716 - Lack of prophylactic newborn vitamin K administration increasing in a US-based electronic health database

Publication Number: 716.5757

Kristan Scott, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Evan Miller, Nemours Children's Hospital, Newark, DE, United States; Jennifer Culhane, Yale School of Medicine, New haven, CT, United States; Jay S. Greenspan, Sidney Kimmel Medical College at Thomas Jefferson University, Voorhees, NJ, United States; Sara Handley, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Justin Y. Lo, Yale School of Medicine, Madison, WI, United States; Lindsey Knake, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Kathryn McKenney, University of Colorado School of Medicine, Aurora, CO, United States; Heather H. Burris, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Kevin Dysart, Nemours Children's Hospital, PHILADELPHIA, PA, United States

Background: Hemorrhage from vitamin K deficiency is rare but can result in clinically significant morbidity and mortality. Since the COVID-19 pandemic, parental hesitancy around routine medication administration has increased. Whether the proportion of newborns lacking prophylactic vitamin K administration during the birth hospitalization has increased is unknown.

Objective: Determine if the proportion of newborns lacking routine vitamin K administration has increased and identify factors associated with lack of vitamin K administration. Secondarily, to quantify the association of lack of vitamin K administration with intracranial hemorrhage in the first two weeks of life.

Design/Methods: Retrospective cohort study of births in Epic Systems’ Cosmos research platform (2017-2023), a US-based electronic health record database with anonymized, de-identified, patient-level data. Health care systems with a minimum of 10 births per year in every year of the study period were included. Newborns were included if they were born between 35 – 43 completed weeks’ gestation. We calculated the proportion of newborns lacking vitamin K administration annually. We examined characteristics associated with lack of vitamin K administration in bivariate analyses.

Results: Of 3,693,558 births in the study period, 2.5% of newborns lacked prophylactic vitamin K administration, with the proportion increasing over time (p for trend < 0.001, Figure 1); in 2017 2.2% (10,409/473,159) lacked vitamin K compared to 2.7% (14,509/533,168) in 2023. Several covariates were associated with lack of vitamin K administration including older maternal age, Hispanic ethnicity, Black race, cesarean birth, lower birth weight, female sex, residence in urban census tracts and tracts within the highest quartile of social vulnerability (all P< 0.001) (Table 1). As expected, the proportion of newborns with intracranial hemorrhage was higher among newborns who lacked Vitamin K administration ((185/92,160), 0.2%) compared to newborns who received it ((2,116/3,601,398), 0.06%) (RR = 3.4).

Conclusion(s): In this large US-based electronic health record birth cohort, the proportion of newborns lacking prophylactic vitamin K administration has increased significantly. Consequently, more newborns may be at risk of significant bleeding, including intracranial hemorrhage. A multidisciplinary approach for public education is needed to improve rates of vitamin K administration and reduce preventable morbidity.

Figure 1
Percentage of newborns lacking prophylactic vitamin K administration after birth.

Table 1
Characteristics among who did and did not receive routine prophylactic vitamin K administration in Epic Cosmos, 2017-2023 (n= 3,693,558)