More parents declining newborn vitamin K linked to higher bleeding risk

Clinical takeaway: Discuss intramuscular vitamin K during prenatal care rather than waiting until delivery. As more parents decline newborn prophylaxis, early counseling may help prevent potentially life-threatening bleeding complications.

As more parents decline newborn vitamin K, clinicians are increasingly being asked to justify a preventive treatment that has long been considered routine. This large Swedish study provides contemporary evidence that infants who do not receive intramuscular vitamin K are at substantially higher risk for bleeding, reinforcing the importance of counseling expectant parents before delivery.

Researchers analyzed more than two million births and found that the proportion of newborns who did not receive intramuscular vitamin K more than doubled, from 0.66% in 2006 to 1.50% in 2021. The findings are consistent with recent reports that more US newborns are not receiving intramuscular vitamin K at birth.

Although the absolute risk of bleeding remained low, infants who did not receive intramuscular vitamin K had a 52% higher adjusted odds of bleeding during the first six months of life and nearly threefold higher odds of intracranial bleeding than infants who received the injection.

The investigators also observed increasing use of oral vitamin K among infants who did not receive the intramuscular injection. However, oral prophylaxis was associated with higher bleeding rates than intramuscular vitamin K, supporting longstanding recommendations that intramuscular administration remains the preferred approach. Because oral regimens require repeated dosing and caregiver adherence, they may provide less reliable protection.

For US clinicians, the study reinforces that vitamin K refusal is no longer an isolated issue. As more families question routine newborn interventions, discussing vitamin K during prenatal visits may be more effective than waiting until the immediate postpartum period, when parents are making multiple decisions in a short time. Early, evidence-based counseling may help address misconceptions before delivery and improve acceptance of intramuscular vitamin K.

Source: Simatou E, et al. (2026 Jul 13) JAMA Pediatr. Vitamin K Prophylaxis in Newborns and Bleeding in Infancy