514 - Newborn medication refusal and childhood under-immunization in military beneficiaries

Poster Number: 514
Publication Number: 514.326

Rasheda J. Vereen, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Fort Sam Houston, TX, United States; James K. Aden, US Army GME, Ft Sam Houston, TX, United States; Caitlin Drumm, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, San Antonio, TX, United States

Background: The American Academy of Pediatrics recommends birth doses of vitamin K, erythromycin ointment and the hepatitis B vaccine. Global disease reduction goals target a birth hepatitis B vaccination rate of 85%, but as of the 2017-2019 National Immunization Survey, 76.3% of newborns received the vaccine with individual centers reporting rates as low as 30%. There is limited national data on erythromycin ointment and Vitamin K refusal. Previous large cohort studies have reported vitamin K administration as high as 98%, however, only one previous study demonstrated an increased risk of childhood non-immunization following vitamin K refusal.

Objective: The relationship between birth medication administration and childhood immunization compliance is understudied. The purpose of this study was to evaluate rates of newborn medication administration, risk factors for refusal in military beneficiaries and to determine the relationship between newborn medication refusal and under-immunization by 15 months.

Design/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 reviewed for birth medication administration, maternal age, 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 were 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(s): Compliance with birth medication recommendations in military beneficiaries is higher than reported national averages. Refusal was associated with older maternal age and higher birth order. Refusal of the hepatitis B vaccine in the nursery is associated with a risk of being under-immunized in childhood. Obstetricians, pediatricians, and nursery providers should be aware of this association for prompt and continued counseling of families.
Table 1: Characteristics of the infants who received or declined vitamin K, erythromycin ointment or the hepatitis B vaccine.In 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 were associated with older maternal age and higher birth order.