AAP emphasizes newborns’ need for vitamin K amid rise in parental refusal

Parents should ensure their newborn receives a dose of vitamin K after birth to prevent a potentially life-threatening bleeding disease, the AAP said in a recent policy announcement.

The AAP has recommended since 1961 that newborns receive a shot of vitamin K to prevent vitamin K deficiency bleeding (VKDB). However, the incidence of VKDB appears to be on the rise as more parents refuse the shot for their newborn infants, or choose alternate and less effective methods of administering it, the AAP said.

Exclusively breastfed infants who do not receive vitamin K prophylaxis at birth are particularly at risk because breast milk “provides relatively low levels of vitamin K,” Ivan Hand, MD, FAAP, and other members of the AAP’s Committee on Fetus and Newborn, Section on Breastfeeding, and Committee on Nutrition, wrote.

“This illness is relatively rare in the United States today because we have offered this dose of vitamin K to infants,” Hand said in a statement. “This bleeding disease can be devastating and is totally preventable, and so we urge parents to ask questions if they have concerns.”

Parental refusal has increased in recent years, resulting in an increase in late-onset VKBD, according to Hand and colleagues. They said parental objections are usually related to belief systems, infant welfare and outside influencing factors.

“Families may believe a ‘natural’ birth is best and want to avoid what seems to be a painful intervention in the process,” they wrote. “There was also a strong association between refusal of both ocular prophylaxis and hepatitis B vaccine with refusal of vitamin K. Parental reasons for refusal of intramuscular vitamin K administration included lack of understanding of the indication for vitamin K, belief that it was unnecessary, concern about pain of the injection, and concern related to the preservative in the formulation.”

Hand and colleagues suggested that pediatricians address parental concerns before birth, and that VKDN should be considered when evaluating bleeding in the first 6 months of life, even in infants who received prophylaxis and especially in those who are exclusively breastfed.

“We understand parents want the best for their children, and we, as pediatricians, share that goal,” Hand said. “We strongly recommend that parents bring their questions to us and help us understand any concerns.”

References:

AAP. American Academy of Pediatrics policy statement: Newborns require vitamin K shortly after birth to prevent bleeding disease. Accessed Feb. 22, 2022.