A Texas Medical Board review of an 11-day-old baby’s death faulted emergency physician Nicole Malouf for not recognizing a life-threatening bleeding disorder, assessing the infant’s blood loss or arranging a prompt transfer to a pediatric referral hospital. The board also found that the New Braunfels emergency room did not have vitamin K on site, according to ProPublica’s report on the findings.
The infant, Gwen Biesenbach, was taken to Lonestar 24HR ER with bleeding from her umbilical cord stump. Her parents told Malouf they had declined the vitamin K injection at birth and were giving Gwen oral drops. Malouf requested a transfer to North Central Baptist Hospital in San Antonio, and Gwen left the ER after spending about seven hours there, The Lund Report said.
Gwen’s condition deteriorated during transport. The board held a closed virtual hearing in September 2025 and issued its decision the following month.
Why an 11-day-old can be at risk
Vitamin K deficiency bleeding can occur at different points in infancy. MedlinePlus describes early-onset cases as occurring from 1 to 14 days after birth and late-onset cases from 2 weeks to 6 months. Gwen’s reported age falls within the early-onset window, but age alone does not establish a diagnosis; in this case, the medical examiner attributed her death to vitamin K deficiency bleeding.
Guidance on oral vitamin K varies by jurisdiction. For parents who decline the injection, the Canadian Paediatric Society recommends an oral dose of 2.0 mg at birth, within six hours, followed by repeat doses at 2 to 4 and 6 to 8 weeks. That Canadian schedule does not establish what oral regimen Gwen received or whether it was appropriate for her.
Studies show trends, not a complete explanation
U.S. research points to changes in both newborn vitamin K use and reported bleeding, but the measures and study populations differ. CIDRAP reported that one study of more than 11 million newborns found receipt of the shot fell from 97% to 95% between 2017 and 2025, while vitamin K deficiency bleeding increased 347%. A separate study of more than 5.2 million infants found injection refusal rose from 3.1% to 6.8% over the same period; bleeding rates by 6 months rose among infants both with and without the shot.
More recent data also indicate a change in documented receipt: Truveta’s analysis found that the share of U.S. births without documented vitamin K rose from 5.2% in January 2026 to 8.1% in June 2026. These findings describe population-level patterns; they do not establish that refusal explains every increase in bleeding or determine what would have happened in an individual case.
A separate comparison underscores the potential risk but does not explain Gwen’s treatment or outcome. In a study of more than five million infants, babies without a vitamin K shot had 33 brain bleeds per 10,000 births in their first six months, compared with 13.2 per 10,000 among babies who received the shot, The New York Times reported.
