SYMPOSIUM ON AIIMS PROTOCOLS IN NEONATOLOGY-I Hypocalcemia in the Newborn (original) (raw)

Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?

International Journal of Pediatrics, 2019

Introduction. Hypocalcemia is a common metabolic problem in newborn period and infancy. There is consensus on the treatment of the symptomatic cases while the calcium level at which the treatment will be initiated and the treatment options are still controversial in asymptomatic hypocalcemia.Methods. This review article will cover hypocalcemia with specific reference to calcium homeostasis and definition, etiology, diagnosis, and treatment of hypocalcemia in newborn and infancy period.Results. Hypocalcemia is defined as total serum calcium <8 mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for term infants or preterm infants weighing >1500 g at birth and total serum calcium <7 mg/dL (1.75 mmol/L) or ionized calcium <4 mg/dL (1 mmol/L) for very low birth weight infants weighing <1500 g. Early-onset hypocalcemia is generally asymptomatic; therefore, screening for hypocalcemia at the 24th and 48th hour after birth is warranted for infants with high risk of...

Occurrence of Hypocalcaemia in Admitted Neonates in NICU

Medical Journal of Shree Birendra Hospital

Introduction: Hypocalcaemia is common metabolic manifestation in neonates and associated with both maternal and foetal conditions. Hypocalcaemia is labeled if term neonate’s total serum calcium is < 8 mg/dl and preterm has < 7 mg/dl. Association of neonatal and maternal hypovitaminosis D is very common. . Methods: One year retrospective study was conducted in a tertiary level private children hospital of Kathmandu, Nepal from 2018 June to 2019 July. Total 299 cases were selected and serum calcium were sent and analysed for its association with illness, associated maternal hypovitaminosis D and other relevant maternal tests. Result: Among 686 NICU cases, calcium level was sent for 299 cases. Among these, 254 were term and 45 were preterm babies and male to female ratio was 4:1. Mean calcium in term babies were 8.6 mg/dl and in preterm it was 8.1 mg/dl. Hypocalcaemia was found in 19% of cases with mean calcium level was 7.1 ± 0.84 mg/dl and severe hypocalcaemia accounted for 12...

Approach to Neonatal Hypocalcemia

Newborn, 2022

Hypocalcemia in neonates is defined as total serum calcium concentration less than 7.5-8 mg/dL and/or ionized calcium less than 4.4 mg/dL in neonates (>1500 g) and total serum calcium concentration less than 7 mg/dL or ionized calcium less than 3.6 mg/dL in low-birth-weight neonates (<1500 g). About 80% of the calcium transfer across the placenta occurs in the last trimester. Parathyroid hormone-related peptide (PTHrP) regulates the positive calcium balance in the placenta. Postpartum serum calcium level in neonates depends on an intricate relationship between PTH and renal and skeletal factors. Based on the timing of the presentation, hypocalcemia can be early onset (develops in the first 72 hours of life) and late onset (occurs after 72 hours of life). Causes of early-onset hypocalcemia include prematurity, SGA, IUGR, birth asphyxia, diabetes mellitus, or toxemia in the mother. Late-onset neonatal hypocalcemia may be caused by increased dietary phosphate content, neonatal vitamin D deficiency, hypomagnesemia, hypoparathyroidism, or parathyroid hormone resistance. We present a neonate with hypocalcemia due to transient hypoparathyroidism secondary to maternal adenoma. A thorough history and physical examination are essential to identify at-risk asymptomatic infants who need screening for hypocalcemia. Neonatal hypocalcemia can be a serious event and can cause serious morbidity and mortality. Majority of the early as well as transient late neonatal hypocalcemia resolves completely, while lifelong treatment may be required in some cases depending on the etiology.

Difference of Calcium Levels in Infants with Low Birth Weight

Indonesian Journal of Medicine, 2020

Background: Hypocalcemia is a condition that can cause serious disorders, especially in newborns. The occurrence of hypocalcemia is an event that often occurs in babies born that can be caused due to late parathyroid hormone function in calcium metabolism in the baby's body. Hypocalcemia is often associated with hypotension and disorders of the heart rhythm, symptoms that are often seen are apnea, tachycardia, lethargy, vomiting, and gastrointestinal disorders. This study aimed to analyze differences in calcium level between low birth weight infants. Subjects and Method: A cross sectional study was conducted at Dr Moewardi Hospital, Surakarta, Central Java, from December 2016 to April 2017. A sample of 158 LBW children was selected using consecutive sampling. The dependent variable is a decrease in calcium levels. The independent variable is low birth weight babies. Data collected by medical records. Data were analyzed using multiple logistic regression. Results: Calcium level ≥1.13 mmol/L (OR= 0.30; 95% CI= 0.15 to 0.57; p <0.001), no seizures (OR= 0.20; 95% CI= 0.06 to 0.64; p = 0.004), and QoTC (OR= 0.20; 95% CI= 0.07 to 0.572; p= 0.003) decreased the risk of low birth weight. Conclusion: Calcium level ≥1.13, no seizures, and QoTC decrease the risk of low birth weight.

Hypocalcemia is common in the first 48 h of life in ELBW infants

Journal of Perinatal Medicine, 2008

Background: The incidence of early hypocalcemia in extremely low birthweight (ELBW) infants is unknown because the distribution of serum calcium values in this population is not defined. Objective: To determine the range of serum calcium values in ELBW infants during the first 48 h of life and the risks associated with low values. Design/methods: Retrospective analysis of all ELBW infants admitted on day 1 of life from April 2004 to October 2006. Demographic variables, therapy, serum calcium (Ca), pH, albumin, and blood ionized Ca were recorded. Results: There were 381 Ca levels obtained from 111 patients. Mean Ca was 6.90 mg/dL (1.73 mmol/L) (5 th -95 th percentile: 5.16-8.80). Ca levels rose after 24 h of life. Almost one quarter (23.1%) of the Ca levels were low by current standards. The majority of subjects (59.9%) had at least one hypocalcemic value. Conclusions: Serum Ca values are lower in ELBW infants and inconsequential. Thus, hypocalcemia should be re-defined for ELBW infants.

Incidence of early onset hypocalcaemia in newborns admitted in level III NICU

IP Innovative Publication Pvt. Ltd., 2017

Background: Metabolic derangements like hypoglycaemia, hypocalcaemia, hyponatremia are common in newborns especially at risk babies like immature babies, infants of diabetic mother (IDM), babies with perinatal asphyxia 1-3. Hypocalcaemia can manifest as seizures, apnoea, jitteriness and stridor. (4) But majority of hypocalcaemia in early neonatal period (<72 Hrs.) are asymptomatic, which cannot be picked up easily. No study has been conducted to know the incidence of early onset hypocalcemia in babies admitted in neonatal intensive care unit. Hence we did this study in Baby Memorial Hospital, a tertiary referral hospital, in Calicut; Incidence of early onset hypocalcaemia is more common in high risk neonates (immature babies, infants of diabetic mothers, babies with perinatal asphyxia). Aims of the study: To know the incidence of early onset hypocalcaemia in neonates admitted in NICU. To know the incidence of asymptomatic and symptomatic early onset hypocalcaemia. To know the high risk period of early onset hypocalcaemia. Materials and Methods: A hospital based prospective observational study with a sample size of 150 consecutive babies admitted in NICU. After taking informed consent each baby in NICU underwent serial serum calcium estimation at 24, 48 & 72 hours and serum magnesium & serum albumin estimation at 24 hours. It was decided that if the baby develops symptoms of hypocalcaemia any time before 72 hours; serum calcium, magnesium and albumin estimation would be done again. Observation and results: The overall incidence of early onset hypocalcaemia in Baby Memorial Hospital was 26.7%. This study shows that 24-48 hours of life has highest risk of early onset hypocalcaemia and 80% of hypocalcaemia were asymptomatic. The incidence of early onset hypocalcaemia among infants of diabetic mothers was found to be 52%.The incidence of early onset hypocalcaemia among perinatal asphyxia babies was 35%. Conclusions: Early onset hypocalcaemia is commonly seen in premature babies, infants of diabetic mothers and perinatal asphyxia. Majority of early onset hypocalcaemia are asymptomatic. Hence it is advisable to do routine serum calcium estimation in babies admitted in NICU within 72 hours of life, preferably at 24,48 and 72 hours of life.

Transient Hypercalcemia in Preterm Infants Insights Into Natural History and Laboratory Evaluation

Global Pediatric Health, 2014

A premature male infant was born after 31 weeks gestation with birth weight of 1705 g. He was the first baby of nonrelated Ashkenazi Jewish parents. There was no history of inherited, genetic, or metabolic disorders in the whole family except for nephrolithiasis in the mother's family. On admission to the neonatal intensive care unit he was given parenteral nutrition. Enteral feeds were started on day of life (DOL) 2. Parenteral nutrition was discontinued at DOL 7. Full enteral feeds of mother's milk were achieved on DOL 10, when routine vitamin D supplementation of 400 IU/day was started. Cow's milk-based powdered human milk fortifier (Similac, Ross/Abbott-Promedico) was added from DOL 11. Hypercalcemia was first detected on DOL 16 when total calcium levels went up to 13.6 mg/dL (normal range for term newborn levels = 8-11.3) while ionized calcium levels were also high (5.8-5.9 mg/dL on DOL 19-46) with highest levels of 6.07 mg/dL measured on DOL 28. Laboratory evaluation as well as treatment was initiated (Table 1). Discussion Calcium and phosphorous are essential minerals that are tightly maintained within their normal ranges by the 560818G PHXXX10.

Calcium adjustment equations in neonates and children

Annals of Clinical Biochemistry, 2012

Background: Calcium exists in human blood in a free form and in a form bound to plasma proteins, principally albumin. Since it is the ionized form that is biologically active, it has long been common practice to present calcium adjusted on the basis of serum albumin concentration. The concept of adjusted calcium has only been evaluated in adults. In this study, we evaluated the use of the adult-adjusted equation to report calcium in children. Methods: We searched the laboratory information system over three teaching hospitals for young patients aged between newborn and 18 years old with a request for calcium and albumin analysis but with no evidence of disturbances of calcium homeostasis. These data were organized on the basis of age and was separated into four age groups (birth to 1 month old, 1 month to 1 year old, 1 to 5 years old and 5 to 18 years old). These data were subjected to regression analysis to derive the calcium-adjusted equation for each age group. Results: There is an inverse relationship between the bias value and the age. The younger the age, the higher the difference between the adjusted calcium calculated by the adult equation and that calculated by the age-specific equation. This pattern was maintained on all sites. Conclusion: For all sites, the adult-adjusted calcium equation may be used to calculate the adjusted calcium for children aged one year old and above.