Optimizing Intramuscular Vitamin K Uptake in Newborns Through Structured Quality Improvement Interventions

Document Type

Conference Proceeding

Publication Date

8-2026

Abstract

Introduction: The American Academy of Pediatrics has recommended routine intramuscular (IM) vitamin K prophylaxis since 1961. Despite this, parental refusal is increasing, ranging from 5.18% in hospitals to over 31% in birthing centers. This is often driven by misinformation and communication gaps. Refusal increases the risk of vitamin K deficiency bleeding (VKDB). 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%. Prior to this initiative, our institution lacked standardized educational materials for families regarding vitamin K.

Objective: To increase vitamin K administration rates through enhanced parental education and provider communication training.

Methods: We implemented a multifaceted intervention in the newborn nursery consisting of a standardized, parent-facing educational sheet addressing common concerns about vitamin K and a brief e-module curriculum training providers in motivational interviewing techniques for counseling families considering refusal. Standardized scripting for introducing newborn medications was also initiated. The intervention targeted attending physicians, residents, advanced practice providers, and nursing staff working in the newborn space. We compared vitamin K administration rates before and after implementation using routinely collected clinical data. Process measures included clinician completion of the e-module, and balancing measures assessed rates of administration of other newborn medications including hepatitis B and erythromycin.

Results: We collected and analyzed data from > 9000 deliveries from 9/1/2024-1/31/2026. The pre-intervention vitamin K refusal rate was 4.0%, compared with a post-intervention refusal rate of 4.4%. Although an improvement in vitamin K acceptance was not observed, refusal rates remained stable over the study period. In contrast, refusal rates for hepatitis B vaccination and erythromycin ointment increased notably during the same timeframe. Providers reported improved comfort and confidence in counseling families about vitamin K, and the intervention was feasible to implement without disrupting workflow.

Discussion/Conclusion: A combined approach of standardized parental education and provider 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 medications. These findings suggest that communication-focused strategies may help mitigate rising parental hesitancy and support sustained uptake of evidence-based newborn care.

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Pediatric Hospital Medicine Conference, August 6-9, 2026, Kansas City, MO

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