An increasing number of parents are refusing vitamin K injections for their newborns, putting infants at a greater risk of avoidable neurodevelopmental issues, according to a systematic review to be presented at the American Academy of Neurology Annual Meeting.
Intramuscular vitamin K prophylaxis at birth prevents vitamin K deficiency bleeding. This condition can cause an intracerebral hemorrhage, a type of stroke that occurs when a blood vessel bursts in the brain. The injection provides an essential vitamin that newborns naturally have at low levels and supports normal blood clotting.
In the systematic literature review, investigators analyzed 25 peer-reviewed studies published between 2005 and 2025 that examined vitamin K refusal, incidence of vitamin K deficiency bleeding, outcomes, parental reasons for refusal, and links to vaccine hesitancy.
Across the studies, refusal rates in the United States remained below 1% in most hospitals but showed measurable increases in some regions. In Minnesota, refusal rose from 0.9% in 2015 to 1.6% in 2019. In California, Connecticut, and Iowa, refusal ranged from 0.2% to 1.3% during 2018 and 2019, with over 50% of hospital staff reporting that they perceived more parents refusing vitamin K.
Internationally, refusal rates were reported at 1% to 3% in Canada, New Zealand, and Scotland, and exceeded 30% in some birthing centers.
The infants who didn't receive intramuscular vitamin K prophylaxis were 81 times more likely to develop late vitamin K deficiency bleeding compared with infants who received the injections.
Among the reported cases of vitamin K deficiency bleeding, approximately 63% presented with intracranial hemorrhage, about 14% of the affected infants died, and approximately 40% of the survivors developed long-term neurologic disability, including cognitive impairment, seizures, or motor deficits.
The investigators also found that refusal of vitamin K prophylaxis was associated with broader health care hesitancy. In US data sets, the parents who declined vitamin K were 90 times more likely to refuse both hepatitis B vaccination and ocular prophylaxis for their newborns. International studies showed similar patterns: parents in Canada who declined vitamin K were about 15 times more likely to have children who remained unimmunized at 15 months, and parents in New Zealand were about 14 times more likely.
The risk factors for vitamin K prophylaxis refusal included home birth, midwife care, and "natural" philosophies. Parents most often cited concerns about injection pain, preservatives, or misinformation about the treatment.
“Vitamin K at birth is safe and effective, and while refusal is still uncommon, with rates in the United States remaining under 1% in most hospitals, our review found in recent years there have been increases in parents refusing this supplement for their newborns,” noted senior study author Kate Semidey, MD, of the Florida International University in Miami.
The investigators noted that the analysis was based on previously published studies rather than longitudinal follow-up of infants, limiting the ability to determine the exact risk for any individual baby.
Dr. Semidey said: “Our findings point to an urgent need for health care professionals to provide prenatal counseling to parents to ensure they understand that vitamin K can dramatically reduce preventable brain injury and its lifelong impact.”
Source: American Academy of Neurology Abstract, Press Release
