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Newborn Vitamin D - single dose is better than daily – RCT Sept 2016

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

VitaminDWiki Summary and comments
1-2 weeks3-4 months% > 50nmol/l
at 1-2 weeks
% >50nmol/L
at 3-4 months
Single dose 154 nmol/L65 nmol/L100 %91%
Daily dose48 nmol/L81 nmol/L31%89%

Note

Overview Loading of vitamin D contains the following

If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given

  • Loading = repletion = quick replacement (previously known as Stoss)
  • Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
  • The size of the loading dose is a function of body weight - see below
    Unfortunately, some doctors persist in using Vitamin D2 instead of D3
  • Loading may be done as quickly as a single day, to as slowly as 3 months.
    It appears that spreading the loading dose over 4-20 days is a good compromise
  • Loading is typically oral, but sometimes by injection (I.M,)
  • The loading dose persists in the body for about 3 months
    The loading dose should be followed up with continuing maintenance
    Unfortunately, many doctors fail to follow-up with the maintenance dosing.
  • As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
    it appears prudent to test with a small amount of vitamin D before giving a loading dose
  • The causes of a mild allergic reaction appear to be: (in order of occurance)
    1) lack of magnesium - which can be easily added
    2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
    3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
Loading dose: 132 studies at VitaminDWiki


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.

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Attached files

ID Name Comment Uploaded Size Downloads
8570 daily vs single for newborns.pdf admin 21 Oct, 2017 11:25 364.37 Kb 145
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