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Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?
Int J Pediatr 2019; 2019:4318075IJ

Abstract

Introduction

Hypocalcemia is a common metabolic problem in newborn period and infancy. There is consensus on the treatment of the symptomatic cases while the calcium level at which the treatment will be initiated and the treatment options are still controversial in asymptomatic hypocalcemia.

Methods

This review article will cover hypocalcemia with specific reference to calcium homeostasis and definition, etiology, diagnosis, and treatment of hypocalcemia in newborn and infancy period.

Results

Hypocalcemia is defined as total serum calcium <8 mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for term infants or preterm infants weighing >1500 g at birth and total serum calcium <7 mg/dL (1.75 mmol/L) or ionized calcium <4 mg/dL (1 mmol/L) for very low birth weight infants weighing <1500 g. Early-onset hypocalcemia is generally asymptomatic; therefore, screening for hypocalcemia at the 24th and 48th hour after birth is warranted for infants with high risk of developing hypocalcemia. Late-onset hypocalcemia, which is generally symptomatic, develops after the first 72 h and toward the end of the first week of life. Excessive phosphate intake, hypomagnesemia, hypoparathyroidism, and vitamin D deficiency are commonest causes of late-onset hypocalcemia. Hypocalcemia should be treated according to etiology. Calcium replacement is the cornerstone of the treatment. Elementary calcium replacement of 40 to 80 mg/kg/d is recommended for asymptomatic newborns. Elementary calcium of 10 to 20 mg/kg (1-2 mL/kg/dose 10% calcium gluconate) is given as a slow intravenous infusion in the acute treatment of hypocalcemia in patients with symptoms of tetany or hypocalcemic convulsion.

Conclusion

Since most infants with hypocalcemia are usually asymptomatic, serum total or ionized calcium levels must be monitored in preterm infants with a gestational age <32 weeks, small for gestational age infants, infants of diabetic mothers, and infants with severe prenatal asphyxia with a 1 min Apgar score of <4. The treatment of hypocalcemia should be initiated immediately in infants with reduced calcium levels while investigating the etiology.

Authors+Show Affiliations

Hacettepe University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Ankara, Turkey.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31320908

Citation

Vuralli, Dogus. "Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?" International Journal of Pediatrics, vol. 2019, 2019, p. 4318075.
Vuralli D. Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated? Int J Pediatr. 2019;2019:4318075.
Vuralli, D. (2019). Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated? International Journal of Pediatrics, 2019, p. 4318075. doi:10.1155/2019/4318075.
Vuralli D. Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated. Int J Pediatr. 2019;2019:4318075. PubMed PMID: 31320908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated? A1 - Vuralli,Dogus, Y1 - 2019/06/19/ PY - 2019/01/03/received PY - 2019/05/28/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline SP - 4318075 EP - 4318075 JF - International journal of pediatrics JO - Int J Pediatr VL - 2019 N2 - Introduction: Hypocalcemia is a common metabolic problem in newborn period and infancy. There is consensus on the treatment of the symptomatic cases while the calcium level at which the treatment will be initiated and the treatment options are still controversial in asymptomatic hypocalcemia. Methods: This review article will cover hypocalcemia with specific reference to calcium homeostasis and definition, etiology, diagnosis, and treatment of hypocalcemia in newborn and infancy period. Results: Hypocalcemia is defined as total serum calcium <8 mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for term infants or preterm infants weighing >1500 g at birth and total serum calcium <7 mg/dL (1.75 mmol/L) or ionized calcium <4 mg/dL (1 mmol/L) for very low birth weight infants weighing <1500 g. Early-onset hypocalcemia is generally asymptomatic; therefore, screening for hypocalcemia at the 24th and 48th hour after birth is warranted for infants with high risk of developing hypocalcemia. Late-onset hypocalcemia, which is generally symptomatic, develops after the first 72 h and toward the end of the first week of life. Excessive phosphate intake, hypomagnesemia, hypoparathyroidism, and vitamin D deficiency are commonest causes of late-onset hypocalcemia. Hypocalcemia should be treated according to etiology. Calcium replacement is the cornerstone of the treatment. Elementary calcium replacement of 40 to 80 mg/kg/d is recommended for asymptomatic newborns. Elementary calcium of 10 to 20 mg/kg (1-2 mL/kg/dose 10% calcium gluconate) is given as a slow intravenous infusion in the acute treatment of hypocalcemia in patients with symptoms of tetany or hypocalcemic convulsion. Conclusion: Since most infants with hypocalcemia are usually asymptomatic, serum total or ionized calcium levels must be monitored in preterm infants with a gestational age <32 weeks, small for gestational age infants, infants of diabetic mothers, and infants with severe prenatal asphyxia with a 1 min Apgar score of <4. The treatment of hypocalcemia should be initiated immediately in infants with reduced calcium levels while investigating the etiology. SN - 1687-9740 UR - https://www.unboundmedicine.com/medline/citation/31320908/Clinical_Approach_to_Hypocalcemia_in_Newborn_Period_and_Infancy:_Who_Should_Be_Treated L2 - https://dx.doi.org/10.1155/2019/4318075 DB - PRIME DP - Unbound Medicine ER -
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