1. Jomana Al-Sulaiman,MD
8l5l2009

2. Jomana Al-Sulaiman,MD
8l5l2009

3. Maternal vitamin D insufficiency is not
.uncommon
Infants born to mothers who are deficient in
vitamin D, and in addition are breastfed, are at
risk of developing vitamin D deficiency
and hypocalcemia
Jomana Al-Sulaiman,MD
8l5l2009

4. The correlation between maternal vitamin D and
neonatal vitamin D and hypocalcemia is not
well documented
Jomana Al-Sulaiman,MD
8l5l2009

5. A 15-days-old, male infant presented to Emergency
Department . (ED) with generalized seizures
FTNVD,APGARS were 8 and 9
.Exclusively breast fed since birth
Mother was neither taking nutritional, nor vitamin
supplements during pregnancy
Jomana Al-Sulaiman,MD
8l5l2009

6. : On the day of presentation
Tonic-Clonic generalized convulsion lasted for
. two minutes
Physical exam including neurological exam was
. normal
Jomana Al-Sulaiman,MD
8l5l2009

7. :Laboratory profile
Normal complete blood count
Normal blood urea nitrogen, creatinine, and
.albumin
.A blood culture and urine culture were negative
The random blood glucose was 80 mg/dL
Jomana Al-Sulaiman,MD
8l5l2009

8. Electroencephalogram (EEG) and Magnetic
Resonance Imaging (MRI) of the brain were
.normal
Normal thymus shadow and great vessels were
.shown on chest X-ray
.Ultrasound scan of the renal system was normal
Jomana Al-Sulaiman,MD
8l5l2009

9. Serum calcium ,magnesium were low
Screening serum calcium, phosphate, magnesium,
25 hydroxy vitamin D, and intact parathyroid
hormone levels were drawn for both the baby
and the mother
Jomana Al-Sulaiman,MD
8l5l2009

10. Time Serum Ca
( 8.8-10.5)
mg/dl
Serum Po4
3.5-)
mg/l(6.7
Serum MG
1.8-)
mg/dl(2.4
25
Hydroxy
vit D3
( 25-57)
mmol/l
Intact PTH
25-)
pgm/ml(75
Admission (low )5.7 (high)9.4 (low)1.1 (low)12 (NL )30
48hours (low)9.8 (high)7 (NL)2.1 ----- -----
5th days 10.3 (NL)5.9 (NL)2.2 ----- -----
Table1. Infant’s Pertinent Laboratory Data Jomana Al-Sulaiman,MD
8l5l2009

11. Screening Serum Ca
( 8.8-10.5)
mg/dl
Serum Po4
3.5-)
mg/l(6.7
Serum MG
1.8-)
mg/dl(2.4
25
Hydroxy
vit D3
25-)
mmol/l(57
Intact PTH
25-)
pgm/ml(75
11.6 2.1 2 10 40
Table 2. Mother’s Pertinent Laboratory Data
Jomana Al-Sulaiman,MD
8l5l2009

12. :The baby was started on
(,Alphacalcidol (100 ng/kg once a day
Calcium gluconate infusion(1 ml/kg then 500
(mg/kg/day
Jomana Al-Sulaiman,MD
8l5l2009

13. On day two of admission oral calcium carbonate
at 50 mg /kg/day in 4 divided doses
alphacalcidol at 0.02 microgram /kg/day in two
.divided doses were started
After 5 days the calcium levels had returned to
.normal
Jomana Al-Sulaiman,MD
8l5l2009

14. The baby was discharged home on day seven
Oral calcium and alphacalcidol continued till 10
.weeks of age
The infant’s calcium profile was monitored
.regularly
Jomana Al-Sulaiman,MD
8l5l2009

15. The follow-up serum calcium level, up to 1 year,
. has been normal
The infant development was according to his
.chronological age
Jomana Al-Sulaiman,MD
8l5l2009

16. Most cases of neonatal hypocalcemia occur
soon after birth, especially in those high-risk
infants with low birth weight, intrauterine growth
restriction , perinatal asphyxia and diabetic
.mothers Jomana Al-Sulaiman,MD
8l5l2009

17. The hypocalcemic seizures are often generalised
. but can also appear focally
Vitamin D serum levels should be checked in all
. cases
Jomana Al-Sulaiman,MD
8l5l2009

18. Therapy with anticonvulsants is typically not
.needed
Treatment for hypocalcemic seizures is calcium
. replacement
Jomana Al-Sulaiman,MD
8l5l2009

19. It is safer to use calcium gluconate rather than
calcium chloride because it is less irritating and
less likely to cause tissue necrosis if extravasation
.occurs
Neonatologist should be alert to the signs of
congenital rickets to start the appropriate
.treatment and prevent the earliest complications
Jomana Al-Sulaiman,MD
8l5l2009

20. Jomana Al-Sulaiman,MD
8l5l2009