The American Academy of Pediatrics recommends that all newborns receive a single dose of intramuscular vitamin K to prevent vitamin K deficiency bleeding. How should the clinician respond when parents decline vitamin K? Although vitamin K deficiency bleeding can have devastating sequelae, they are uncommon; therefore, parents are generally allowed to decline vitamin K after counseling is provided. When parents ask for a vitamin K preparation of unproven effectiveness, should the clinician honor that request? To address these questions, we present a case of a healthy newborn whose parents declined intramuscular vitamin K and requested an oral preparation. Two general pediatricians discuss the medical and ethical issues these situations pose, and the parents describe their experience.
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October 2015
Ethics Rounds|
October 01 2015
Are Pediatricians Complicit in Vitamin K Deficiency Bleeding?
Melissa Weddle, MD;
aDepartment of Pediatrics, Oregon Health & Science University, Portland, Oregon;
Address correspondence to Melissa Weddle, MD, MPH, Oregon Health & Science University, Mail code: CDRCP 707 SW Gaines St, Portland, OR 97239. E-mail: weddle@ohsu.edu
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Allison Empey, MD;
Allison Empey, MD
aDepartment of Pediatrics, Oregon Health & Science University, Portland, Oregon;
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Eric Crossen, MD;
Eric Crossen, MD
bDepartment of Pediatrics, University of California, San Francisco, California; and
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Carrie A. Phillipi, MD
Carrie A. Phillipi, MD
aDepartment of Pediatrics, Oregon Health & Science University, Portland, Oregon;
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Address correspondence to Melissa Weddle, MD, MPH, Oregon Health & Science University, Mail code: CDRCP 707 SW Gaines St, Portland, OR 97239. E-mail: weddle@ohsu.edu
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2015) 136 (4): 753–757.
Article history
Accepted:
January 02 2015
Citation
Melissa Weddle, Allison Empey, Eric Crossen, Aaron Green, Joy Green, Carrie A. Phillipi; Are Pediatricians Complicit in Vitamin K Deficiency Bleeding?. Pediatrics October 2015; 136 (4): 753–757. 10.1542/peds.2014-2293
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I read the Ethics Rounds about vitamin K refusal with interest, having seen a recent increase in parents who initially decline injected vitamin K. The discussion by the treating pediatricians shows a true commitment to educating parents and providing the best care for newborns.
The ethical dilemma of the evidence-based pediatrician who agonizes about whether to offer oral vitamin K pales in comparison to the true ethical breach: Why were these caring, well-intentioned parents offered advice that could have led to their newborn's entirely preventable death or disability? Was this unnamed chiropractor reported to or sanctioned by her professional organization? What about the websites that recommend refusing injected vitamin K? Have their proprietors taken any responsibility for the increase in VKDB that has resulted from their prospective supplement customers following their advice?
While pediatricians should continue to aspire to the highest ethical standards, it's discouraging to note how blase we've become about the enormous ethical violations perpetrated by so-called alternative medicine providers.
Conflict of Interest:
None declared