title: Impact of supplemental vitamin K1 administration on postoperative blood component requirements after craniosynostosis repair: a prospective, placebo-controlled, randomized, blinded study.
abstract: Total cranial vault craniosynostosis repairs often require additional blood transfusions in the intensive care unit. Vitamin K1 participates in hepatic production of procoagulant proteins, and body stores of vitamin K1 are limited and dietary dependent. Surgical stress and diet interference may place infants at risk for vitamin K deficiency. Through design of a surgically stratified, randomized, placebo-controlled, blinded pilot study, we evaluated impact of vitamin K1 supplementation on coagulation parameters in infants after craniosynostosis repair. Patients received intramuscular vitamin K1 or placebo coincident with surgical incision. Serum vitamin K1 levels, protein induced in vitamin K absence-prothrombin, and factor VII were obtained at predetermined intervals after surgery. Patients received blood products in the intensive care unit in accordance with transfusion thresholds. Fifteen patients (vitamin K1 = 6, placebo = 9) completed the study procedures. Despite group assignment, patients received an average of 3 postoperative transfusions. Variations were observed with respect to intraoperative resuscitation of patients between comparably trained pediatric anesthesiologists. Thirty-three percent of patients were vitamin K1 deficient on 1 or more laboratory specimens. All breast-fed patients became deficient. Compared with placebo, elevated serum vitamin K1 levels at 6, 12, and 24 hours in the active drug group (P < 0.0001) were not associated with increased factor VII levels or reduced need for postoperative blood products. However, lack of a standardized intraoperative resuscitation plan may contribute to postoperative coagulopathy and is a major study limitation.
authors.affiliation: From the *Pediatric Intensive Care Unit, Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington; and †Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia Children's Hospital, and Departments of ‡Neurosurgery and §Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Kicker
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Willson
authors.forename: Robin L
authors.initials: RL
authors.lastname: Kelly
authors.forename: John A
authors.initials: JA
authors.lastname: Jane
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Roberts
authors.forename: Mark R
authors.initials: MR
authors.lastname: Conaway
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001942:Breast Feeding; D003398:Craniosynostoses / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011516:Prothrombin; D010837:Vitamin K 1 / Q000008:administration & dosage*; D014813:Vitamin K Deficiency / Q000150:complications* / Q000188:drug therapy*
chemical_list: D010837:Vitamin K 1; D011516:Prothrombin