1. Bauer, Jill A. MA, RN

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Vitamin K is administered by injection to newborns after birth to prevent vitamin K deficiency bleeding (VKDB) (American Academy of Pediatrics, 2003); however, lately there has been a significant rise in parental refusal (Sahni, Lai, & McDonald, 2014). In a recent study of 282,378 infants between 2006 and 2012, refusal rates of vitamin K were found to have nearly doubled (Sahni et al.). Though small, the rise from 0.21% to 0.39% is concerning, and is predicted to result in devastating or even deadly clinical implications for a growing number of infants.


Infants that do not receive vitamin K after birth are at risk of developing VKDB for up to 6 months and can suffer severe or fatal consequences. Brain damage from intracranial hemorrhage or gastrointestinal bleeding related to coagulopathy is the main cause of long-term morbidity and mortality. These potentially devastating complications can include a 20% or greater risk of death (Shearer, 2009). In the Far East where vitamin K has not been administered at birth, incidence of devastating outcomes related to VKDB is approximately 1 in 1,000 births (Danielson, Hoa, Thang, & Loughnan, 2004). However, in countries where vitamin K injections are administered routinely, the number of affected infants is approximately 1 in 100,000 (Shearer).


Eventov-Friedman et al. (2013) interviewed 217 expectant parents to learn about their perceptions of vitamin K injections for infants and found that 60% to 69% lacked basic knowledge about vitamin K, and 68% were undecided about whether they would consent to treatment for their baby. Sahni et al. (2014) found that parents of babies born at home or in a nonhospital birth center by a midwife were eight times more likely to decline consent as compared to an almost 0% rate of refusal for those giving birth in a hospital setting. Parents rejecting vitamin K for their infant may not fully understand why it became a standard of care or what the consequences of VKDB can ultimately mean for their child.


During the prenatal period and during the admission process for labor when parents are offered the opportunity to consent to various routine treatments, nurses can provide much needed education about vitamin K and potential risks to the baby if vitamin K is not administered soon after birth. Nurses can make sure that parents understand that the choice to decline an evidence-based standard of care intended for their baby's protection may be a choice that increases risk of harm. When parental concerns are identified during pregnancy, there is an opportunity for open, nonjudgmental, knowledge-sharing conversations between members of the healthcare team and parents. Including parents as partners in the care of their baby and developing a trusting relationship should begin well before the admission for labor and birth. There are many myths, misconceptions, and misinformation about vitamin K throughout social media and Internet Web sites. Nurses can help parents identify and review accurate information before making a choice to refuse vitamin K. They can make sure the parents have spoken to the baby's provider in detail about their plans. These nursing measures may not be applicable for women choosing to give birth outside of the hospital setting. Consumer education would be beneficial for all parents, but especially for those who are not within the traditional health system. A choice to either consent to or reject the standard practice of vitamin K administration after birth is one that must be a fully informed decision.




American Academy of Pediatrics. (2003). Controversies concerning vitamin K and the newborn. American Academy of Pediatrics Committee on Fetus and Newborn. Pediatrics, 112(1 Pt 1), 191-192. [Context Link]


Danielsson N., Hoa D. P., Thang N. V., Vos T., Loughnan P. M. (2004). Intracranial haemorrhage due to late onset vitamin K deficiency bleeding in Hanoi province, Vietnam. Archives of Disease in Childhood: Fetal and Neonatal Edition, 89(6), F546-F550. [Context Link]


Eventov-Friedman S., Vinograd O., Ben-Haim M., Penso S., Bar-Oz B., Zisk-Rony R.Y. (2013). Parents' knowledge and perceptions regarding vitamin K prophylaxis in newborns. Journal of Pediatric Hematology/Oncology, 35(5), 409-413. doi:10.1097/MPH.0b013e318279e509 [Context Link]


Sahni V., Lai F. Y., MacDonald S. E. (2014). Neonatal vitamin K refusal and nonimmunization. Pediatrics, 134(3), 497-503. doi:10.1542/peds.2014-1092 [Context Link]


Shearer M. J. (2009). Vitamin K deficiency bleeding (VKDB) in early infancy. Blood Reviews, 23(2), 49-59. doi:10.1016/j.blre.2008.06.001 [Context Link]