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Running head: VITAMIN K DEFICIENCY 1

Vitamin K Deficiency
Christina Accinelli
Brigham Young University - Idaho
Nursing 420 Section 01
Sara Hawkins
October 14, 2016

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Vitamin K Deficiency
World views have shifted dramatically since the first vaccine for Smallpox came out in
May, 1796. What once was a life saving measure, has now become a major controversy over
implied adverse reactions. Currently there is a 28% refusal rate for the Vitamin K shot which is a
threat to the lives of infants. Stephani experienced this threat with her daughter, Olive, who was
only two months old at the time. She states, This may be the hardest part of Olives story that I
will write. The part where I admit that what happened to her was nearly 100% preventable. And
yet it happened. It happened because she didnt receive her dose of Vitamin K when she was
born (CDC, 2016). Stephani is just one of many parents that has shared her story with the CDC
regarding the lack of the Vitamin K shot. Olive, a survivor of the disease, still has some residual
effects.
Recent research published by the Center for Disease Control (CDC), shows an increasing
risk for bleeding. Particularly brain hemorrhage after not receiving the Vitamin K shot.
Increasing study of this issue is important to help us understand what can be done to decrease the
mortality and neurological delays in infants. Moreover, there is concern that not enough
education is taught about Vitamin K for people to be health literate, which would allow them a
more informed decision. Statistically, without receiving the Vitamin K shot at birth, there is an
81% change of developing late Vitamin K Deficiency Bleeding (VKDB). The newborn infant
can have hemorrhaging in the intestines, brain, and seizures, which lead to life threatening
effects. The mortality rate following the development of VKDB is approximately 20% (Shearer
2009; Lippi and Franchini, 2011).
Although the body naturally produces Vitamin K, an infants body produces an
insufficient amount for the first six months. Therefore, decreased amounts of Vitamin K can lead

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to Hemorrhagic Disease in newborns. One intramuscular shot of Vitamin K given after birth can
decrease the rate of this potentially fatal disease. However, parents have begun refusing the
prophylaxis Vitamin K shot, which is leading to dramatic medical emergencies.
The Center for Disease Control (CDC) in 2013 did a study listing a few reasons why
Vitamin K is being refused. The initial claim is that Vitamin K doubles the risk of childhood
Leukemia. Also, due to a recent study done by Dr. Ben Wheeler of the University of Otago in
New Zealand, published a claim that the Vitamin K shot is unnecessary and is beginning to
convince parents to refuse this aiding vitamin. Consequently, for these reasons parents feel that
the shot is unnecessary because they dont understand the repercussions. Parents have stated,
We believe God created us and knew what he was doing, (Goldberg, 2016) as one of many
other reasons. Other parents claim, If baby really needed more Vitamin K, theyd get it from
me (Goldberg, 2016). The purpose of this study is to determine the impact of an educational
campaign for new parents decision to immunize with Vitamin K to prevent the unnecessary
outcome of Hemorrhagic Disease of Newborn (HDNB).
Methods, Theory, and Framework
Method
The goal is to educate parents during prenatal care on Vitamin K and the effects of being
deficient in newborn infants. The objective to overcome is being health illiterate on the
information pertaining to vitamin K and how essential it is in the body. Lack of education of
Vitamin K could place the infant in danger on many degrees, even mortal peril.
Studies have been done to show that education is beneficial to health literacy, but few
studies have been done to measure the impact it left or how it has been able to change minds.

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This research study will answer the question if education will change the minds of newborn
parents to accept the vitamin K shot to prevent HDNB.
The type of study that will be used is quasi-experimental. The population will consist of
women in their third trimester with the ages between 20 to 29. The age group was chosen by a
study done by the CDC indicating that 51% of all births fall between this age group (CDC,
2013). There will be a select number of facilities chosen randomly in the Southeastern Idaho
region. The study will be offered to those fitting the criteria and chosen by random there will be
100 to participate. There will be education offered through a pre-recorded video that is 30
minutes about Vitamin K deficiency in infants and why it is so important. A video was chosen to
ensure that the participants receive the same information in the experimental group. The study
will be conclusive 1 month after birth which will be enough time to have the vitamin K shot
given. The study will include all of those that have taken the class and have accepted or refused
along with those that did not sign up for the class and accepted or refused the immunization. All
participants will be given a consent form to give permission to gather the data needed for the
study. This form will also include data on how their information will be used and that it will be
kept confidential.
We are aware that ethical issues that could arise during a study and we are combating this
by randomly selecting the facilities and participants without any bias as long as they fit the
criteria. This is a low risk study therefore it does not place anyone in harms way and it does not
change anything other than having them attend a class and not change any daily habits. This
study will be submitted to BYU Idahos International Review Board (IRB) for approval before
commencing.
Data Collection

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The data will be collected with the patients consent at the beginning of the study. We will
be gathering the data from the hospital that they delivered or from the Pediatrician. Each facility
that was authorized to participate in the study will be called to release their data to be compiled.
Data Analyzed
Once the data has been obtained from all of the selected facilities, the data will then be
compiled to find a conclusion. The data is separated into those that signed up for the educational
class and then split into two groups, those that chose the immunization and those that refused.
The subjects that did not sign up for the educational class will also be split into the same
categories. The data will be compiled to show the final results for those that took the educational
class and those that did not, to prove that those that have been educated will refuse less, than
those that are not educated about Vitamin K deficiency.
Theory/Framework
In order to continue with the study, it is important to determine the factors affecting the
behaviors towards the Vitamin K shot. A method to determine these behaviors is through the
Health Belief Model (HBM). The Health Belief Model was developed in 1950s, by Hochbaum,
Rosenstock, and Kegels (ReCAPP, 2016). This model was based on understanding behaviors and
how to motivate individuals to promote their health. The HBM is comprised of 6 constructs.
Four of the constructs are formed from perceptions while one is action based and the other is
goal based. See Table 1 for depiction of model.
Table 1. Health Behavioral Model
Concept
1. Perceived
Susceptibility

Definition
Parents believe
something bad may happen to
their child after birth by

Application
Newborn infants are
at risk

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2. Perceived Severity

3. Perceived Benefits

4. Perceived Barriers

5. Self-Efficacy

6. Cues to Action

getting Vitamin K shot


Parents believe the

Newborn infant could

infant could get Hemorrhagic

become handicapped

Disease with or without

or even death

Vitamin K shot
If the Vitamin K shot

Parents believe

is given to infant, then less

Vitamin K shot may

risk of developing

help the infant

Hemorrhagic Disease
Lack of education

Not having enough

regarding Vitamin K shot

information or

information may hinder

education regarding

decision

Hemorrhagic Disease

Parents received

may cause more harm


Becoming health

educational training and

literate will allow

information to make educated

parents to make a

decision

more educated

Parents now have a

decision
Parents are more

piece of mind knowing all the

educated and able to

facts of the Vitamin K

make a better decision

immunization and the

regarding Vitamin K

positive effects for their child

shots

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The HBM represents the promotion to change the minds of the population and motivate
them to make better health decisions. The goal of this study is to educate the parents of newborns
to change their outlook on how the benefits will out weight any risk they have against the
Vitamin K shot.
Annotated bibliography
In 1979, Dr. Stan Block graduated from University of Kentucky College of Medicine. He
is a member of the Fellow of the American Academy of Pediatrics (FAAP), he specializes in, and
is the president of Pediatrics and Adolescent Medicine. The article that Dr. Block writes is
written for a scholarly audience and medical community.
The journal article gives an account of parents that have refused the Vitamin K shot and
the adverse effects it had on the infant. Dr. Block discusses and explains that infant parents do
not have adequate information about the hemorrhagic disease, how the vitamin K shot can help
the infant, and how it is for the best wellbeing of the infant. Dr. Block conducted this research by
obtaining this information through the Tennessee study as to why parents were refusing the
vitamin k shot. He goes on to share his experience with parents that have refused the IM vitamin
K and the effect it had. Dr. Block provided this information to the medical community to bring
awareness with the arising problem of the refusal of vitamin K.
This article by Dr. Block fosters critical evaluation of how important the vitamin K
prophylaxis shot is to newborns and what is causing parents to refuse the life saving measure.
The primary reason stated in Dr. Blocks research is misinformation.
Doctors Helen Bernhardt, David Barker, David M. Reith, Roland Broadbent, Pamela
Jackson, and Benjamin Wheeler are all medical graduates from the University of Otago located

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in Dunedin, New Zealand. Dr. Helen Bernhardt studied in the Department of Medicine, while the
other five colleagues studied in the Department of Womens and Child Health.
These doctors put this article together to address a scholarly audience amongst the
medical community. Their concern is to address the declining rates of immunization and vitamin
K. The research they conducted shows a link that parents that decline one immunization, will
decline the other, increasing mortality rates in the population.
The experienced authors took into account that no conflicts of interest were to arise in the
research. Through their extensive background in childrens health, they pulled together to make
their point stronger. They also agreed that additional education would also benefit and should be
offered especially at a time when there is a resurgence of immunization preventable diseases
(Barker, Reith, Broadbent, Jackson, Wheeler, 2015). This article went through an ethics
committee and was granted approval by Southern Health and Disability to continue their study.
Aya Saitoh, Satoko Nagato, Akihiko Saitoh, Yuki Tsukahara, Florin Vaida, Tomoyoshi
Sonobe, Hajime Kamiya, Takashi Naruse, and Sachiyo Murashima have come together to prove
that education improves immunization rates. They bring medical educational credentials such as
Department of Community Health Nursing, Department of Medical Specialties, and Division of
Infectious Diseases from as far as Japan to San Diego.
The article addresses the scholarly community with background in the medical field. It
was discovered that there is a lack of education regarding the importance of immunization and
the threat that occurs when immunization is refused. A randomized control group was used to
build a stronger case. This study was reviewed by the Institutional Review Board of the
University of Tokyo and National Center for Child Health and Development. Weakness in this
study consisted of a small population. It included 31 participants in each group. The study

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concluded that education did improve the end result to immunize although more research needs
to be done to determine what information would be needed for the education material.
This study echoes the need of education of vitamin K and the effects of the prophylaxis
along with the consequences of denying it. The case study had strong results which also proves
that education is strongly recommended to prevent other infant deaths.
Dr. Rachael Schulte, Dr. Lori Jordan, Dr. Anna Morad, Dr. Robert Naftel, Dr, John
Wellons, and Dr. Robert Sidonio are all medical graduates from Vanderbilt University Medical
Center located in Nashville, Tennessee and have all collaborated to research a rise in late onset
vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at
birth. The doctors wrote this article to address the increase in hemorrhagic disease in newborns
related to the decline in vitamin K prophylaxis shot. They are addressing the medical community
to provide awareness in changing patterns.
The study was weak as it only consisted of seven cases where parents refused vitamin K
with 5 of them ending up with hemorrhagic disease. Although it does not have a strong case with
participants, it does show the importance of prevention. This articles correlation regarding the
awareness of vitamin K for newborns still remains as important as the education of it.
Findings, Implications, and Recommendations
Findings
The results from this study implicate that education will change the rates of parents
refusing Vitamin K shots. The number of subjects in this study seemed to be successful with
those parents that were educated verses the parents that were not. Parents that were not educated
had a higher risk for declining the prophylaxis than those that were vitamin K educated.
Implications

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Limited studies have been done to fix the problem with the declining rates of vitamin K.
The studies that have been completed have been to demonstrate the trend of increased rates of
Hemorrhagic disease of newborns. Along with the rates of declined vitamin K, evidence has
correlated in other studies that education was used to decrease rates of unnecessary admission
and increase compliance with treatment, plus increase the relationship with the medical
community. Education may be one of the greatest things nurses can offer to help the community
become health literate. This education will allow people to make more informed decisions for the
benefit of the infant.
Recommendations
Since little studies have been done on education and the declining vitamin K shot, the
recommendation would be to study different populations at varying times during pregnancy
about the benefits vitamin K has to offer. The studies should include different materials to
determine the best delivery of the message. This area of study needs to be given a thorough
research.
Insights Gained
Parents who decide to refuse vitamin K for wanting their children to grow up naturally
without the use of any prophylaxis, actually pose greater harm to the child. In this case, parents
place their child at risk for hemorrhaging problems. To reduce this risk, education is greatly
needed to offer health literacy to all parents so they can make more informed decisions which
will greatly improve patient outcome.

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References
Bernhardt, H., Barker, D., Reith, D. M., Broadbent, R. S., Jackson, P. M., & Wheeler, B. J.
(2015). Declining newborn intramuscular vitamin K prophylaxis predicts subsequent
immunisation refusal: A retrospective cohort study. Journal of Paediatrics and Child
Health, 51(9), 889-894. doi:10.1111/jpc.12887
Block, S. L. (2014, February 01). Playing Newborn Intracranial Roulette: Parental Refusal of
Vitamin K Injection. Pediatric Annals Pediatr Ann, 43(2), 53-59. doi:10.3928/0090448120131223-04
Curtin, S. C., Abma, J. C., PHD, & Ventura, S. J., M.A. (2013, December). Pregnancy
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Goldberg, C. (2016, August 12). When New Parents Refuse Vitamin K Shots and Their Babies
Get Brain Bleeds. Retrieved from
http://www.wbur.org/commonhealth/2016/08/12/vitamin-k-newborn
Haelle, T. (2014, August 19). More Parents Nixing Anti-Bleeding Shots for Their Newborns.
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Health Belief Model. (2016). Retrieved from
http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.TheoriesDetail&PageID=13#def
inition Lippi, G. and M. Franchini (2011). Vitamin K in neonates: facts and
myths. Blood Transfus 9(1): 4-9.

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Miller, H. (2016, August 8). Why do parents decline newborn intramuscular vitamin K
prophylaxis? Retrieved from
http://jme.bmj.com/content/early/2016/08/08/medethics-2016-103534.abstract
Saitoh, A., Nagata, S., Saitoh, A., Tsukahara, Y., Vaida, F., Sonobe, T., . . . Murashima, S.
(2013). Perinatal immunization education improves immunization rates and knowledge:
A randomized controlled trial. Preventive Medicine, 56(6), 398-405.
doi:10.1016/j.ypmed.2013.03.003
Schulte, R., MD. (2014, June). Rise in Late Onset Vitamin K Deficiency Bleeding in Young
Infants Because of Omission or Refusal of Prophylaxis at Birth. Retrieved October 17,
2016, from http://www.pedneur.com/article/S0887-8994(14)00141-6/fulltext
Shearer, M. J. (2009). Vitamin K deficiency bleeding (VKDB) in early infancy. Blood
Rev 23(2): 49-59.
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