Acta Scientific Paediatrics (ISSN: 2581-883X)

Review Article Volume 3 Issue 1

Hypocalcemia in Neonates: A Significant Concern

Mir Mohammad Yusuf*

Assistant Professor, Critical Care Pediatric, Bangladesh Institute of Child Health (BICH), Dhaka Shishu (Children) Hospital, Bangladesh

*Corresponding Author: Mir Mohammad Yusuf, Assistant Professor, Critical Care Pediatric, Bangladesh Institute of Child Health (BICH), Dhaka Shishu (Children) Hospital, Bangladesh.

Received: December 17, 2019; Published: December 26, 2019

×

  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

×

References

  1. Cardenas-Rivero N., et al. “Hypocalcaemia in critically ill children”. Journal of Pediatrics 114.6 (1989): 946-951.
  2. Chernow B., et al. “Hypocalcaemia in critically ill patients”. Critical Care Medicine 10.12 (1982): 848-851.
  3. Desai TK., et al. “Hypocalcemia and hypophosphatemia in acutely ill patients”. Critical Care Clinics 3.4 (1987): 927-941.
  4. Zivin JR., et al. “Hypocalcemia: a pervasive metabolic abnormality in the critically ill”. American Journal of Kidney Diseases 37.4 (2001): 689-698.
  5. Aderka D., et al. “Bacteremic hypocalcaemia. A comparison between the calcium levels of bacteremic and nonbacteremic patients with infection”. Archives of Internal Medicine 147.2 (1987): 232-236.
  6. Taylor B., et al. “Ionized hypocalcemia in critically ill patients with sepsis”. Canadian Journal of Surgery 21.5 (1978): 429-433.
  7. Zaloga GP and Chernow B. “The multifactorial basis for hypocalcemia during sepsis. Studies of the parathyroid hormone-vitamin D axis”. Annuals of Internal Medicine 107 (1987): 36-41.
  8. Lind L., et al. “Hypocalcemia and parathyroid hormone secretion in critically ill patients”. Critical Care Medicine 28 (2000): 93-99.
  9. Moore EW. “Ionized calcium in normal serum, ultrafiltrates, and whole blood determined by ion-exchange electrodes”. Journal of Clinical Investigation 49.2 (1970): 318-334.
  10. Zaloga GP., et al. “Free fatty acids alter calcium binding: a cause for misinterpretation of serum calcium values and hypocalcaemia in critical illness”. The Journal of Clinical Endocrinology and Metabolism 64 (1987): 1010-1014.
  11. Van Abel M., et al. “The epithelial calcium chanels TRPV5 and TRPV6: regulation and implications for disease”. Naunyn-Schmiedeberg's Archives of Pharmacology 371.14 (2005): 295-305.
  12. Tsang RC., et al. “Possible pathogenetic factors in neonatal hypocalcaemia of prematurity. The role of gestation hyperphosphatemia, hypomagnesaemia, urinary calcium loss, and parathormone responsiveness”. Journal of Pediatrics 82.3 (1973): 423-429.
  13. Nekvasil R., et al. “Detection of early onset neonatal hypocalcaemia in low birth weight infants Q-Tc and Q-oTc interval measurement”. Acta Paediatrica Academiae Scientiarum Hungaricae 21.4 (1980): 203-210.
  14. Venkataraman PS., et al. “Lowered serum Ca, blood ionized Ca, and unresponsive serum parathyroid hormone with oral glucose ingestion in infants of diabetic mothers”. Journal of Pediatric Gastroenterology and Nutrition 6.6 (1987): 931-935.
  15. Minagawa M., et al. “Transient pseudohypoparathyroidism of the neonate”. European Journal of Endocrinology 133.2 (1995): 151-155.
  16. IP P. “Neonatal convulsion revealing maternal hyperparathyroidism: an unusual case of late neonatal hyperparathyroidism”. Archives of Gynecology and Obstetrics 268.3 (2003): 227-229.
  17. Venkataraman PS., et al. “Late infantile tetany and secondary hyperparathyroidism in infants fed humanized cow milk formula. Longitudinal follow-up”. The American Journal of Diseases of Children 139.7 (1985): 664-668.
  18. Shprintzen RJ. “Velo-cardio-facial syndrome: 30 years of study”. Developmental Disabilities Research Reviews 14.1 (2008): 3-10.
  19. Cuneo BF., et al. “Evolution of latent hyperparathyroidism in familial 22q11 deletion syndrome”. American Journal of Medical Genetics 69 (1997): 50-55.
  20. Hasegawa T., et al. “The transition from latent to overt hyperparathyroidism in a child with CATCH 22 who showed subnormal parathyroid hormone response to ethylenediaminetetraacetic acid infusion”. European Journal of Pediatrics 155.3 (1996): 255.
  21. Imrie CW., et al. “Hypocalcaemia of acute pancreatitis: the effect of hypoalbuminaemia”. Current Medical Research and Opinion 4.2 (1976): 101-116.
  22. Desai TK., et al. “Parathyroid-vitamin D axis in critically ill patients with unexplained hypocalcemia”. Kidney International 22 (1987): S225-S228.
  23. Ghent S., et al. “Refractory hypotension associated with hypocalcemia and renal disease”. American Journal of Kidney Diseases 23.3 (1994): 430-432.
  24. Sung JK., et al. “A case of hypocalcemia-induced dilated cardiomyopathy”. Journal of Cardiovascular Ultrasound 18 (2010): 25-27.
  25. Jankowski S and Vincent JL. “Calcium administration for cardiovascular support in critically ill patients: when is it indicated?” Journal of Intensive Care Medicine 10.2 (1995): 91-100.
  26. Vernal S., et al. “Hypocalcemia nutritional rickets: a curable cause of dilated cardiomyopathy”. Journal of Tropical Pediatrics 57.2 (2011): 126-128.
  27. Bartoszewska M., et al. “Vitamin D, muscle function, and exercise performance”. Pediatric Clinics of North America 57 (2010): 849-861.
  28. Forskythe RM., et al. “Parenteral calcium for intensive care unit patients”. Cochrane Database System Review 4 (2008): CD006163.
  29. “Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 10: pediatric advanced life support. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation”. Circulation 102.8 (2000): 1291-1342.
  30. Srinivasan V., et al. “Calcium use in- hospital pediatric cardiopulmonary resuscitation a report from the National Registry of Cardiopulmonary Resuscitation”. Pediatrics 121.5 (2008): 1144-1151.
  31. American Heart Association. “2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients pediatric advanced life support”. Pediatrics 117 (2006): 1005-1028.
  32. Dellinger RP., et al. “Surviving Sepsis Campaign international guidelines for management of severe sepsis and septic shock: 2008”. Critical Care Medicine 36.10 (2008): 296-327.
  33. Boehning D., et al. “Cytochrome c binds to inositol (1,4,5) triphosphate receptors, amplifying calcium dependent apoptosis”. Nature Cell Biology 5.12 (2003): 1051-1061.
  34. Szydlowska K and Tymianski M. “Calcium, ischemia and excitotoxicity”. Cell Calcium 47.2 (2010): 122-129.
  35. Murgia M., et al. “Controlling metabolism and cell death: at the heart of mitochondrial calcium signalling”. Journal of Molecular and Cellular Cardiology 46.6 (2009): 781-788.
×

Citation

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



Member In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for March Issue
    The last date for submission of articles for regular Issues is March 10, 2020.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US