Background: Hypocalcemia is a common metabolic disorder in the neonatal period and may involve life-threatening situations. The aim is to analyze the main causes of hypocalcemia and its management.
Objective and hypotheses: The aim is to analyze the main causes of hypocalcemia and its management.
Method: Retrospective descriptive study by reviewing reports of 75 patients diagnosed of neonatal hypocalcemia (total Ca <7.6 mg/dl and/or ionic fraction<1 mmol/l) in the last 5 years (20092013) in a tertiary hospital. It was considered deficiency <20 and severe <10 ng/ml.
Results: 70% of the babies were born at term. There was no mother with phosphocalcic alterations. 18% of the mothers had gestational diabetes. Mean plasma calcium levels at diagnosis 6.2 mg/dl, and ionic fraction 0.7 mmol/l. Calcemia recovered after 9 days on average. Etiology by order of frequency: vitamin D deficiency (31 cases, 41%, six of them were also premature, 11 (33%) associated transient hypoparathyroidism), prematurity (13, 17%), idiopathic transient hypocalcemia (17, 22%), transient hypoparathyroidism (4, 5%), infant of diabetic mother (5, 6%), primary hypoparathyroidism (2, 2.6%), suffocation (2, 2.6%), and renal failure (1, 1.3%). Regarding the clinic, 93% were asymptomatic, two had tremors, and four generalized seizures. Those four neonates had vitamin D deficiency (<4 ng/ml). There were five patients with radiological signs of rickets. 40% of deficient patients received vitamin D at prophylactic doses (400 IU/day) and 60% at treatment doses (10002000 IU/day). 20% received oral calcium when they were discharged. We did maternal study in 7 (20%) of the deficient patients. All the mothers had severe vitamin D deficiency and none had received supplements during pregnancy. Most of them were dark skinned.
Conclusions: Vitamin D deficiency is the most common etiology of hypocalcemia in our sample. Transient hypoparathyroidism may aggravate the clinical manifestations of vitamin D deficiency and makes the diagnosis more difficult. The determination of vitamin D levels in risky pregnancies is essential to prevent perinatal complications.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology