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:

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.