Clinical Insights - Feb 10, 2026

National data demonstrate a continued rise in the proportion of newborns not receiving routine intramuscular vitamin K prophylaxis in U.S. hospitals. Analysis of Epic Cosmos data from more than 5 million infants born at 35-43 weeks’ gestation across 403 hospitals showed nonreceipt increased from 2.92% in 2017 to 5.18% in 2024. After adjustment for maternal and infant characteristics, the upward trend persisted, with adjusted nonreceipt rising from 2.57% to 4.62%.

Several factors were associated with higher likelihood of not receiving vitamin K. Vaginal delivery was associated with higher nonreceipt compared with cesarean delivery. Infants identified as non-Hispanic White or as “other or unknown” race or ethnicity also had higher nonreceipt rates. Maternal age, insurance status, social vulnerability index, and infant birth weight did not change meaningfully over time, suggesting the observed increase reflects evolving practice patterns or parental decision-making rather than shifts in patient demographics.

The timing of this trend is notable. Nonreceipt increased gradually before 2020, indicating that pandemic-era skepticism alone does not explain the findings. This pattern is consistent with prior work describing parental concerns related to perceived necessity, injection pain, and safety of vitamin K prophylaxis.

From a clinical standpoint, these findings highlight the importance of consistent counseling at birth and the potential role of system-level interventions. The authors emphasize standardized clinician communication and consideration of public health or regulatory strategies to maintain uptake of this long-established, highly effective preventive therapy. Ongoing surveillance will be needed to assess whether rising nonreceipt is associated with changes in bleeding-related morbidity.¹

Gentamicin is a concentration-dependent aminoglycoside, and antibacterial efficacy depends on achieving high peak concentrations relative to the organism’s MIC. In neonates, standard weight-based doses reliably achieve therapeutic peak levels, making routine peak monitoring unnecessary in most cases.

Safety is driven by accumulation. Therapeutic drug monitoring therefore focuses on the trough concentration. A trough below 1 mcg/mL significantly decreases nephrotoxicity and ototoxicity risk while also minimizing resistance development by supporting the post-antibiotic effect. Elevated troughs should prompt adjustment of the dosing interval.

A step-by-step explanation of why troughs, not peaks, guide neonatal gentamicin safety is reviewed in Gentamicin Therapeutic Drug Monitoring in Neonates: Everything You Need to Know.

National standards for pediatric readiness in emergency departments were recently released in a joint policy statement by the American Academy of Pediatrics and the Emergency Nurses Association. The guidance outlines required pediatric-specific equipment, standardized medication concentrations, weight-based dosing systems, and designated pediatric leadership.

Modeling cited in the statement estimates that improved pediatric readiness could prevent more than 2,100 pediatric deaths annually in the U.S. The recommendations emphasize the role of a Pediatric Emergency Care Coordinator to oversee education, implementation, and quality improvement, particularly in community and non-children’s hospitals. For pediatric clinicians and pharmacists, the statement provides a framework to support safer medication systems and pediatric advocacy beyond specialty centers.²

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— Dr. Su