Hypocalcemia is frequently observed clinical and biochemical abnormality in neonates. In this population, however, the diagnosis of hypocalcemia is complicated by limitations in the interpretation of the total plasma calcium concentration. These limitations are principally the result of the effects of hypoalbuminemia and disorders of acid-base balance on the total calcium concentration. Thus, measurement of ionized calcium must be essential in determining an individual’s true serum calcium status. Small changes in ionized serum calcium levels are poorly tolerated. It is responsible for initiating neuromascular action potentials and is involved in many of the cellular enzymatic reactions as cofactor. Ionic calcium is also crucial for other biochemical process including blood coagulation and cell membrane integrity. Healthy term neonates undergo a physiological nadir in serum calcium levels by 24-48 hours of age. This nadir may drop to hypocalcemia levels in high risk neonates including prematures, infants of diabetic mothers and infants of perinatal asphyxia. This early onset hypocalemia which presents within 72 hours.
Hypocalcemia in this period generally asymptomatic; screening for hypocalcemia at the 24th and 48th hour after birth is warranted for neonates with high risk of developing hypocalcemia and requires treatment with calcium supplementation for at least 72 hours. In contrast, late onset hypocalcemia- which is generally symptomatic, develops after the first 72 hour and toward the end of the first week of life. Babies with this disorder occurs not in preterm. Term babies having excess phosphate intake, hypomagnesemia, hypoparathyroidism, vitamin D deficiency are commonest causes of late onset hypocalcemia and requires longer term therapy. Hypocalcemia in neonates may have apnea, hypotonia, tachycardia, tachypnea, poor feeding, jitteriness, tetany and/or seizures. In this review, we first describe the regulation of normal calcium metabolism and then focus on the various etiologies of hypocalcemia, which are encountered in the neonatal care settings. The approach to the treatment of hypocalcemia and the current consensus on treatment of hypocalcemia in neonates is also presented.

Keywords:Hypocalcemia; Neonates; Calcium Therapy

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Citation

Citation: Mir Mohammad Yusuf. “Hypocalcemia in Neonates: A Significant Concern”. Acta Scientific Paediatrics 4.1 (2020): 39-44.

Copyright

Copyright: © 2020 Mir Mohammad Yusuf. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.