Newborn Vitamin D - single 50,000 IU is better than daily – RCT
Vitamin D in newborns. A randomised controlled trial comparing daily and single oral bolus vitamin D in infants
J. of Paediatics and Child Health, First published: 27 September 2016, DOI: 10.1111/jpc.13338
Julie Huynh, Thao Lu, Danny Liew, James CG Doery, Ronald Tudball, Madeleine Jona, Roisin Bhamjee, Christine P Rodda
at 1-2 weeks | % >50nmol/L
at 3-4 months || Single dose | 154 nmol/L | 65 nmol/L | 100 % | 91% || Daily dose | 48 nmol/L | 81 nmol/L | 31% | 89% |Note* Many researchers believe repletion should be 75 nmol/L, not 50 nmol/L,* Bolus = Loading = Stoss* Longest time between doses should be 17 days, not 3 months * Third study found that Infants needed 1600 IU of vitamin D – JAMA RCT May 2013* Children getting 60,000 IU monthly got to vitamin D level of 33 ng – Sept 2015* 50,000 IU Vitamin D one time after birth helped – RCT Jan 2015* 600,000 IU of vitamin D2 every 4 months for decades in East Germany – 1987* Over 3 million infants - with no reported problems* Loading Dose of Vitamin D **category listing has items along with related searches** Overview Loading of vitamin D contains the following {include}
Aim: There are no published data to demonstrate the efficacy of bolus dose vitamin D in newborn infants. The study sought to evaluate this alternative approach of supplementation.
Methods: This single centre, open randomised controlled trial was conducted from August 2013 to May 2014. It compared the efficacy and safety of daily (400 IU) versus a bolus dose (50 000 IU) of cholecalciferol in newborn infants of vitamin D deficient mothers. The primary outcome measure was the rate of 25 hydroxyvitamin D (25OHD) repletion-defined as 25OHD greater than 50 nmol/L. The secondary objective was determining safety using adjusted total serum calcium.
Results: Of 70 eligible infants, 36 received a daily dose and 34 received a single high-dose cholecalciferol. Mean 25OHD in the bolus group (154 nmol/L, 95% confidence interval (CI) 131–177) was higher than the daily group (48 nmol/L, 95% CI 42–54) at 1–2 weeks of age. This was reversed at 3–4 months, (65 nmol/L, 95% CI 59–71) compared with the daily group (81 nmol/L, 95% CI 77–85). More infants in the single bolus group achieved vitamin D repletion (100 vs. 31%) at 1–2 weeks. By 3–4 months, both groups achieved similar vitamin D repletion rates (91 vs. 89%). Mean adjusted total serum calcium in the bolus group were normal at 1–2 weeks (2.73 mmol/L) and 3–4 months (2.55 mmol/L).
Conclusion: Single bolus dosing of 50 000 IU cholecalciferol achieves higher 25OHD repletion rates at 1–2 weeks of age compared with daily dosing, but repletion rates were similar by 3–4 months. There was no hypercalcaemia documented with single bolus dosing in this study.