GME Patient Safety Quality and Innovation Symposium

Introduction:

Current universal standards of care in the healthy newborn include intramuscular vitamin K (prevent vitamin K deficiency bleeding), topical erythromycin (prevent gonococcal ophthalmia neonatorum), hepatitis B vaccination (prevent hepatitis B), newborn screen (identify significant congenital diseases), hearing screen, and pulse oximeter screening for critical congenital heart disease.1-6 However, refusals for these services have been increasing.7 Other studies have identified factors that may contribute to declinations, but these studies have variable refusal patterns especially with refusal of all interventions.8-9 Most studies previously focused on vitamin K, erythromycin, and hepatitis B vaccine refusals, but none have been comprehensive to include other recommended preventative efforts.

Objectives:

Assess rates and patterns of refusal. Identify common demographic and clinical factors in families who refusal these neonatal preventative services.

Materials and Methods:

This is a quality improvement, retrospective chart review study looking at data over a span of five years (2018-2023) of singleton newborns, gestational age ≥ 37 weeks, born at two University of California San Diego Health newborn nurseries. Statistical analysis was used to assess refusal outcomes, rates of refusal, and chi square analysis was used to determine significance between various demographic and clinical factors.

Results:

17,618 charts were reviewed. Of the entire population, 11% refused at least one preventative service, 8% refused more than one, and 0.2% refused all the recommended services. Hepatitis B had the most refusals followed by erythromycin and then vitamin K. There were refusers of the newborn screen, hearing  screen, and CCHD, but less than 1% each. There were significantly higher rates of refusal of hepatitis B in families who were English speaking, had increased maternal age, delivered in birth centers, had certified nurse midwives as providers, and delivered vaginally. People who had lower social vulnerability index (SVI) had the most refusals compared to upper and middle SVI categories.

Conclusion:

For families that refuse recommended neonatal preventative services, our data has shown that there are certain patterns of refusals. There are also significant differences in certain demographic and clinical characteristics of families that refuse the hepatitis B vaccine. This has enlightened possibilities of future targeted educational interventions in hopes of increasing compliance with these recommended preventative services.

References

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