Effects of 1,25-Dihydroxycholecalciferol on Recovery and Resolution of Late Transient Neonatal Hypocalcemia
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Research Article Effects of 1,25-Dihydroxycholecalciferol on Recovery and Resolution of Late Transient Neonatal Hypocalcemia Jennifer M. Amaral,1 Steve Abrams,2 Lefkothea Karaviti,1 and Siripoom V. McKay1 1 The
Pediatric Endocrinology & Metabolism Section, Texas Children’s Hospital and Baylor College of Medicine, Clinical Care Center, Houston, TX 77030, USA 2 Neonatology Section, Texas Children’s Hospital and Baylor College of Medicine, Clinical Care Center, Houston, TX 77030, USA Correspondence should be addressed to Jennifer M. Amaral, [email protected] Received 1 October 2009; Revised 11 December 2009; Accepted 13 February 2010 Academic Editor: Thomas O. Carpenter Copyright © 2010 Jennifer M. Amaral et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Late transient neonatal hypocalcemia with hyperphosphatemia is potentially life-threatening. The use of 1.25 dihydroxycholecalciferol in the management of neonatal hypocalcemia is unexplored. Objective. We hypothesized adding 1.25 dihydroxycholecalciferol to intravenous continuous calcium infusion (CaI) will achieve accelerated correction of hypocalcemia. Design/Methods. 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 ≥1.1 mmol/L. CaI was discontinued when ionized calcium levels were ≥1.1 mmol/L on two measurements and the infant tolerated feeds. Results. 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). Conclusions. 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.
1. Introduction Late transient neonatal hypocalcemia with hyperphosphatemia is a potentially life-threatening condition first reported in the 1930s. The condition presents between days of life 3–14, typically with tetanic seizures in a previously healthy term neonate [1]. This condition is rarely seen in breast-fed infants and is believed to be associated with a high phosphate load in the formula [2, 3]. Introduction of formulas with lower phosphate loads has not eliminated the occurrence of transient neonatal hypocalcemia [1, 4– 8]. This condition continues to be seen with a frequency of 30/10,000 among formula-fed neonates [2, 8]. The standard treatment of symptomati
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