Trends in and Documentation of Refusal of Common Routine Newborn Interventions: 2013-2019.

Abstract

BACKGROUND:

Refusals of intramuscular (IM) vitamin K, ocular prophylaxis, and hepatitis B vaccine (HBV) during the birth hospitalization continue to occur. Refusal of IM vitamin K increases the risk of life-threatening vitamin K deficiency bleeding. Trends in refusal rates and how well clinicians document IM vitamin K refusal is unknown.

METHODS:

We reviewed charts of livebirths admitted to 5 well newborn units from 2013 to 2019. We report trends in rates of refusal and documentation of no IM vitamin K by clinicians during the birth hospitalization and within the first 6 months of life at emergency department (ED) visits.

RESULTS:

Of 67 750 live births, 283 (0.4%) did not receive IM vitamin K, and 1645 (2.4%) did not receive ocular prophylaxis. Rates of IM vitamin K refusal increased slightly over time (P < .05). For HBV, 7551 (11.1%) did not receive the birth dose, but refusal rates decreased from 16.1% to 8.7% (P < .0001). Of 283 newborns who did not receive IM vitamin K, refusal was documented in 49.8% of discharge summaries, 17 (6%) had an invasive procedure without documentation of IM vitamin K administration, and 30 (10.6%) infants <6 months old had ED visits. A total of 4 infants were evaluated for potential bleeding, and there was no documentation about IM vitamin K prophylaxis.

CONCLUSION:

Refusal rates of IM vitamin K and ocular prophylaxis remained low, and uptake of HBV increased over time. Documentation of IM vitamin K refusal by clinicians during the birth hospitalization, before invasive procedures, and in ED visits can be improved.

• Authors: Jaspreet Loyal, Elena Aragona
• Journal: Hospital pediatrics (Hosp Pediatr) Vol. 11 Issue 9 Pg. 962-967 (09 2021) ISSN: 2154-1671 [Electronic] United States
• PMID: 34380669 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 by the American Academy of Pediatrics.

Chemical References

• Vitamin K

Topics

• Documentation
• Humans
• Infant
• Infant, Newborn
• Parents
• Treatment Refusal
• Vitamin K
• Vitamin K Deficiency Bleeding (epidemiology, prevention & control)