Declining Newborn Vitamin K Use Linked to Higher Risk of Infant Bleeding

Newborn Bleeding Risks Rise as Vitamin K Refusal Doubles Across U.S. Hospitals

Infants who do not receive the routine intramuscular vitamin K injection at birth face a 47% higher risk of bleeding during their first six months of life, according to a large national cohort study published in The Journal of the American Medical Association. Researchers at Children’s Hospital of Philadelphia documented that as more parents decline the preventative treatment, the national nonreceipt rate more than doubled from 3.1% in 2017 to 6.8% in 2025.

Key Clinical Takeaways:
• Infants without vitamin K prophylaxis had more than double the risk of intracranial bleeding compared to those who received the injection.
• The proportion of newborns missing the routine birth dose climbed from 3.1% to 6.8% over an eight-year period.
• Researchers estimated that roughly one additional bleeding event occurs in the first six months for every 114 newborns who skip the injection.

Analysis of 5.2 Million Newborn Health Records Documents Declining Administration Rates

Investigators analyzed deidentified electronic health record data through Epic Cosmos for infants born at 35 to 43 weeks’ gestation between January 2017 and December 2025. The study population included 5,240,780 infants across all 50 states and Washington, D.C., with 234,825 newborns not receiving intramuscular vitamin K at birth, prnewswire.com reported. The research team was supported by a National Institutes of Health training grant.

Bleeding events increased across all study participants over the eight-year timeline, but accelerated faster among infants who did not receive prophylaxis. Among nonrecipients, recorded bleeding by six months rose from 225.3 to 394.0 per 10,000 births. Recipients saw an increase from 136.6 to 221.8 per 10,000 births. The annual increase in bleeding odds stood at 8.7% for nonrecipients compared to 5.6% for recipients.

Bleeding Hazard Links to Lack of Documented Administration

To evaluate these occurrences, investigators reviewed a combination of ICD-10 diagnostic codes covering newborn hemorrhage, intracranial bleeding, intraventricular bleeding, and vitamin K deficiency bleeding. After adjusting for gestational age, sex, maternal characteristics, insurance status, and neighborhood measures, the lack of documented administration tied directly to the elevated bleeding hazard.

“The difference was particularly concerning for bleeding in or around the brain, a potentially life-threatening complication,” said Kevin Dysart, MD, a senior study co-author and attending neonatologist at CHOP, per prnewswire.com. Babies who did not receive the injection experienced more than twice the risk of recorded intracranial bleeding, registering 33 cases per 10,000 births versus 13 per 10,000 among recipients. Researchers also noted that death during hospitalization at birth in the presence of a bleeding diagnosis occurred more frequently among infants without documented administration.

Study Documents Declining Administration Paired with Increased Infant Bleeding Risks

“Routine intramuscular vitamin K administration has been highly effective at preventing vitamin K deficiency bleeding in newborns for decades,” Burris, MD, MPH, an attending neonatologist at CHOP and study co-author, told prnewswire.com. The study represents the first nationwide documentation of declining administration paired with measured increases in infant bleeding risks.

Lead author Kristan Scott, MD, MSHP, an assistant professor at Emory University School of Medicine who completed the work as an NIH T-32 postdoctoral research fellow at CHOP, stated to prnewswire.com that the findings reinforce longstanding recommendations for the one-time birth injection while highlighting the need to understand why refusal rates are climbing. In an accompanying editorial in JAMA, Laura R. Kair, MD, MAS, of the University of California Davis School of Medicine, and co-authors noted that the data makes communicating bleeding risks associated with vitamin K declination more straightforward.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.