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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Infant girls are approximately twice as likely to not receive intramuscular vitamin K prophylaxis as boys. Researchers conducted the study after noticing a recent rise in parental declines. Newborn females are significantly less likely to receive intramuscular vitamin K prophylaxis and slightly less likely to receive the hepatitis B vaccine than newborn males, according to retrospective cohort study data. Findings published in JAMA Network Open from three centers in the University of Pennsylvania health system showed that overall parental decline of both vitamin K prophylaxis and the HBV vaccine has increased since 2018.
\u201cThis is something that we\u2019re seeing in Philadelphia,\u201d Sarah A. Coggins, MD, MSCE, a neonatologist at Pennsylvania Hospital and assistant professor of pediatrics at the Children\u2019s Hospital of Philadelphia, told Healio. \u201cOur study doesn\u2019t say this is happening in the entire country, but our results may be generalizable to other cities similar to Philadelphia in terms of geography or patient population.\u201d Coggins and colleagues analyzed newborn births from 2018 to 2025 for babies eligible for care in the well-newborn nursery. They used linear regression to determine crude annual trends and multivariable logistic regression to understand factors associated with both vitamin K prophylaxis and HBV administration. Data showed newborn female sex to be associated with significantly higher odds of parental decline of vitamin K prophylaxis (adjusted OR = 2.03; 95% CI, 1.74-2.35) and parental decline of HBV administration (aOR = 1.06; 95% CI, 1.01-1.1) compared with newborn males. The rate of parental decline of vitamin K prophylaxis among female newborns increased from 9.6 per 1,000 births in 2018 to 19.8 per 1,000 births in 2025, while the rate for male newborns increased from 4 per 1,000 births to 10.1 per 1,000 births over the same period. Meanwhile, the rate of parental decline of HBV administration increased annually by 10.3 newborns per 1,000 births from 2018 to 2025; data show it increased annually by 11 newborns per 1,000 births for male newborns over the same period. Healio spoke with Coggins about the rising rates of nonreceipt of both vitamin K prophylaxis and HBV, potential reasons for sex-based differences in parental decline and what additional research on this topic might look to address. Healio: What sparked your interest in pursuing this study topic? Coggins: My research team and I are NICU doctors and specialists in the care of newborn babies. Clinically, parents declining various aspects of recommended preventive newborn care isn\u2019t all that new, but we\u2019ve been struck by the increasing rates of declining care over the last 6 months to a year. We\u2019ve personally noticed higher rates of parental decline of vitamin K prophylaxis, which again isn\u2019t anything new, but the volume of parents declining seemed to be markedly different. We are currently in a societal milieu where distrust of the medical system is rising. Parents are doing a lot of their own research, which is informing a lot of these decisions about whether they\u2019re going to accept recommended newborn preventative care or not. Unfortunately, some of the sources that parents are consulting with are providing disinformation, so this study was born out of our clinical everyday observations. Healio: How did the sex-based differences aspect become a focal point of the study? Coggins: That was also rooted in a clinical observation. When I counsel families who decline vitamin K prophylaxis in order to address any questions or concerns they might have, I tell them that it\u2019s my job to inform them of the potential consequences of that decision. I tell them that their child could develop spontaneous bleeding that could cause brain damage, gastrointestinal bleeding, or even death, and some families would still be willing to take that risk. But if it was a male infant, we would also inform them that our hospitals don\u2019t perform circumcisions if the baby doesn\u2019t receive vitamin K prophylaxis. We noted that this piece of information seemed to change some parents\u2019 minds. It wasn\u2019t so much about the counseling and morbidity and mortality that could be associated with vitamin K deficiency bleeding, it was the fact that their son couldn\u2019t get a circumcision. There are no similar procedures that are specifically earmarked for female infants in the nursery that would prompt parents to make that kind of a switch in decision-making. So we asked ourselves: what are the rates of vitamin K refusal over time, and is there a difference in refusal rates between male and female infants? It\u2019s a very simple question but I have to say, we were a little shocked by what we found. Healio: What are the reasons you\u2019ve heard personally for declining vitamin K prophylaxis? Coggins: There are various reasons. Some of it is general mistrust of medical interventions. Vitamin K refusal often precedes vaccine hesitancy. There are also folks who don\u2019t trust the safety of the interventions that we\u2019re offering. Some of this is also rooted in a desire for holistic care; we\u2019ve heard things like \u201cvitamin K isn\u2019t natural\u201d or \u201cvaccines aren\u2019t natural.\u201d Finally, some parents desire to avoid interventions that they perceive as unnecessary, or even just painful exposures to their newborn after birth. Healio: Having anecdotally observed what you believed to be a rise in overall refusals and the potential separation of sex-based differences, did you expect the results to be as dramatic as they were? Coggins: This study looked at three birthing hospitals within the University of Pennsylvania health system that reflect different parts of the Philadelphia area, including Center City Philadelphia and the suburbs. 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