Parental refusal of routine newborn vitamin K shots increased from 3.1% in 2017 to 6.8% in 2025 across the United States. Nationwide studies in JAMA and JAMA Pediatrics revealed that infants missing the birth shot face more than double the risk of intracranial hemorrhage and bleeding-related death during birth hospitalization. Rates of vitamin K deficiency bleeding quadrupled over the eight-year period, leading clinicians to emphasize early prenatal education and evaluate harm-reduction strategies such as oral vitamin K alternatives.
Intracranial hemorrhage and brain bleeding risks
- ▪Newborns who did not receive a birth vitamin K shot faced more than double the risk of intracranial hemorrhage compared to infants who received the shot
- ▪Brain hemorrhages occurred in 6.9% of infants diagnosed with vitamin K deficiency and in 2.4% of infants with vitamin K deficiency bleeding between 2017 and 2025
- ▪Late vitamin K deficiency bleeding, which occurs between 1 week and 6 months after birth, carries a 30% to 60% risk of intracranial hemorrhage
Overall bleeding and mortality risks
- ▪Newborns who did not receive prophylactic vitamin K shots faced more than double the risk of death with concurrent bleeding during birth hospitalization
- ▪A study editorial led by Laura Kair noted that one additional infant would suffer a bleeding event for every 114 infants who do not receive vitamin K
- ▪Infants who did not receive a prophylactic vitamin K shot had a 47% higher overall bleeding risk during their first 6 months of life
Rising rates of refusal and vitamin K deficiency
- ▪Vitamin K deficiency bleeding rates among U.S. infants aged 0 to 6 months rose from 24.0 to 107.4 per 100,000 between 2017 and 2025
- ▪Parental refusal of routine prophylactic vitamin K shots for U.S. newborns increased from 3.1% in 2017 to 6.8% in 2025
- ▪Diagnosed vitamin K deficiency among U.S. infants aged 0 to 6 months increased from 11.8 per 100,000 in 2017 to 37.3 per 100,000 in 2025
- ▪Among U.S. infants who developed vitamin K deficiency bleeding between 2017 and 2025, 80.8% had not received a prophylactic birth vitamin K shot
Clinical guidelines and parental education recommendations
- ▪Clinicians led by Laura Kair recommend educating parents on newborn vitamin K benefits during prenatal care, pediatric pre-birth visits, and hospital delivery care
- ▪The American Academy of Pediatrics has recommended routine prophylactic vitamin K shots for newborns since 1961, typically administered within six hours of birth
Oral vitamin K alternatives
- ▪A research letter by Elizabeth Wolf suggested that offering oral vitamin K as a second-line option in the U.S. may be warranted if injection refusal continues
- ▪Countries including France, Germany, the Netherlands, Switzerland, and Canada offer oral vitamin K routinely or as an alternative to intramuscular vitamin K shots
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