CIDRAP-Increased infant bleeding tied to lower acceptance of newborn vitamin K dose

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Increased infant bleeding tied to lower acceptance of newborn vitamin K dose​

Today at 4:02 p.m.



Two large studies published yesterday look at declining rates of newborns receiving the vitamin K birth injection and come to a grim conclusion—skipping the birth dose leads to an increase in infant bleeding.

Babies are born with a vitamin K deficiency, because they are unable to receive it through the placenta. Breastfeeding also fails to transfer enough of the vitamin to newborns. Without it, babies can experience vitamin K deficiency (VKD) and vitamin K–deficient bleeding (VKDB). An intramuscular (IM) dose of vitamin K at birth helps infants’ blood clot correctly.

“Nonreceipt of IM vitamin K was associated with greater than twice the risk of both intracranial bleeding during the first 6 months and death with a bleeding diagnosis during the birth hospitalization,” wrote the authors of an accompanying editorial in JAMA.

Deficiency-related bleeding rose 350%​

For the first study, published in JAMA Pediatrics, researchers at Virginia Commonwealth University examined electronic health record data from more than 2,300 hospitals and 50,000 outpatient settings for infants from birth to 6 months from January 2017 to December 2025. More than 11 million newborns were included.

During that period, the proportion of infants receiving a vitamin K shot dipped from 97% to 95%, representing an increase in VKD of almost 216% and in VKDB of a whopping 347%.
Similar to the recent measles outbreaks, we are seeing the real-world implications of growing mistrust of doctors and public health professionals.
Elizabeth Wolf, MD, MPH
Of infants with VKD, only 40% had received the shot, and of newborns with VKBD, only 19% received an injection.

“We knew from prior studies that vitamin K refusal had been increasing in the US, and we wanted to learn if there were any real-life consequences of this trend,” lead author Elizabeth Wolf, MD, MPH, said in a Virginia Commonwealth University news release. “We found that the answer is undeniably yes, with the rates of VKD and VKDB multiplying over the course of our study.”

Among infants with VKD and VKDB, 7% and 2%, respectively, were also diagnosed as having intracranial or intracerebral hemorrhage.

“Similar to the recent measles outbreaks, we are seeing the real-world implications of growing mistrust of doctors and public health professionals,” Wolf said. “We need clear messaging from all levels of public health about the benefits of vitamin K administration for newborns.”

Refusals proliferate from 2017 to 2025​

The second paper, this one in JAMA, examined electronic health data from every state and Washington, DC, that included more than 5.2 million infants from January 2017 to December 2025.

During that time, refusal of the IM vitamin K dose increased from 3.1% to 6.8%. At the same time, rates of bleeding by 6 months in infants who didn’t receive the shot increased from 225.3 to 394.0 per 10,000 newborns. For babies who received the vitamin K shot, the rate increased from 136.6 to 221.8 per 10,000 infants.

“Our study is the first to document a nationwide decline in administration paired with increases in bleeding risks,” Heather H. Burris, MD, MPH, neonatologist and coauthor of the study, said in a Children’s Hospital of Philadelphia news release. “Our findings underscore the importance of continued education and awareness, so families understand the serious, preventable bleeding risks for infants who do not receive vitamin K at birth.”

‘If only I had known the risk’ ​

The editorial stressed the need for healthcare professionals across specialties—including pediatrics, obstetrics and gynecology, public health, nursing, and the US Food and Drug Administration—to communicate how the vitamin K birth dose protects newborns.

“Every clinician would be distraught to learn an infant experienced a bleeding event and to hear a parent report, ‘If only I had known the risk,’” the authors wrote. “Armed with the information from this study, pediatric clinicians can now more confidently communicate the protection provided by IM vitamin K prophylaxis.”

Increased infant bleeding tied to lower acceptance of newborn vitamin K dose

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