Jessica Cheng Poster.pptxOral Vitamin K Prophylaxis to Prevent Vitamin K Deficiency in Newborns: A Survey of Clinician Opinions and Practices
Oral Vitamin K Prophylaxis to Prevent Vitamin K Deficiency in Newborns: A Survey of Clinician Opinions and Practices
Jessica Cheng, MD, Jaspreet Loyal, MD, MS, Kelly Wood, MD, Laura R. Kair, MD, MAS
Jessica Cheng, MD, Jaspreet Loyal, MD, MS, Kelly Wood, MD, Laura R. Kair, MD, MAS
Oral Presentation
Oral Presentation
Jessica Cheng Oral Presentation.m4aBackground: The vast majority of newborns in the United States (US) receive intramuscular (IM) vitamin K for prophylaxis against vitamin K deficiency bleeding (VKDB), a serious and life-threatening bleeding condition. Oral vitamin K is not as effective as IM vitamin K in preventing VKDB but is widely used in Europe and by an increasing number of US parents who refuse IM vitamin K for their newborn.
Background: The vast majority of newborns in the United States (US) receive intramuscular (IM) vitamin K for prophylaxis against vitamin K deficiency bleeding (VKDB), a serious and life-threatening bleeding condition. Oral vitamin K is not as effective as IM vitamin K in preventing VKDB but is widely used in Europe and by an increasing number of US parents who refuse IM vitamin K for their newborn.
Objective: To assess the opinions and practices of newborn clinicians regarding oral vitamin K prophylaxis against VKDB when parents refuse IM vitamin K.
Objective: To assess the opinions and practices of newborn clinicians regarding oral vitamin K prophylaxis against VKDB when parents refuse IM vitamin K.
Methods: Newborn clinicians from 3 academic medical centers in California, Iowa and Connecticut were invited to participate in an electronic cross-sectional survey. The survey was created following literature review and expert opinion. We asked participants about their opinions, practices, and knowledge regarding oral vitamin K and compared responses from clinicians in the neonatal intensive care unit (NICU) and the well-newborn nursery. Descriptive statistics and one-way ANOVA analyses were performed.
Methods: Newborn clinicians from 3 academic medical centers in California, Iowa and Connecticut were invited to participate in an electronic cross-sectional survey. The survey was created following literature review and expert opinion. We asked participants about their opinions, practices, and knowledge regarding oral vitamin K and compared responses from clinicians in the neonatal intensive care unit (NICU) and the well-newborn nursery. Descriptive statistics and one-way ANOVA analyses were performed.
Results: Of 160 newborn clinicians at 3 sites, 105 (66%) completed the survey. Of respondents, 56 (56%) believed that the incidence of IM vitamin K refusal is increasing and had prescribed or recommended oral vitamin K at least once. Of prescribed formulations, liquid was most common (78%) followed by crushed tablets (13%). Regarding knowledge, 28 (28%) and 21 (21%) respondents did not know if oral vitamin K decreases the risk of early- and late-onset VKDB, respectively. There were no significant differences among institutions or practice setting (NICU, well-newborn nursery or both) with regards to opinions, practices, and knowledge. The most common reasons given for prescribing oral vitamin K were that it is better than no prophylaxis and parental preference. The most common reasons given for not prescribing oral vitamin K were concerns for efficacy, poor compliance, and lack of encounters with parents that have refused IM vitamin K.
Results: Of 160 newborn clinicians at 3 sites, 105 (66%) completed the survey. Of respondents, 56 (56%) believed that the incidence of IM vitamin K refusal is increasing and had prescribed or recommended oral vitamin K at least once. Of prescribed formulations, liquid was most common (78%) followed by crushed tablets (13%). Regarding knowledge, 28 (28%) and 21 (21%) respondents did not know if oral vitamin K decreases the risk of early- and late-onset VKDB, respectively. There were no significant differences among institutions or practice setting (NICU, well-newborn nursery or both) with regards to opinions, practices, and knowledge. The most common reasons given for prescribing oral vitamin K were that it is better than no prophylaxis and parental preference. The most common reasons given for not prescribing oral vitamin K were concerns for efficacy, poor compliance, and lack of encounters with parents that have refused IM vitamin K.
Conclusions: Over half of the clinicians surveyed had prescribed oral vitamin K to newborns as prophylaxis against VKDB. For some respondents, knowledge was lacking regarding the efficacy of oral vitamin K in early- and late-onset VKDB. Clinicians need to be prepared to counsel parents about VKDB and the effectiveness of IM versus oral vitamin K prophylaxis in preventing VKDB. Additional data is needed regarding currently prescribed oral vitamin K regimens.
Conclusions: Over half of the clinicians surveyed had prescribed oral vitamin K to newborns as prophylaxis against VKDB. For some respondents, knowledge was lacking regarding the efficacy of oral vitamin K in early- and late-onset VKDB. Clinicians need to be prepared to counsel parents about VKDB and the effectiveness of IM versus oral vitamin K prophylaxis in preventing VKDB. Additional data is needed regarding currently prescribed oral vitamin K regimens.
Resident Statement of Involvement: I helped conceived of the idea, obtained IRB approval, designed the survey, aggregated results, performed data analysis, and was first author on the published manuscript.
Resident Statement of Involvement: I helped conceived of the idea, obtained IRB approval, designed the survey, aggregated results, performed data analysis, and was first author on the published manuscript.