Hypocalcemia in the newborn: analysis of clinical features and risk factors

  • Živa Lenarčič Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center, Ljubljana, SlovenijaDepartment of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • Aneta Soltirovska Šalamon Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center, Ljubljana
Keywords: hypocalcaemia, newborn, vitamin D, risk factors

Abstract

Background: Neonatal hypocalcaemia (hypoCa) is frequently observed clinical and laboratory finding in neonates. A healthy newborn reaches the lowest serum calcium level at 24–48 hours of age. It can deteriorate to hypoCa levels in newborns with specific risk factors.

Methods: In the analysis, 50 newborns with hipoCa were included. Details of clinical signs and laboratory investigations were obtained from the available medical records and were statistically analysed.

Results: Early hipoCa was identified in 41 (82 %) and late in 9 (18 %) cases; 36 (72 %) were asymptomatic and 14 (28 %) symptomatic with the average serum calcium 1.8 (lowest 1.27) and ionized 0.92 mmol /l (lowest 0.63 mmol/l); 18 (36 %) infants had sepsis, 14 (28 %) were premature, 13 (26 %) mothers had gestational diabetes, three were after perinatal asphyxia, three after exchange transfusion, two after bleeding in twins and two had DiGeorge syndrome. Serum levels of 25-OH-vitamin D analysed in 13 newborns was lower than 52 nmol/l; 70 % of convulsions associated with HipoCa were due to vitamin D insuficiency.

Conclusion: Neonatal sepsis, maternal gestational diabetes, prematurity and vitamin D deficiency are the predominant risk factors. A low neonatal vitamin D reservoir can be associated with the development of PTH insufficiency, resulting in hipoCa, which can be presented with neonatal convulsions. The results suggest the need to establish guidelines for the prophylactic treatment of pregnant women with vitamin D.

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References

Thomas TC, Smith JM, White PC, Adhikari S. Transient neonatal hypocalcemia: presentation and outcomes. Pediatrics. 2012 Jun;129(6):e1461–7.

Cho WI, Yu HW, Chung HR, Shin CH, Yang SW, Choi CW, et al. Clinical and laboratory characteristics of neonatal hypocalcemia. Ann Pediatr Endocrinol Metab. 2015 Jun;20(2):86–91.

Tuchman S. Disorders of mineral metabolism in the newborn. Curr Pediatr Rev. 2014;10(2):133–41.

Salles JP. Bone metabolism during pregnancy. Ann Endocrinol (Paris). 2016 Jun;77(2):163–8.

Kovacs CS. Calcium, phosphorus, and bone metabolism in the fetus and newborn. Early Hum Dev. 2015 Nov;91(11):623–8.

Soltirovska Šalamon A. Motnje v presnovi kalcija in fosforja pri novorojenčkih. Hemodinamsko, tekočinsko in elektrolitsko ravnovesje pri novorojenčku. Ljubljana: Pediatrična klinika; 2016. (Zbirka Poglavja iz neonatologije; letn. 7,2). p. 231–247.

Abrams S. Neonatal hypocalcemia. UpToDate [cited 2016 Jun 27]. Available from: https://www.uptodate.com/contents/neonatal-hypocalcemia.

Namgung R, Tsang RC. Neonatal calcium, phosphorus and magnesium homeostasis. In: Polin RA Fox WW. Fetal and Neonatal physiology. 4thed. Philadelphia: WB Saunders; 2011.

Singhi SC, Singh J, Prasad R. Hypocalcaemia in a paediatric intensive care unit. J Trop Pediatr. 2003 Oct;49(5):298–302.

Hästbacka J, Pettilä V. Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Acta Anaesthesiol Scand. 2003 Nov;47(10):1264–9.

Broner CW, Stidham GL, Westenkirchner DF, Tolley EA. Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients. Crit Care Med. 1990 Sep;18(9):921–8.

Zhang Z, Xu X, Ni H, Deng H. Predictive value of ionized calcium in critically ill patients: an analysis of a large clinical database MIMIC II. PLoS One. 2014 Apr;9(4):e95204.

Dias CR, Leite HP, Nogueira PC, Brunow de Carvalho W. Ionized hypocalcemia is an early event and is associated with organ dysfunction in children admitted to the intensive care unit. J Crit Care. 2013 Oct;28(5):810–5.

Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2010 Oct;77(10):1123–8.

Rigo J, Mohamed MJ, Curtis M. Disorders of calcium, phosphorus, and magnesium metabolism. In: Martin R, Fanaroff A, Walsh M, editors. Fanaroff and Martin’s Neonatal-perinatal medicine: Diseases of the fetus and infant. 9th ed. St. Louis: Mosby; 2011.

Canaff L, Hendy GN. Calcium-sensing receptor gene transcription is up-regulated by the proinflammatory cytokine, interleukin-1beta. Role of the NF-kappaB PATHWAY and kappaB elements. J Biol Chem. 2005 Apr;280(14):14177–88.

Canaff L, Zhou X, Hendy GN. The proinflammatory cytokine, interleukin-6, up-regulates calcium-sensing receptor gene transcription via Stat1/3 and Sp1/3. J Biol Chem. 2008 May;283(20):13586–600.

Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Crit Care. 2013 Jun;17(3):R106.

Khalesi N, Bahaeddini SM, Shariat M. Prevalence of maternal vitamin D deficiency in neonates with delayed hypocalcaemia. Acta Med Iran. 2012;50(11):740–5.

Soltirovska Šalamon A, Benedik E, Bratanič B, Velkavrh M, Rogelj I, Fidler Mis N, et al. Vitamin D Status and Its Determinants in Healthy Slovenian Pregnant Women. Ann Nutr Metab. 2015;67(2):96–103.

Högler W. Complications of vitamin D deficiency from the foetus to the infant: one cause, one prevention, but who’s responsibility? Best Pract Res Clin Endocrinol Metab. 2015 Jun;29(3):385–98.

Venkataraman PS, Wilson DA, Sheldon RE, Rao R, Parker MK. Effect of hypocalcemia on cardiac function in very-low-birth-weight preterm neonates: studies of blood ionized calcium, echocardiography, and cardiac effect of intravenous calcium therapy. Pediatrics. 1985 Oct;76(4):543–50.

Published
2018-04-21
How to Cite
1.
Lenarčič Živa, Soltirovska Šalamon A. Hypocalcemia in the newborn: analysis of clinical features and risk factors. TEST ZdravVestn [Internet]. 21Apr.2018 [cited 28Mar.2024];87(3-4):114-22. Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/2620
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Original article