Newborn Medication Refusal and Childhood Under-immunization in Military Beneficiaries

Background: The American Academy of Pediatrics recommends birth doses of vitamin K, erythromycin ointment and the hepatitis B vaccine to decrease the prevalence of hemorrhagic disease of the newborn, ophthalmia neonatorum and hepatitis B. Global disease reduction goals target a birth hepatitis B vaccination rate of 85%. Per the 2017-2019 National Immunization Survey, 76.3% of newborns received the birth hepatitis B vaccine but individual centers reported rates as low as 30%. Relationship between birth medication administration and childhood immunization compliance is understudied. One prior study does show increased risk of childhood non-immunization following vitamin K refusal only.

The purpose of this study was to evaluate rates of newborn medication administration and risk factors for refusal in military beneficiaries and to determine the relationship between newborn medication refusal and under-immunization by 15 months.

Methods: A retrospective chart review was completed for all newborns admitted to the Brooke Army Medical Center nursery from January 1, 2016 to December 31, 2019. The electronic medical record was queried for birth medication administration, maternal age, active duty status, rank, and birth order. Childhood immunization records were queried for all patients who continued care at our facility.

Results: Seven thousand one hundred and thirty-nine infants met inclusion criteria; within this cohort, 99.3% received vitamin K, 98.8% received erythromycin and 93.8% received the hepatitis B vaccine. Refusal of erythromycin and hepatitis B vaccine was associated with older maternal age and higher birth order (Table 1). Childhood immunization records were available for 607 infants; within this cohort, 100% received vitamin K, 99% received erythromycin and 95.5% received the hepatitis B vaccine. Of the 607 infants, 7.2% (n=44) were under-immunized by 15 months with no infants being non-immunized. Refusal of only the hepatitis B vaccine at birth was associated with a higher risk being under-immunized (RR = 2.7, CI 1.18-6.42).

Conclusion: Compliance with birth medication recommendations is high in the military beneficiary population and the administration of the hepatitis B vaccine is well above the national average. Refusal was associated with older maternal age and higher birth order. High adherence in our population may be due to mandatory vaccination policy for active duty service members. Newborn providers should be aware that birth hepatitis B vaccine refusal is associated with under-immunization status at 15 months.