When the mother arrived with her newborn, blood oozing from the umbilical-cord stump, Dr. Jessica Kirk and a nurse were alone in a small pediatric emergency room in Florida.<\/p>\n
After two decades in medicine, Dr. Kirk, a pediatric hospitalist now practicing in Fairhope, Ala., usually has an idea of possible diagnoses within moments of meeting a patient. But she hadn\u2019t seen this before. As the nurse took vital signs, Dr. Kirk called her medical director.<\/p>\n
\u201cOh no,\u201d she recalled the director saying upon hearing the child\u2019s name. The parents, the director said, had declined the vitamin K injection newborns routinely receive to help blood clot. Without it, infants are vulnerable to spontaneous bleeding.<\/p>\n
This baby was hemorrhaging internally.<\/p>\n
Within minutes, he was cold, pulse high, blood pressure low, Dr. Kirk recalled. She gave IV fluids, an emergency dose of vitamin K and a plasma transfusion, all while trying to arrange a transfer to a neonatal intensive care unit. The baby\u2019s abdomen became firm from blood flooding into it. He started to fade out of consciousness.<\/p>\n
It was 2021, and the number of parents refusing the vitamin K shot had begun to increase<\/a>, quietly enough that encountering a baby who hadn\u2019t received it still shocked Dr. Kirk. Now, many doctors say they see that regularly, and bleeding cases are accumulating.<\/p>\n A study of electronic medical records<\/a> found that 5.2 percent of babies in the U.S. went without the shot in 2024, up from 2.9 percent in 2017, meaning tens of thousands more unprotected babies. And more than 15 doctors told The New York Times they had observed a further increase in the past two years.<\/p>\n The resulting hemorrhages aren\u2019t tracked nationally. But experts estimate<\/a> that as many as one in 60 untreated infants \u2014 1.7 percent \u2014 will suffer a bleed in the first week of life, and another fraction of a percent within six months.<\/p>\n More than a dozen doctors around the country \u2014 including emergency physicians, neonatologists and pediatricians \u2014 told The Times they had treated brain or abdominal hemorrhages in infants who hadn\u2019t received vitamin K, mostly in the past five years. They did not always know the outcomes, since some patients were transferred to other facilities. But at least 12 of these babies died, and at least 14 others had brain damage.<\/p>\n Some doctors described cases in broad terms to protect patient privacy, and some who provided more details asked that babies\u2019 sex or exact age not be published.<\/p>\n Dr. Meghan Martin, a pediatric emergency medicine physician at Johns Hopkins All Children\u2019s Hospital in St. Petersburg, Fla., said she and her colleagues now treated a hemorrhaging infant every month or two on average.<\/p>\n \u201cIt\u2019s not unusual anymore,\u201d Dr. Martin said.<\/p>\n On June 29, Senator Angela Alsobrooks of Maryland and Representative Kim Schrier of Washington, both Democrats, wrote to Dr. Jay Bhattacharya, who is currently leading the Centers for Disease Control and Prevention, urging the C.D.C. to publicly track vitamin K refusal and deficiency bleeding. A spokeswoman for the Department of Health and Human Services did not say whether it would.<\/p>\n National data would enable doctors \u201cto sit down with a family and say, \u2018Let me tell you what we\u2019re seeing,\u2019\u201d Ms. Schrier, who was a pediatrician before coming to Congress, said in an interview. \u201cIt feels like a more real-world discussion than a theoretical risk.\u201d<\/p>\n Several doctors described vitamin K deficiency bleeding cases as so horrific that they were seared in their minds, though they treat sick children every day.<\/p>\n Dr. Donna Schoonover, a pediatric hospitalist in Washington, said she would never forget one image: an eye popping out of its socket from the blood pooling in an infant\u2019s skull.<\/p>\n A Routine Injection<\/p>\n Infants are naturally deficient in vitamin K because it doesn\u2019t cross the placenta well, and breast milk contains little. Formula can contain more \u2014 but newborns\u2019 digestive systems can\u2019t fully absorb it, said Dr. Leela Sarathy, the medical director of newborn nursery services at Mass General Brigham for Children.<\/p>\n The risk of bleeding from vitamin K deficiency is highest in the first week but persists at a lower level for months. One injection within six hours of birth<\/a> nearly eliminates it. (Unrelated factors can also cause bleeding.)<\/p>\n The American Academy of Pediatrics recommended the shot in 1961, and vitamin K deficiency bleeding became very rare in the United States<\/a>. \u201cWe learned about it, but it was something that happened mostly in other countries,\u201d said Dr. Judy Felgenhauer, the medical director of the pediatric hematology and oncology program at Providence Sacred Heart Children\u2019s Hospital in Spokane, Wash.<\/p>\n The injection is very safe. But in the 2010s, doctors started to notice<\/a> more Americans turning it down for their children. While the vitamin K shot is not a vaccine, rejection of it rose alongside vaccine rejection, among many of the same parents.<\/p>\n Misinformation online has contributed, said Dr. Stephanie DeLeon, the associate chief medical officer at Oklahoma Children\u2019s Hospital OU Health.<\/p>\n Some Facebook groups and other forums for expectant parents are full of inaccurate claims and parents expressing anguished indecision, unsure what to believe and terrified of harming their children.<\/p>\n Though the C.D.C. still recommends vitamin K, Health Secretary Robert F. Kennedy Jr. and other Trump administration officials have amplified distrust of standard medical guidance in many areas. And Children\u2019s Health Defense \u2014 an organization Mr. Kennedy previously led \u2014 has suggested vitamin K shots could be dangerous.<\/p>\n Emily Hilliard, a spokeswoman for the health department, blamed the Biden administration\u2019s Covid policies for the increase in vitamin K rejection and said the department was seeking to \u201crebuild\u201d trust \u201cthrough honesty, informed consent, sound science and respect for individual choice.\u201d<\/p>\n Some parents tell doctors they are worried about a preservative called benzyl alcohol, though there is no evidence of harm from the tiny amount in the vitamin K shot, and preservative-free shots are available. Some believe the shot is linked to leukemia, based on a small study from the early 1990s that multiple larger studies have contradicted.<\/p>\n Other parents oppose interventions that they consider unnatural. Some want to spare their baby the discomfort of an injection, and think the danger of skipping it is insignificant.<\/p>\n \u201cThey\u2019ll say it\u2019s a one-in-a-million bleeding risk,\u201d said Dr. Annemarie Stroustrup, the senior vice president of pediatric services at Northwell Health, a large health care network in New York and Connecticut where several infants have hemorrhaged in the past two years. \u201cIt\u2019s decidedly not.\u201d<\/p>\n An emergency vitamin K injection can start the clotting process within hours, and some babies can be kept alive until then with transfusions, surgery to relieve pressure on the brain by removing part of the skull, or life support.<\/p>\n