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
|1-2 weeks||3-4 months||% > 50nmol/l |
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%|
- 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
143 items along with related searches
Overview Loading of vitamin D contains the followingLoading dose:
143 studies at VitaminDWiki
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 )
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.