Rising Parental Refusal of Newborn Vitamin K: Implications for Neurology and Child Development (P5-8.001)

Objective To review recent trends in vitamin K refusal and their neurological consequences. Background Intramuscular (IM) vitamin K prophylaxis at birth prevents vitamin K deficiency bleeding (VKDB), a rare but severe condition. Late VKDB often presents with intracranial hemorrhage (ICH), carrying 15–20% mortality and up to 50% long-term neurological disability. Despite proven safety, refusal of IM vitamin K is rising worldwide, paralleling vaccine hesitancy. Design/Methods Systematic literature review (2005–2025) using PubMed and Google Scholar. Twenty-five peer-reviewed studies met inclusion criteria. Data extracted included refusal prevalence, VKDB incidence, outcomes, parental reasoning, and links to vaccine refusal. Results Although refusal in the United States remains low (<1% in most hospitals), upward trends are evident. In Minnesota, rates rose from 0.9% in 2015 to 1.6% in 2019. In California, Connecticut, and Iowa, refusal ranged 0.2–1.3% (2018–2019), with over half of providers perceiving increases. Internationally, refusal is 1–3% in Canada, New Zealand, and Scotland, and >30% in some birthing centers. Risk factors include home birth, midwife care, and “natural” philosophies. Infants without IM prophylaxis are 81 times more likely to develop late VKDB. Across case series, ~63% present with ICH, ~14% die, and ~40% of survivors sustain neurological disability. Refusal also predicts later healthcare hesitancy: in Canada, refusers were 14.6 times more likely to be unimmunized at 15 months; in New Zealand, 14.1 times more likely; and in the U.S., 90 times more likely to refuse Hepatitis B vaccine and ocular prophylaxis. Parental concerns include pain, preservatives, and misinformation. Conclusions Vitamin K refusal, though uncommon, is rising and poses disproportionate neurological risk, leading to preventable infant death and lifelong disability. It also marks broader healthcare hesitancy. For neurologists, this trend signals growing burdens of avoidable developmental disorders. Universal uptake requires prenatal counseling, targeted messaging, and policy safeguards to reduce preventable neurodevelopmental disability. Disclosure: Miss De Faria Sousa has nothing to disclose. Ms. Imran has nothing to disclose. Miss Holz has nothing to disclose. Dr. Semidey has received personal compensation for serving as an employee of FIU HWCOM. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.