One of lectures presented in our Port said fifth neonatology conference 23-24 October 2014, presented by prof Olfat Fawzy, M.D, M.Sc.,Professor of Endocrinology Al Azhar university

2. •Hypocalcemia is a common
metabolic problem in newborns.
• The diagnosis, clinical
manifestations, and treatment of
neonatal hypocalcemia will be
reviewed.

4. • Patient born preterm at 34 weeks
•Normal spontaneous vaginal
delivery
• Birth Weight: 2050 g
• APGAR 8

5. • 28 year old G1P0
• Irrelevant medical History
•Denies smoking
•No medication use
•No HTN, no DM
•Negative serologic studies

6. • Irritable, with weak cry
• +ve hypertelorism
• jaw held tightly closed
• cleft palate
• CV: RR, systolic murmur
• Extremities: hypertonic

7. • CBC: WNL
• CMP: WNL except Ca
• Ca: 6.0 mg/dL
• P: 9.2 mg/dL (4.5-9.0)
•Mg: 1.5 mEq/L (1.3-2.0)
• PTH: 44 pg/mL (N 40-100)

8. •2D Echo reveals a small VSD
•Hypoplastic thymus

9. •Hypocalcemia
•Hypoparathyroidism
•VSD
•Hypoplastic thymus

12. • Plasma calcium totals 2.4 mM (9.4
mg/dl)
– Free calcium is 1.2 mM

13. – Albumin
– Blood pH
– Serum phosphate
– Serum magnesium
– Serum bicarbonate

16. Hormone Effect Bone Gut Kidney
PTH  Ca  Po4 Increases
Osteoclasts
Indirect
via Vit. D
Ca reab
Po4 exr.
Vit D3  Ca  Po4 No direct
action
 Ca  Po4
absorption
No direct
effect
Calcitonin  Ca  Po4 Inhibits
Osteoclasts
No direct
effect
Ca & Po4
excretion

17. • Ca messenger system – regulates cell
function
• Activates cellular enzyme cascades
• Smooth muscle and myocardial
contraction
•Nerve impulse conduction
• Secretory activity of glands

18. • Neuromuscular
excitability
• Tetany
• Seizures
• Stridor or cyanosis
from laryngospasm
• Hypotension
• Impaired cardiac
contractility

19. •May be unspecific
– Asymptomatic
– Lethargy
– Poor feeding
– Vomiting
– Abdominal distention

21. • Fetus: Ca and P concentration
higher than mother plasma, s Ca
falls at 24 hrs.
•Neonates: Ca lower than children at
2nd and 3th day
• Return to normal by 5-10 days

22. •Total serum Ca less than:
– 7.0 mg/dL in Preterm infants
– 8.0 mg/dL in Term newborns
– 8.8 mg/dL in children

24. Early neonatal hypocalcemia (48-72 hours)
Prematurity
Poor intake, hypoalbuminemia, ↓ responsiveness
to vit D
Birth asphyxia
Delayed feeding, ↑ calcitonin, endogenous
phosphate load , alkali therapy
Infant of diabetic mother
Mg depletion functional hypoparathyroidis→ m →
↓ Ca
IUGR

25. Late neonatal hypocalcemia (Full
term)
•Exogenous phosphate load
•Mg deficiency
•Transient hypoparathyroidism of
newborn
•Congenital Hypoparathyroidism
•Maternal Vit D deficiency
•Maternal Hyperparathyroidism
•Gentamycin

26. Bicarbonate infusion → metabolic
alkalosis
Transfusion with citrated blood→
formation of Ca complexes, ↓ Ca++
Lipid infusions → Ca complexes with
FFAs → ↓ Ca++
Phototherapy for hyperbilirubinemia
Acute renal failure →
hyperphosphatemia
Rotavirus infection

27. • ↓ Mg → impaired PTH secretion &
resistance to PTH → hypocalcemia
•Usually idiopathic & transient
•May be secodary to disorders of
intestinal and/or renal tubular Mg
transport

28. • Antagonizes PTH secretion or
actions → ↑ Ca & P deposition in
bones → hypocalcemia.

29. Cardiac defects, Abnormal facies,
Thymic hypoplasia, Cleft palate, and
Hypocalcemia caused by
Chromosome 22 deletion
DiGeorge Syndrome is a severe
phenotype of this group of related
disorders.
FISH establishes the diagnosis.

31. •What is the diagnosis?
•How could we confirm the
diagnosis?

32. • Total Ca
• Ionized Ca
• Phosphorus
•Magnesium
• PTH
• Vitamin D
• Liver function
• Renal function

33. Only in infants with risk factors
Measure Ca at 24, and 48 hrs of age.
Measure Ca in infants with congenital
heart ds.
Ionized Ca should be the primary
measurement.

34. 1. Depends on underlying cause &
severity
2. Mild asymptomatic: ↑ dietary Ca by
initiating early feeding
3. For infants who require parenteral
nutrition, Ca is added to the solution .
4. If symptomatic: treat immediately

35. –Ca gluconate:10 mg/kg (1 ml/kg of
10% solution) Slowly IV
–Start oral Calcium as soon as possible
–Early neonatal hypocalcaemia
normalizes in 2-3 d

36. Late neonatal hypocalcemia
–Associated with ­ S-phosphate
– Decrease phosphate intake
–Give calcium containing phosphate
binder
–Oral calcium gluconate 100
mg/kg/dose 4 hourly

37. –Tissue necrosis/calcification if
extravasates
–Calcium can inhibit sinus node ®
bradycardia + arrest
–Avoid complete correction of
hypocalcemia
–Give Ca before correcting acidosis
–If ¯ Mg – first treat & correct
hypomagnesemia