Neonatal hypocalcemia

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
SpecialtyNeonatology

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 PTH or Parathyroid hormone.[2]

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
  • Magnesium deficiency
  • Transient hypoparathyroidism of newborn
  • Hypoparathyroidism due to other causes (DiGeorge Syndrome)

References
  1. 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. 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
  • 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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