Neonatal Vitamin K Refusal and Nonimmunization

BACKGROUND: Neonatal Vitamin K prophylaxis is an effective intervention for reducing vitamin K deficiency bleeding. A recently published report of parental refusal of vitamin K prompted an investigation of the prevalence and characteristics of this group, and exploration of whether these same parents were likely to subsequently refuse immunization for their children. METHODS: We conducted a retrospective population-based cohort study of all infants born in Alberta between 2006 and 2012 by using linkage of administrative health data. Risk factors for vitamin K refusal were determined by using Poisson regression. The association between vitamin K refusal and nonimmunization was assessed using relative risk. RESULTS: Among the 282 378 children in the cohort, 99.7% received vitamin K and 0.3% declined. Midwife-assisted deliveries were more likely to be associated with vitamin K refusal compared with physician-attended delivery (risk ratio 8.4, 95% confidence interval [CI] 6.5–11.0). Planned home delivery (risk ratio 4.9, CI 3.8–6.4) or delivery in a birth center (risk ratio 3.6, CI 2.3–5.6) were more likely to result in decline of vitamin K compared with hospital delivery. Vitamin K refusal was associated with a 14.6 (CI 13.9–15.3) higher relative risk of having no recommended childhood vaccines at 15 months. CONCLUSIONS: This is the first population-based study to characterize parents who are likely to decline vitamin K for their infants and whose children are likely to be unimmunized. These findings enable earlier identification of high-risk parents and provide an opportunity to enact strategies to increase uptake of vitamin K and childhood immunizations. Pediatrics 2014;134:497–503 AUTHORS: Vanita Sahni, MHSc,a Florence Y. Lai, MPhil,a and Shannon E. MacDonald, PhDbc aAlberta Health Surveillance and Assessment, Edmonton, Alberta, Canada; bDepartment of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and cFaculty of Nursing, University of Alberta, Edmonton, Alberta, Canada