):165–169
    OpenUrlCrossRefPubMed
    1. Hubbard D,
    2. Tobias JD
    . Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth. South Med J. 2006;99(11):1216–1220
    OpenUrlCrossRefPubMed
    1. Darlow BA,
    2. Phillips AA,
    3. Dickson NP
    . New Zealand surveillance of neonatal vitamin K deficiency bleeding (VKDB): 1998-2008. J Paediatr Child Health. 2011;47(7):460–464
    OpenUrlCrossRefPubMed
    1. Enz R,
    2. Anderson RS Jr.
    . A blown pupil and intracranial hemorrhage in a 4-week-old: a case of delayed onset vitamin K deficiency bleeding, a rare “can’t miss” diagnosis. J Emerg Med. 2016;51(2):164–167
    OpenUrl
    1. Danielsson N,
    2. Hoa DP,
    3. Thang NV,
    4. Vos T,
    5. Loughnan PM
    . Intracranial haemorrhage due to late onset vitamin K deficiency bleeding in Hanoi province, Vietnam. Arch Dis Child Fetal Neonatal Ed. 2004;89(6):F546–F550
    OpenUrlAbstract/FREE Full Text
  21. ↵
    1. Boujan MM,
    2. Sharef KH
    . Change in hospital protocol regarding the use of vitamin K prophylaxis in newborns following a case of spontaneous subdural haematoma in a previously healthy 40-day-old infant. East Mediterr Health J. 2013;19(5):502–505
    OpenUrl
    1. Ozdemir MA,
    2. Karakukcu M,
    3. Per H,
    4. Unal E,
    5. Gumus H,
    6. Patiroglu T
    . Late-type vitamin K deficiency bleeding: experience from 120 patients. Childs Nerv Syst. 2012;28(2):247–251
    OpenUrlCrossRefPubMed
    1. Per H,
    2. Kumandaş S,
    3. Ozdemir MA,
    4. Gümüş H,
    5. Karakukcu M
    . Intracranial hemorrhage due to late hemorrhagic disease in two siblings. J Emerg Med. 2006;31(1):49–52
    OpenUrlPubMed
    1. Sutor AH,
    2. Dagres N,
    3. Niederhoff H
    . Late form of vitamin K deficiency bleeding in Germany. Klin Padiatr. 1995;207(3):89–97
    OpenUrlCrossRefPubMed
    1. Pooni PA,
    2. Singh D,
    3. Singh H,
    4. Jain BK
    . Intracranial hemorrhage in late hemorrhagic disease of the newborn. Indian Pediatr. 2003;40(3):243–248
    OpenUrlPubMed
    1. Choo KE,
    2. Tan KK,
    3. Chuah SP,
    4. Ariffin WA,
    5. Gururaj A
    . Haemorrhagic disease in newborn and older infants: a study in hospitalized children in Kelantan, Malaysia. Ann Trop Paediatr. 1994;14:231–237
    OpenUrlPubMed
    1. Siauw C,
    2. Wirbelauer J,
    3. Schweitzer T,
    4. Speer CP
    . Late vitamin K deficient bleeding in 2 young infants–renaissance of a preventable disease. Z Geburtshilfe Neonatol. 2015;219(5):238–242
    OpenUrl
    1. Shendurnikar N,
    2. Rana H,
    3. Gandhi DJ
    . Late hemorrhagic disease of the newborn. Indian Pediatr. 2001;38(10):1198–1199
    OpenUrlPubMed
    1. Chaunsumrit A,
    2. Isarangkura P,
    3. Hathirat P
    . Vitamin K deficiency bleeding in Thailand: a 32-year history. Southeast Asian J Trop Med Public Health. 1998;29(3):649–654
    OpenUrlPubMed
    1. Beach MW,
    2. Paul JR Jr.,
    3. Aycock EK
    . Hemorrhagic disease of the newborn: a report of seven cases in a two year period, recommendations for prevention particularly with reference to infants delivered by midwives of South Carolina. J S C Med Assoc. 1957;53(12):455–458
    OpenUrlPubMed
    1. Adame N,
    2. Carpenter SL
    . Closing the loophole: midwives and the administration of vitamin K in neonates. J Pediatr. 2009;154(5):769–771
    OpenUrlCrossRefPubMed
    1. Binder L
    . Hemorrhagic disease of the newborn: an unusual etiology of neonatal bleeding. Ann Emerg Med. 1986;15(8):935–938
    OpenUrlPubMed
    1. Lulseged S
    . Haemorrhagic disease of the newborn: a review of 127 cases. Ann Trop Paediatr. 1993;13(4):331–336; discussion 337–338
    OpenUrlPubMed
    1. Marchili MR,
    2. Santoro E,
    3. Marchesi A,
    4. Bianchi S,
    5. Rotondi Aufiero L,
    6. Villani A
    . Vitamin K deficiency: a case report and review of current guidelines. Ital J Pediatr. 2018;44(1):36
    OpenUrl
    1. Moreland P,
    2. Brown DL,
    3. Corcoran C
    . A 5-week-old infant with lethargy, irritability, poor feeding, and vomiting. J Emerg Nurs. 2009;35(1):43–45
    OpenUrlCrossRefPubMed
    1. Phillippi JC,
    2. Holley SL,
    3. Morad A,
    4. Collins MR
    . Prevention of vitamin K deficiency bleeding. J Midwifery Womens Health. 2016;61(5):632–636
    OpenUrl
    1. Plank RM,
    2. Steinmetz T,
    3. Sokal DC,
    4. Shearer MJ,
    5. Data S
    . Vitamin K deficiency bleeding and early infant male circumcision in Africa. Obstet Gynecol. 2013;122(2, pt 2):503–505
    OpenUrl
    1. Ratageri VH,
    2. Shepur TA,
    3. Kiran G
    . Vitreous hemorrhage secondary to vitamin K deficiency bleeding. Indian J Pediatr. 2007;74(3):314
    OpenUrlPubMed
    1. Rech MA,
    2. Wittekindt L,
    3. Friedman SD,
    4. Kling K,
    5. Ubogy D
    . Prothrombin complex concentrate for intracerebral hemorrhage secondary to vitamin K deficiency bleeding in a 6-week-old child. J Pediatr. 2015;167(6):1443–1444
    OpenUrl
    1. Thapa R,
    2. Biswas B,
    3. Mallick D
    . Classic hemorrhagic disease of the newborn presenting with bilateral vitreous hemorrhage. J Emerg Med. 2011;41(1):84–85
    OpenUrlPubMed
    1. Woods CW,
    2. Woods AG,
    3. Cederholm CK
    . Vitamin K deficiency bleeding: a case study. Adv Neonatal Care. 2013;13(6):402–407
    OpenUrlCrossRefPubMed
    1. Bruns LA,
    2. Isbey S,
    3. Tanverdi M,
    4. Kane I
    . Late-onset vitamin K deficiency presenting as scrotal bruising and mediastinal mass. Pediatr Emer Care. 2019;35(10):e192–e193
    OpenUrl
  22. ↵
    1. Elalfy MS,
    2. Elagouza IA,
    3. Ibrahim FA,
    4. AbdElmessieh SK,
    5. Gadallah M
    . Intracranial haemorrhage is linked to late onset vitamin K deficiency in infants aged 2-24 weeks. Acta Paediatr. 2014;103(6):e273–e276
    OpenUrl
    1. Aggarwal V,
    2. Mishra K,
    3. Rath B,
    4. Chaudhary S,
    5. Kumar P
    . Hemothorax and hematocele: unusual presentations of vitamin K deficiency bleeding disorder. Indian J Pediatr. 2013;80(1):80–81
    OpenUrl
    1. Burke CW
    . Vitamin K deficiency bleeding: overview and considerations. J Pediatr Health Care. 2013;27(3):215–221
    OpenUrlCrossRefPubMed
    1. Thomas MW,
    2. Gebara BM
    . Difficulty breathing. Late onset vitamin K deficiency bleeding. Clin Pediatr (Phila). 2004;43(5):499–502
    OpenUrlCrossRefPubMed
    1. Su CT,
    2. Hung FC,
    3. Huang CB
    . Hemorrhagic disease in a newborn due to inadequate vitamin K prophylaxis: case report. Chang Gung Med J. 2000;23(5):309–313
    OpenUrlPubMed
  23. ↵
    1. Kaur P,
    2. Tan KK
    . Hemothorax due to hemorrhagic disease of the newborn. Acta Paediatr Jpn. 1994;36(1):95–96
    OpenUrlPubMed
    1. Wolpert K,
    2. Szadkowski M,
    3. Miescier M,
    4. Hewes HA
    . The presentation of a fussy infant with bruising: late-onset vitamin K deficiency bleeding. Pediatr Emerg Care. 2019;35(4):e70–e71
    OpenUrl
  24. ↵
    1. Ceratto S,
    2. Savino F
    . Vitamin K deficiency bleeding in an apparently healthy newborn infant: the compelling need for evidence-based recommendation. Ital J Pediatr. 2019;45(1):30
    OpenUrl
  25. ↵
    1. Loyal J,
    2. Weiss TR,
    3. Cheng JH,
    4. Kair LR,
    5. Colson E
    . Refusal of vitamin K by parents of newborns: a qualitative study. Acad Pediatr. 2019;19(7):793–800
    OpenUrl
  26. ↵
    1. Laubscher B,
    2. Bänziger O,
    3. Schubiger G
    ; Swiss Paediatric Surveillance Unit (SPSU). Prevention of vitamin K deficiency bleeding with three oral mixed micellar phylloquinone doses: results of a 6-year (2005-2011) surveillance in Switzerland. Eur J Pediatr. 2013;172(3):357–360
    OpenUrl
  27. ↵
    1. Hansen KN,
    2. Minousis M,
    3. Ebbesen F
    . Weekly oral vitamin K prophylaxis in Denmark. Acta Paediatr. 2003;92(7):802–805
    OpenUrlCrossRefPubMed
  28. ↵
    1. von Kries R,
    2. Hachmeister A,
    3. Göbel U
    . Oral mixed micellar vitamin K for prevention of late vitamin K deficiency bleeding. Arch Dis Child Fetal Neonatal Ed. 2003;88(2):F109–F112
    OpenUrlAbstract/FREE Full Text
  29. ↵
    1. Wariyar U,
    2. Hilton S,
    3. Pagan J,
    4. Tin W,
    5. Hey E
    . Six years’ experience of prophylactic oral vitamin K. Arch Dis Child Fetal Neonatal Ed. 2000;82(1):F64–F68
    OpenUrlAbstract/FREE Full Text
  30. ↵
    1. Strehle EM,
    2. Howey C,
    3. Jones R
    . Evaluation of the acceptability of a new oral vitamin K prophylaxis for breastfed infants. Acta Paediatr. 2010;99(3):379–383
    OpenUrlCrossRefPubMed
  • Copyright © 2020 by the American Academy of Pediatrics
View Abstract
PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Hospital Pediatrics: 10 (3)
Hospital Pediatrics
Vol. 10, Issue 3
1 Mar 2020
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review
Jaspreet Loyal, Eugene D. Shapiro
Hospital Pediatrics Mar 2020, 10 (3) 286-294; DOI: 10.1542/hpeds.2019-0228

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review
Jaspreet Loyal, Eugene D. Shapiro
Hospital Pediatrics Mar 2020, 10 (3) 286-294; DOI: 10.1542/hpeds.2019-0228
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Abstract
    • Methods
    • Discussion
    • Conclusions
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • A Review of Long QT Syndrome: Everything a Hospitalist Should Know
  • Vancomycin Dosing in Children With Overweight or Obesity: A Systematic Review and Meta-analysis
Show more Review Articles

Similar Articles

Subjects

  • Fetus/Newborn Infant
    • Fetus/Newborn Infant
  • Journal Info
  • Editorial Board
  • Editorial Policies
  • Overview
  • Licensing Information
  • Authors/Reviewers
  • Author Guidelines
  • Reviewer Guidelines
  • Submit My Manuscript
  • Open Access
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Subscribe
  • Contact Us
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • RSS Feeds
  • shopAAP
  • AAP.org
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
American Academy of Pediatrics

© 2021 American Academy of Pediatrics