This Infant Disease Was Eradicated. Now It's Back. Why?

Some parents are refusing routine vitamin K shots for their newborns, as F. Perry Wilson, MD, explains




Vitamin K deficiency bleeding (VKDB), a completely preventable condition that can leave infants permanently disabled, can occur when parents refuse intramuscular vitamin K injections for their newborns. In this analysis, F. Perry Wilson, MD, discusses a new study examining the rates and risk factors for refusal.

This is vitamin K.





Vitamin K is a friendly, fat-soluble vitamin. Without it, your blood will stop clotting and you die.

You can find vitamin K in all sorts of good things, like kale



and other green leafy vegetables, and some gross things like liver.



You can also find vitamin K in this form:




This form of vitamin K -- an intramuscular injection -- has been recommended for newborns by the American Academy of Pediatrics since 1961.

Newborns have low reserves of vitamin K. Without this shot, they are prone to a condition called Vitamin K deficiency bleeding or VKDB, which can cause intracranial hemorrhage and lifelong disability or death. VKDB had been, essentially, eradicated.


That is, until recently, when new cases started popping up – here's an early report from the CDC in 2013:




Why are we seeing a resurgence in this totally preventable disease? Because parents have started to refuse to allow their newborns to receive vitamin K injections, as revealed in this paper appearing in the journal Pediatrics.





The researchers examined the birth records of nearly 103,000 newborns from centers participating in the Better Outcomes through Research for Newborns study. Of those, 638, 0.6%, had parents who refused vitamin K injections.

I know what you're thinking -- that's less than 1 in 100. You're right -- it's not too bad. But the refusal behavior is associated with a variety of other dangerous behaviors.

For example, 82% of the vitamin K refusers also refused ocular prophylaxis for gonococcal ophthalmia neonatorum, which can result in permanent blindness. And 74% of the vitamin K refusers also refused hepatitis B vaccination.

The study examined the characteristics of the refusers. Consistent with prior research, those who refused vitamin K shots were more likely to be non-Hispanic whites, to have private insurance, and to plan to feed the newborn only with breast milk. This is ironic, as formula has substantially more vitamin K than breast milk does.

I asked lead author Dr. Jaspreet Loyal what is behind these refusals.

"Vitamin K is a victim in a sense, as there are many families that think that vitamin K is a vaccine and a lot of fear comes from that perception in some cases. I don't think that prominent individuals speaking about vaccines in a negative way helps the situation."

No. It certainly does not.

Vitamin K refusal is a symptom of a bigger problem – mistrust of the medical establishment. It is a mistrust born out of our failure to connect with our patients in the context of the 10-minute visits mandated by our administrators and by the vicissitudes of payer reimbursement rates. And it is exacerbated by a diet, supplement, and alternative medicine industry that depends on undercutting established medical science for their own profits. We need to address these issues head on. If not, our patients -- and their children -- will pay for it.

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