Oral Administration of Injectable Calcium Gluconate versus Intravenous Calcium Gluconate in Neonates with Asymptomatic Hypocalcaemia

Abstract

Background: Neonatal hypocalcaemia is a common metabolic abnormality requiring appropriate calcium supplementation. Intravenous calcium gluconate is frequently used for correction, whereas oral administration may offer a less invasive approach in clinically stable neonates with asymptomatic hypocalcaemia.

Aim: To compare the biochemical response and treatment-related outcomes of oral administration of injectable calcium gluconate versus intravenous calcium gluconate in neonates with asymptomatic hypocalcaemia.

Methods: This retrospective comparative study was conducted in the Department of Pediatrics, Tertiary Care Hospital in Dakshina Kannada, Karnataka from May 2025 to May 2026. Medical records of 60 eligible neonates were reviewed. Of these, 34 received oral administration of injectable calcium gluconate and 26 received intravenous calcium gluconate. Baseline and 72-hour serum calcium concentrations, treatment duration, neonatal intensive care unit (NICU) stay, recurrence, feeding intolerance, rescue therapy and documented adverse events were evaluated. Continuous variables were compared using Welch’s independent-samples t-test, and categorical variables were assessed using Fisher’s exact test.

Results: Mean baseline serum calcium concentrations were 6.80 ± 0.62 mg/dL in the oral group and 6.70 ± 0.68 mg/dL in the intravenous group (p = 0.56). At 72 hours, concentrations increased to 8.40 ± 0.54 and 8.50 ± 0.61 mg/dL, respectively. The mean calcium increase was 1.60 ± 0.60 versus 1.80 ± 0.65 mg/dL (p = 0.23). Differences in treatment duration and NICU stay were not statistically significant.

Conclusion: Both groups demonstrated improved serum calcium concentrations. Larger prospective studies are required to establish comparative effectiveness and safety.