- 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 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 is transferred actively from the maternal circulation to the fetus by a transplacental Ca pump 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 and leads to fetal hypercalcemia, with 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, total serum Ca concentration falls to 8 to 9 mg/dL (2 to 2.25 mmol/L) and ionized Ca to as low as 4.4 to 5.4 mg/dL (1.1 to 1.35 mmol/L) at 24 hours [3,4]. Serum Ca concentration subsequently rises, reaching levels seen in older children and adults by two weeks of age .
Within the plasma, calcium (Ca) circulates in different forms. Approximately 40 percent is bound to serum proteins, principally albumin; 10 percent is complexed with citrate, bicarbonate, sulfate, or phosphate; and 50 percent exists as the physiologically important ionized (or free) calcium . The ionized Ca concentration is tightly regulated by parathyroid hormone and vitamin D.
- Kovacs CS, Lanske B, Hunzelman JL, et al. Parathyroid hormone-related peptide (PTHrP) regulates fetal-placental calcium transport through a receptor distinct from the PTH/PTHrP receptor. Proc Natl Acad Sci U S A 1996; 93:15233.
- Rubin LP, Posillico JT, Anast CS, Brown EM. Circulating levels of biologically active and immunoreactive intact parathyroid hormone in human newborns. Pediatr Res 1991; 29:201.
- Loughead JL, Mimouni F, Tsang RC. Serum ionized calcium concentrations in normal neonates. Am J Dis Child 1988; 142:516.
- Wandrup J, Kroner J, Pryds O, Kastrup KW. Age-related reference values for ionized calcium in the first week of life in premature and full-term neonates. Scand J Clin Lab Invest 1988; 48:255.
- Rubin LP. Disorders of calcium and phosporus metabolism. In: Avery's Diseases of the Newborn, 7th ed, Taeusch HW, Ballard RA (Eds), WB Saunders, Philadelphia 1998. p.1189.
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- Camadoo L, Tibbott R, Isaza F. Maternal vitamin D deficiency associated with neonatal hypocalcaemic convulsions. Nutr J 2007; 6:23.
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- Venkataraman PS, Tsang RC, Greer FR, et al. Late infantile tetany and secondary hyperparathyroidism in infants fed humanized cow milk formula. Longitudinal follow-up. Am J Dis Child 1985; 139:664.
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- PERINATAL METABOLISM
- EARLY HYPOCALCEMIA
- Infants of diabetic mothers
- Birth asphyxia
- Intrauterine growth restriction
- - DiGeorge syndrome
- - Maternal hyperparathyroidism
- - Hypomagnesemia
- Other causes
- - Gentamicin therapy
- - Maternal vitamin D deficiency
- LATE HYPOCALCEMIA
- Vitamin D insufficiency
- High phosphate intake
- Other causes
- CLINICAL MANIFESTATIONS
- Symptomatic infants
- - Risks of calcium infusion
- Correction of hypomagnesemia