- Steven A Abrams, MD
Steven A Abrams, MD
- Section Editor — Neonatology
- Professor, Department of Pediatrics
- Dell Medical School at the University of Texas at Austin
- Section Editors
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Joseph I Wolfsdorf, MB, BCh
Joseph I Wolfsdorf, MB, BCh
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Harvard Medical School
Hypocalcemia is a common metabolic problem in newborns.
The diagnosis, clinical manifestations, and treatment of neonatal hypocalcemia are reviewed here. Calcium (Ca) requirements, neonatal bone health, and the etiology of hypocalcemia after the neonatal period are discussed elsewhere. (See "Management of neonatal bone health" and "Etiology of hypocalcemia in infants and children".)
During pregnancy, calcium (Ca) is transferred actively from the maternal circulation to the fetus by a transplacental Ca pump, which is regulated by parathyroid hormone-related peptide (PTHrP) . The majority of fetal Ca accretion occurs in the third trimester. This process results in higher plasma Ca concentrations in the fetus than in the mother, which in turn results in fetal total and ionized Ca concentrations of 10 to 11 mg/dL (2.5 to 2.75 mmol/L) and 6 mg/dL (1.5 mmol/L), respectively, in umbilical cord blood at term .
After the abrupt cessation of placental transfer of Ca at birth, neonatal total serum Ca falls to 8 to 9 mg/dL (2 to 2.25 mmol/L), and ionized Ca falls to as low as 4.4 to 5.4 mg/dL (1.1 to 1.35 mmol/L) at 24 hours after delivery [3,4]. Serum Ca concentration subsequently rises, reaching levels seen in older children and adults by two weeks of age .
To evaluate calcium (Ca) status, we recommend measurement of ionized Ca in whole blood rather than total Ca, because it more accurately reflects the physiologically available Ca . (See "Relation between total and ionized serum calcium concentrations".)
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- PERINATAL METABOLISM
- EARLY HYPOCALCEMIA
- Fetal growth restriction
- Infants of diabetic mothers
- Birth asphyxia
- - Syndromes
- CATCH-22 and DiGeorge syndrome
- Other syndromes
- - Maternal hyperparathyroidism
- - Hypomagnesemia
- LATE HYPOCALCEMIA
- High phosphate intake
- Other causes
- Unclear role for vitamin D insufficiency
- - Maternal vitamin D deficiency
- CLINICAL MANIFESTATIONS
- FURTHER EVALUATION
- Asymptomatic infants
- Symptomatic infants
- - Acute therapy
- Risks of acute calcium infusion
- - Maintenance therapy
- Correction of hypomagnesemia
- SUMMARY AND RECOMMENDATIONS