Effects of 1,25-Dihydroxycholecalciferol on Recovery and Resolution of Late Transient Neonatal Hypocalcemia

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 symptomatic neonatal hypocalcemia is intravenous calcium infusion [8, 9].Extravasation of intravenous calcium can result in severe tissue necrosis [3]. IV infiltration rates among neonates vary from 57% to 70% and extravasation occurs in 11% to 23% of reported cases [10–12]. The most common cause of IV infiltration is total parenteral nutrition (76%) and calcium (72%) [11, 12]. In addition, intravenous calcium has also been associated with cardiac arrhythmias, notably bradycardia. The use of 1,25-Dihydroxyvitamin D 1,25(OH)2Vitamin D in the management of transient hypocalcemia is less clear [3, 9]. 1,25(OH)2 Vitamin D might reduce the time of correction of hypocalcemia and the duration of intravenous calcium administration by stimulating calcium mobilization from the bones, reducing renal proximal tubular excretion of calcium, and promoting absorption of calcium from the duodenum during hypocalcemia [9, 13, 14].To our knowledge there are no controlled studies that have evaluated the effect of adding 1,25(OH)2 Vitamin D to intravenous continuous calcium infusion for late transient neonatal hypocalcemia. We hypothesized that the addition of 1,25(OH)2 Vitamin D to standard intravenous continuous calcium infusion would achieve more rapid resolution of hypocalcemia and shorten the duration of intravenous continuous calcium infusion w