1. Chapter 38 Neonatal Hypocalcemia © American Society for Bone and Mineral Research Contributed by Thomas O. Carpenter

2. Neonatal Hypocalcemia  Early: Usually transient; occurs by day 3-4 of life; seen in infants of diabetic mothers, perinatal asphyxia, pre-eclampsia, an exaggerated post-natal decrease in serum calcium 6Late: Occurs after day 5, associated with phosphate load; more likely to be long-standing,  Other Causes: Infants of hyperparathyroid or vitamin D deficient mothers, hypomagnesemia, rickets (vitamin D deficiency), osteopetrosis © American Society for Bone and Mineral Research Contributed by Thomas O. Carpenter

3. Treatment of Neonatal Hypocalcemia Acute tetany: –Slow IV infusion of Ca gluconate (< 1 ml/min of 10% solution) –1-3 ml will usually arrest convulsions –Do not exceed 20 mg of elemental Ca/kg body wt –May repeat up to 4 x in 24 hr period –Check Mg status Maintenance therapy: –20-60 mg/kg of elemental Ca over 24 hr © American Society for Bone and Mineral Research Contributed by Thomas O. Carpenter

4. Neonatal Hypocalcemia: Presentation Often asymptomatic Generalized or focal clonic seizures Jitteriness, twitches, limb-jerking Hyperacusis, laryngospasm Non-specific signs: – irritability, apnea, tachycardia, tachypnea, cyanosis, edema, vomiting © American Society for Bone and Mineral Research Contributed by Thomas O. Carpenter