Neonatal hypocalcemia
SpecialtyNeonatology

Neonatal hypocalcemia is an abnormal clinical and laboratory hypocalcemia condition that is frequently observed in infants. It is commonly presented within the first 72 hours of a newborn's life.[1] Neonatal hypocalcemia can cause seizures in infants requiring a calcium infusion until homeostasis is achieved; allowing for positive clinical outcomes within weeks of treatment.[2][3][4][5]

Healthy term infants go through a physiological nadir of serum calcium levels at 7.5 - 8.5 mg/dL by day 2 of life. Hypocalcemia is a low blood calcium level. A total serum calcium of less than 8 mg/dL (2mmol/L) or ionized calcium less than 1.2 mmol/L in term neonates is defined as hypocalcemia. In preterm infants, it is defined as less than 7mg/dL (1.75 mmol/L) total serum calcium or less than 4mg/dL (1 mmol/L) ionized calcium.

Both early onset hypocalcemia (presents within 72h of birth) and late onset hypocalcemia (presents in 3-7 days after birth) require calcium supplementation treatment.

Infants with intrauterine growth retardation, perinatal asphyxia, preterm, and diabetic mothers are most likely to develop neonatal hypocalcemia.[1] It is not understood why premature infants have hypocalcemia, but a proposed idea is that a large increase of calcitonin may lead to hypocalcemia. Another hypothesis includes impaired secretion of parathyroid hormone.[6]

Cause

Risk factors of early neonatal hypocalcemia

Risk factors

Risk factors of late neonatal hypocalcemia

  • Exogenous phosphate load
  • Use of gentamicin
  • Gender and ethnic: late neonatal hypocalcemia occurred more often in male infants and Hispanic infants
  • Others

References

  1. 1 2 Vuralli, Dogus (2019-06-19). "Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?". International Journal of Pediatrics. 2019: 1–7. doi:10.1155/2019/4318075. ISSN 1687-9740. PMC 6607701. PMID 31320908.
  2. ↑ Donner, Julia R.; Ganta, Avani; Polikoff, Lee; Snelling, Linda; Serrano-Gonzalez, Monica (2023-05-01). "A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium". AACE Clinical Case Reports. 9 (3): 85–88. doi:10.1016/j.aace.2023.04.003. ISSN 2376-0605. PMC 10213609. PMID 37251976.
  3. ↑ Vuralli, Dogus (2019-06-19). "Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?". International Journal of Pediatrics. 2019: e4318075. doi:10.1155/2019/4318075. ISSN 1687-9740. PMC 6607701. PMID 31320908.
  4. ↑ Jain, Ashish; Agarwal, Ramesh; Sankar, M. Jeeva; Deorari, Ashok; Paul, Vinod K. (2010-10-01). "Hypocalcemia in the Newborn". The Indian Journal of Pediatrics. 77 (10): 1123–1128. doi:10.1007/s12098-010-0176-0. ISSN 0973-7693. PMID 20737250. S2CID 28454275.
  5. ↑ Kossoff, Eric H.; Silvia, Mary T.; Maret, Alexander; Carakushansky, Mauri; Vining, Eileen P.G. (2002-03-01). "Neonatal Hypocalcemic Seizures: Case Report and Literature Review". Journal of Child Neurology. 17 (3): 236–239. doi:10.1177/088307380201700319. ISSN 0883-0738. PMID 12026245. S2CID 42642716.
  6. ↑ Schafer, Anne L.; Shoback, Dolores (2013-07-19), "Hypocalcemia: Definition, Etiology, Pathogenesis, Diagnosis, and Management", Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Ames, USA: John Wiley & Sons, Inc., pp. 572–578, doi:10.1002/9781118453926.ch71, ISBN 978-1-118-45392-6, retrieved 2020-12-07
  7. ↑ Tran, Vinh Phu; Ton-Nu, Van Anh; Nguyen, Huu Son; Nguyen-Thi, Diem Chi; Le-Thy, Phuong Anh; Le-Binh, Phuong Nguyen (2022-03-15). "Status Epilepticus Secondary to Hypocalcemia Due to Vitamin D Deficiency". Case Reports in Neurology. 14 (1): 124–129. doi:10.1159/000521864. ISSN 1662-680X. PMC 8958578. PMID 35431874.
  8. ↑ Donner, Julia R.; Ganta, Avani; Polikoff, Lee; Snelling, Linda; Serrano-Gonzalez, Monica (2023-05-01). "A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium". AACE Clinical Case Reports. 9 (3): 85–88. doi:10.1016/j.aace.2023.04.003. ISSN 2376-0605. PMC 10213609. PMID 37251976.
  • Jain, A., Agarwal, R., Sankar, M. J., Deorari, A., & Paul, V. K. (2010). Hypocalcemia in the newborn. Indian Journal of Pediatrics, 77, 1123-1128.
  • Oden, J., Bourgeois, M. (2000). Neonatal endocrinology. Indian Journal of Pediatrics, 77, 21
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