713 - The beginning of change: Characterizing families who refuse neonatal preventive services.

Publication Number: 1690.713

Connie Hu, University of California San Diego, San Diego, CA, United States; Zaineb Boulil, Rady Children's Hospital San Diego, San Diego, CA, United States; Joshua M. Rothman, University of California, San Diego School of Medicine, La Jolla, CA, United States; Richard Silva, University of California, San Diego School of Medicine, San Diego, CA, United States; Eustratia M. Hubbard, UC San Diego School of Medicine, San Diego, CA, United States

Background: Current universal standards of care in the healthy newborn include intramuscular vitamin K, topical erythromycin, hepatitis B vaccination, newborn screening, hearing screening, and pulse oximeter screening for critical congenital heart disease. However, refusals for these services have been increasing. Other studies have identified factors that may contribute to declinations but have variable refusal patterns especially with refusal of all interventions. Most studies focused on vitamin K, erythromycin, and hepatitis B vaccine, but none have been comprehensive to include other recommended preventive efforts.

Objective: This study aims to assess refusal patterns and identify common characteristics in birthing parents that refuse infant preventive services in hopes of targeting future educational interventions towards these families.

Design/Methods: This retrospective cohort study evaluated birth hospitalization data from January 1, 2018 to December 31, 2023 of all singleton newborns, gestational age ≥37 weeks, born at two California academic medical centers. Statistical analysis was used to assess refusal outcomes, rates of refusal, and determine significance between various demographic and clinical factors.

Results: 17,618 electronic health records of birthing parent-infant dyads were reviewed. 11% of infants did not receive at least one preventive service, 8% missed more than one, and 0.2% missed all recommended services. Hepatitis B vaccine had the most refusals followed by erythromycin and then vitamin K. Refusals for newborn bloodspot, hearing, or CCHD screenings were near 0%. Looking at refusal of hepatitis B vaccine and erythromycin ointment, birthing parents were more likely to be English speaking, 30-40 years or older, partnered, non-Hispanic white, non-Catholic Christian, and have lower social vulnerability indices. Refusers were also more likely to have delivered vaginally late/post-term infants by certified nurse midwives in birth centers compared to those who did not refuse a service. All these characteristics had p values < 0.006.

Conclusion(s): For birthing parents who refuse infant preventive services, our data has shown that there are certain patterns of refusals and significant differences in demographic and clinical characteristics. This has enlightened possibilities of future targeted educational interventions in hopes of increasing compliance with these neonatal services to prevent morbidity and mortality.

Figure 1. Comparison of refusal rates compared to the entire study population
The graph depicts the refusal trend of neonatal preventative services.

Table 1a. Hepatitis B vaccine and erythromycin ointment - Full analysis
This table assess various demographic and clinical factors with refusal and acceptors of hepatitis B vaccine and erythromycin ointment.

Table 1b. Hepatitis B vaccine and erythromycin ointment - Focused analysis
This table assesses the refusal and acceptors of hepatitis B vaccine and erythromycin ointment when focusing on social vulnerability indices (SVI), delivery location, and delivery provider.