Addressing Vitamin K Hesitancy in the Newborn Nursery

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

The American Academy of Pediatrics has recommended the use of routine prophylactic intramuscular (IM) vitamin K in newborns since 1961. Late vitamin K deficiency bleeding occurs in up to 1 out of 15000 infants who have not received IM vitamin K. A single injection of IM vitamin K after birth has been shown to reduce the incidence of late-onset vitamin K deficiency bleeding by 98%. Despite these longstanding recommendations, parental refusal rates have been on the rise with frequencies ranging from 5.18% in hospitals to upwards of 31% in birthing centers. This is often driven by misinformation and communication gaps. Prior to this project, there were no standardized resources available to parents at our facility regarding vitamin K. This quality improvement project aimed to increase vitamin K administration rates by enhancing parental education as well as clinician communication skills.

A multifaceted intervention was implemented in the Butterworth Hospital newborn nursery consisting of a standardized, parent-facing educational sheet addressing common concerns about vitamin K and a brief e-module curriculum training clinicians in motivational interviewing techniques for counseling families considering refusal. The intervention targeted attending physicians, residents, and advanced practice providers working in the newborn space. Surveys were conducted before and after providers completed the motivational interviewing curriculum assessing confidence in use of this communication skill with families. Vitamin K administration rates before and after implementation were compared using routinely collected clinical data. Process measures included clinician completion of the e-module, and balancing measures assessed workflow disruption.

Data from over 9000 deliveries was collected and analyzed. The pre-intervention vitamin K refusal rate was 4.0%, compared with a post-intervention refusal rate of 4.4%. Although a significant improvement in vitamin K acceptance was not observed, refusal rates remained relatively stable over the study period. In contrast, refusal rates for hepatitis B vaccination and erythromycin ointment increased notably during the same timeframe. Clinicians reported improved comfort and confidence in counseling families about vitamin K, and the intervention was feasible to implement without disrupting workflow.

A combined approach of standardized parental education and clinician training in motivational interviewing was associated with stabilization of vitamin K administration rates in the newborn nursery during a period of increasing refusal of other preventive newborn interventions. These findings suggest that communication-focused strategies may help mitigate rising parental hesitancy and support sustained uptake of evidence-based newborn care.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2018

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