The frequency of early and late neonatal hypocalcemia : prince Zaid Bin Al Hussein Military Hospital experience

Abstract EN

Neonatal hypocalcemia is the most prevalent type of hypocalcemia encountered by pediatricians.

A fall in total calcium below 7.5 mg/dL or ionized calcium concentration below 4.4 mg/dL (or 1.1 mmol/L) usually defines neonatal hypocalcemia.

Neonatal hypocalcemia categorized into early hypocalcemia (within the first72 hour) and late hypocalcemia (occurs after 3-4 days to 6 weeks of life).

The mechanisms for neonatal hypocalcemia are unclear, but may represent a delayed response to the rise of parathyroid hormone (PTH) following hypocalcemia.

Objective: to determine the frequency of early and late neonatal hypocalcemia and the most common risk factors in the development of neonatal hypocalcemia.

Methods: A retrospective study was conducted at the neonatal ward of Prince Zaid Bin Al Hussein Military Hospital (Tafila-Jordan) from June 2018 to May 2019.

The total number of Ninety-four neonates with or without clinical manifestations of hypocalcemia were included in this study from 3542 deliveries, by year, admitted to neonatal units at Prince Zaid Bin Alhussien Military Hospital.

Clinical data were analyzed in terms of gender, gestational age (GA), type of delivery, birth weight, perinatal history, signs, and symptoms at diagnosis of hypocalcemia, and Apgar score at the first minute.

Total serum calcium, magnesium, albumin, phosphorus, total bilirubin, and glucose levels were measured.

Arterial blood gas and chest radiographs were measured.

In all hypocalcemic infants, serum calcium levels and blood samples were obtained before calcium therapy.

We explain the major risk factor to develop neonatal hypocalcemia: premature baby (< 37 weeks of gestational age), low birth weight (< 2500gram), neonatal asphyxia is a condition characterized by an impairment of exchange of the respiratory gases resulting in hypoxemia, hypercapnia and metabolic acidosis.

We excluded all neonates with congenital anomalies or metabolic syndromes.

For statistical evaluation, we used the Microsoft Excel 2010 software and SPSS version 18.

Results: Ninety-four neonates admitted to the neonatal ward were ascertained with a final diagnosis of neonatal hypocalcemia.

Fifty-seven were male (60.6%).

Thirty-seven (39.4%) were female.

Of all mothers, 70.2% delivered their infants through Cesarean Section (CS) and 29.8% had gone through normal vaginal delivery (NVD), and the mean birth weight was 2388 ± 1383 g.

Four neonates (4.26%) had neonatal asphyxia, 47 had premature and low birth weight (51.06%), and 5 cases had diabetic mothers (5.32%).

Sixty cases (63.8%) had early hypocalcemia, while 34 (36.2%) had late hypocalcemia.

Seven cases presented with convulsion, six cases presented with muscle twitch and four cases with poor feeding.

There was a statistically significant prevalence of early and late hypocalcemia among neonates who had a low first minute Apgar score (≤ 5) (P = 0.02, P = 0.03).

Conclusion: The frequency of early hypocalcemia is more common than late hypocalcemia, and the most common risk factors associated with transient hypocalcemia are premature, birth asphyxia, low birth weight, and diabetic mothers.