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Title: Effects of 1,25-dihydroxycholecalciferol on recovery and resolution of late transient neonatal hypocalcemia

Author
item AMARAL, JENNIFER - Texas Children'S Hospital
item ABRAMS, STEVEN - Children'S Nutrition Research Center (CNRC)
item KARAVITI, LEFKOTHEA - Texas Children'S Hospital
item MCKAY, SIRIPOOM - Texas Children'S Hospital

Submitted to: International Journal of Pediatric Endocrinology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/13/2010
Publication Date: 7/1/2010
Citation: Amaral, J.M., Abrams, S., Karaviti, L., Mckay, S.V. 2010. Effects of 1,25-dihydroxycholecalciferol on recovery and resolution of late transient neonatal hypocalcemia. International Journal of Pediatric Endocrinology. Available: http://www.hindawi.com/journals/ijpe/2010/409670.html

Interpretive Summary: Low blood calcium at birth, in babies is a serious problem that can cause seizures in the infant. We wanted to know whether giving extra amounts of the active form of vitamin D, called calcitriol, would help in caring for babies with this problem. We studied 14 babies. Half were given placebo and half were given the calcitriol. We found a small improvement in the length of time the babies who were given the calcitriol had for their low blood calcium. This indicates that babies with low blood calcium may have a small benefit to being given the calcitriol when they are admitted to the hospital.

Technical Abstract: Late transient neonatal hypocalcemia with hyperphosphatemia is potentially life-threatening. The use of 1.25 dihydroxycholecalciferol in the management of neonatal hypocalcemia is unexplored. We hypothesized adding 1.25 dihydroxycholecalciferol to intravenous continuous calcium infusion (CaI) will achieve accelerated correction of hypocalcemia. A controlled double-blind randomized placebo group was organized to compare the addition of 1.25 dihydroxycholecalciferol to CaI in 3–14 day old neonates presenting with hypocalcemia, hyperphosphatemia, and seizures. Ionized calcium and phosphorus were measured to adjust CaI and maintain eucalcemia. Time to resolution of hypocalcemia was defined as time from starting CaI to the first ionized calcium of greater than or equal to 1.1 mmol/L. CaI was discontinued when ionized calcium levels were greater than or equal to 1.1 mmol/L on two measurements and the infant tolerated feeds. Fourteen neonates were studied without statistical difference between groups. Time to correction of hypocalcemia for 1, 25 dihydroxycholecalciferol versus placebo was 7.2 +/- 1.9 versus 11.5 +/- 3.4 hours respectively (p=.26). The duration of CaI was 15.0 +/- 1.5 versus 24.8 +/- 4.4 hours respectively (p=.012). The addition of 1.25 dihydroxycholecalciferol to standard CaI therapy reduced the duration of CaI, but did not reduce the time to correct hypocalcemia in neonates with late transient hypocalcemia.