1. Parental vaccine refusal
2. Newborn standard-of-care practices
3. Neonatal prophylactic interventions
4. Intramuscular vitamin K declination
5. Erythromycin ophthalmic prophylaxis

The topic of parental refusal of standard-of-care prophylactic practices for newborns has been met with increasing concern in the healthcare community. Recent evidence suggests that parental refusal of common neonatal interventions, essential for reducing early infant morbidity and mortality, is on the rise despite clear medical guidelines and proven safety records. This article delves into the findings of a revealing study on the rate of declination of such interventions, and considers the broader implications for pediatric healthcare providers and public health policy.

DOI: 10.1542/hpeds.2019-0029


The arrival of a newborn is usually accompanied by a series of standardized medical procedures aimed at safeguarding the health and well-being of the infant. These procedures, which include administering intramuscular (IM) vitamin K (VK), providing erythromycin ophthalmic prophylaxis, and delivering the hepatitis B vaccine, are backed by a substantial body of evidence and are widely considered critical elements of neonatal care. Additionally, maternal vaccination against pertussis is strongly recommended to protect infants from potentially life-threatening respiratory infections.

Despite the robust evidence and widespread endorsement by medical professionals, a study published in “Hospital Pediatrics” (DOI: 10.1542/hpeds.2019-0029) has brought to light a concerning trend: a growing number of parents are refusing one or more of these standard-of-care interventions for their newborns, potentially putting their children at risk.

Study Overview

The study, conducted by Danziger et al., consisted of a retrospective cohort analysis of data from all inborn singletons admitted to the well newborn nursery over a 12-month period, from November 15, 2015, through November 15, 2016, at a large quaternary medical center. The cohort included a total of 3758 infants who met the inclusion criteria.

The researchers sought to determine the current rate of declination of the recommended newborn interventions and to explore the associations between refusal of one practice and the likelihood of refusing others. Their findings, revealed in the article “Parental Refusal of Standard-of-Care Prophylactic Newborn Practices: In One Center’s Experience, Many Refuse One but Few Refuse All,” provide valuable insights into the patterns of parental vaccination hesitancy and declination of neonatal care interventions.

Key Findings

The results of the study were indeed alarming, showing that as many as 25% of the cohort’s parents refused at least one recommended core infant health intervention. This statistic is indicative of a significant level of skepticism and reticence among parents when it comes to universally endorsed newborn practices.

Interestingly, the data also emphasized that there was only modest overlap in the refusal of each intervention. This suggests that refusals are not necessarily driven by a blanket opposition to medical intervention but perhaps by specific concerns or misconceptions about individual practices.

One of the first of its kind, the study plays a crucial role in shedding light on an under-researched area and paves the way for developing targeted interventions aimed at educating and reassuring skeptical parents about the importance of these practices.

Implications for Healthcare Providers

Healthcare providers are at the frontline of this emerging challenge. The rising rate of parental refusal requires pediatricians and neonatologists to be well-prepared to engage in informed discussions with parents about the benefits and risks of neonatal preventive care. The ability to communicate effectively, debunk myths, and address specific parental concerns is critical to ensuring that newborns receive the recommended standard-of-care interventions.

Developing Targeted Interventions

The nuanced patterns of refusal observed in the study underscore the need for targeted interventions that address the unique concerns parents may have regarding each specific practice. Public health campaigns and education programs need to be tailored to counteract the particular myths and misinformation that lead parents to decline each intervention.

For example, vitamin K is crucial for preventing hemorrhagic disease of the newborn, a rare but potentially fatal condition. Despite its safety and efficacy, some parents are influenced by unfounded fears or misinformation found on the internet. Clear, evidence-based information must be delivered to combat this phenomenon.

Similarly, while misconceptions about vaccines are widespread, erythromycin ophthalmic prophylaxis, which prevents blindness caused by neonatal conjunctivitis, may be declined due to a lack of awareness of its benefits. It is essential to convey the risks of not administering these preventative measures to ensure parents make fully informed decisions.


The study by Danziger et al. is a significant contribution to the ongoing discourse on medical compliance and parental autonomy. It highlights a critical area in pediatric healthcare that must be addressed urgently to reverse the tide of increasing parental refusal rates. Engaging parents with empathy and providing them with evidence-based information will be crucial to safeguarding the health of newborns. As the research community continues to investigate parental declination patterns, healthcare professionals must translate these insights into practices that will convince parents to embrace the standard-of-care interventions that can save lives.


1. Danziger P.P., Skoczylas M.M., Laventhal N.N. (2020). Parental Refusal of Standard-of-Care Prophylactic Newborn Practices: In One Center’s Experience, Many Refuse One but Few Refuse All. Hospital Pediatrics, 9(6), 429-433. DOI: 10.1542/hpeds.2019-0029

2. American Academy of Pediatrics Committee on Infectious Diseases. (2018). Red Book: 2018-2021 Report of the Committee on Infectious Diseases. Itasca, IL: American Academy of Pediatrics.

3. Centers for Disease Control and Prevention. (2019). Vaccine Safety. Retrieved from

4. Lantos, J.D., Jackson, M.A., Opel, D.J., Marcuse, E.K., Myers, A.L., & Connelly, B.L. (2010). Controversies in vaccine mandates. Current Problems in Pediatric and Adolescent Health Care, 40(3), 38-58.

5. World Health Organization. (2019). Maternal, newborn, child and adolescent health: Newborn health. Retrieved from

By acknowledging both the intricacies of parental decision-making and the pivotal role of medical professionals in educating and guiding parents, our collective efforts can ensure that newborns receive the best possible start in life.