Neonatal hypocalcemia

Fifth stage

Pediatric
Lec. 7
د. رياض

14/12/2016

Neonatal hypocalcemia

Definition

Defined as total serum calcium less than 7mg/dl normal range(8-10mg/dl;2-2.2mmol/l) and an ionized calcium <4mg/dl (1 mmol/l).

Types

early hypocalcemia appears at first 1- 3days
late hypocalcemia at 4-7 days of life.

Causes

Early neonatal hypocalcemia
Prematurity; and SGA(LBW,VLBW) due to lower amount of calcium passage via the placenta, low level or immature function of hypoparathyroid H.


Congenital hypoparathyridim as in DiGeorge syndrome with aplasia of thymus and parathroid glands present with early and late hypocalcemia

Infant of diabetic mother IDM: due to low PTH function and high calcitonin, low mg level comes from mother in diabetic mother.

Birth asphyxia ; due to high phosphate release from damaged cells and high calcitonin level.

Late neonatal hypocalcemia

high phosphate containing milk like whole cow milk or formula with high phosphate .
prematurity on breast milk not supplemented with vit.D and oral calcium.
hypoparathyroidism;congenital or transient .
maternal low vit.D store in breast fed baby.
renal dysfunction in the baby.

Features of neonatal hypocalcemia

Clinical features can appear when total calcium is reaching <7mg/dl and ionized Ca <3.5 and it includes;
Hypotonia,, tachypnea, apnea, poor feeding, jitteriness, tetany, seizures. Similar symptoms occurs in hypoglycemia, so that you should do both (rapid BS and serum calcium) levels. ECG shows pronged QTc .
Premature babies usually need high Ca and Phosphate for their rapid growth of bones and so they need formula of (high Ca and phosphate) and vitD or breast feeding supplemented with vit D after discharge from the hospital. otherwise they may develop osteopenia or rickets of prematurity.

Treatment

Early symptomatic hypocalcemia; emergency condition by IV 10% calcium gluconate 2ml/kg. slowly under cardiac checking. followed by maintenance oral calcium for some days and vit D.
For symptomatic late hypocalcemia ; should do correction of formula with Ca=P ratio by 4:1 , plus vit.D oral drops and oral calcium as maintenance