Sixteen cases of neonatal tetany are reported, all of whom were fed cow's milk formulas.Relative to human milk, cow's milk has a low Ca:P ratio and increased total P concentration. These differences are accentuated in some commercial milks prepared for infant feeding.Cow's milk, even if diluted 2:1 with water, is an unphysiologic food for the human infant in the neonatal period, producing elevated serum P and decreased serum Ca and Mg levels.Increasing the Ca:P ratio of cow's milk to that of human milk or dilution 1:2 with water limits the abnormal changes in serum P, Ca and Mg concentrations referred to.A high P diet of an inadequately diluted cow's milk formula causes hypertrophy of the parathyroid glands of the newborn infant.The maximum renal P clearance of the human newborn infant in the first week of life appears to approximate 3500 ml./sq. m./24 hrs.Our observations indicate that when newborn infants are fed cow's milk formulas commonly used in this country limitation in parathyroid and renal function predisposes to tetany.The foregoing data emphasize the physiologic character of human milk for the newborn infant. If breast milk is unavailable, a suitable formula for the neonatal period appears to be cow's milk 1 part, water 2 parts, 10% carbohydrate and Ca-gluconate to produce a Ca:P ration approaching that of breast milk. The added water and Ca should then be gradually reduced.
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