Hypocalcemia in the newborn: analysis of clinical features and risk factors

Abstract

Background: Neonatal hypocalcaemia (hypoCa) is frequently observed clinical and laboratory finding in neonates. A healthy newborn reaches the lowest serum calcium level at 24–48 hours of age. It can deteriorate to hypoCa levels in newborns with specific risk factors. Methods: In the analysis, 50 newborns with hipoCa were included. Details of clinical signs and laboratory investigations were obtained from the available medical records and were statistical-ly analysed. Results: Early hipoCa was identified in 41 (82 %) and late in 9 (18 %) cases; 36 (72 %) were asymp-tomatic and 14 (28 %) symptomatic with the average serum calcium 1.8 (lowest 1.27) and ionized 0.92 mmol /l (lowest 0.63 mmol/l); 18 (36 %) infants had sepsis, 14 (28 %) were premature, 13 (26 %) mothers had gestational diabetes, three were after perinatal asphyxia, three after exchange transfusion, two after bleeding in twins and two had DiGeorge syndrome. Serum levels of 25-OH-vitamin D analysed in 13 newborns was lower than 52 nmol/l; 70 % of convulsions associated with HipoCa were due to vitamin D insuficiency. Conclusion: Neonatal sepsis, maternal gestational diabetes, prematurity and vitamin D deficiency are the predominant risk factors. A low neonatal vitamin D reservoir can be associated with the development of PTH insufficiency, resulting in hipoCa, which can be presented with neonatal convulsions. The results suggest the need to establish guidelines for the prophylactic treatment of pregnant women with vitamin D.