Neonatal Hypocalcaemia

Hypocalcemia is a total serum calcium concentration of <8 mg / dl (<2 mmol / l) at term infants or <7 mg / dl (<1.75 mmol / l) in premature infants before. It is also defined as a mirror of the ionized calcium of <3.0-4.4 mg / dl (<0.75 to 1.10 mmol / l), depending on the method used (type of electrode). Symptoms are mainly neurological and include hypotension, apnea and tetany. Treatment consists of po or iv Calcium supplementation.

Hypocalcemia is a total serum calcium concentration of <8 mg / dl (<2 mmol / l) at term infants or <7 mg / dl (<1.75 mmol / l) in premature infants before. It is also defined as a mirror of the ionized calcium of <3.0-4.4 mg / dl (<0.75 to 1.10 mmol / l), depending on the method used (type of electrode). Symptoms are mainly neurological and include hypotension, apnea and tetany. Treatment consists of po or iv Calcium supplementation.

(See also general discussion hypocalcemia.) A hypocalcemia is (<2 mmol / l) at a total serum calcium concentration of <8 mg / dl in term infants or <7 mg / dl (<1.75 mmol / L) in front of prematurity. It is also defined as a mirror of the ionized calcium of <3.0-4.4 mg / dl (<0.75 to 1.10 mmol / l), depending on the method used (type of electrode). Symptoms are mainly neurological and include hypotension, apnea and tetany. Treatment consists of po or iv Calcium supplementation. Etiology Neonatal hypocalcemia occurs in two forms: Early onset (within the first 2 days of life) Late onset (> 3 days) (in rare cases, some children with a congenital hypoparathyroidism eg with DiGeorge syndrome with agenesis or dysgenesis. the parathyroid glands), both the early and the late (prolonged) hypocalcemia. Early hypocalcemia Risk factors for early hypocalcemia include prematurity, SGA, maternal diabetes and perinatal asphyxia. The mechanisms vary. Normally, the parathyroid hormone helps maintain normal calcium levels when the constant transmission ionized calcium through the placenta at birth is interrupted. A transient relative hypoparathyroidism can hypocalcemia in premature infants and some SGA children whose parathyroid function is not adequate, and in infants of mothers with diabetes or hyperparathyroidism, because these women have ionized calcium during pregnancy than normal levels cause. As part of perinatal asphyxia may lead to an increase in the Serumkalzitonins, which inhibits calcium release in bone and a hypocalcemia caused. In other newborns, the normal response of the kidney phosphaturic missing on parathyroid hormone; the increased phosphate levels leads to Hypokalzämie.Späte hypocalcemia The cause of the late (late-onset) hypocalcemia is often the inclusion of cow’s milk or commercial finished foods with a high phosphate support; increased phosphate levels lead to hypocalcaemia. Symptoms Symptoms of hypocalcemia in neonates are rare, unless the serum calcium level is <7 mg / dl (<1.75 mmol / l) or the ionized calcium is <3.0 mg / dl (<0.75 mmol / l). Possible symptoms include hypotension, tachycardia, tachypnea, apnea, refusing food, tremors, tetany and seizures. Similar symptoms also occur with hypoglycemia and opioid withdrawal. Diagnosis Whole or ionized serum calcium level The diagnosis of neonatal hypocalcemia is performed by the determination of the total or ionized serum calcium; the physiologic determination is that of the ionized calcium, as this obviates the question of the protein concentration and the pH. A prolongation of the corrected QT interval (QTc) in the ECG may be indicative of hypocalcemia. Clinical calculator: QT interval correction (ECG) Treatment Early onset: 10% calcium gluconate i.v. Late start: calcitriol or calcium p.o. The early form of hypocalcemia usually returns to normal within a few days, asymptomatic newborns with a calcium levels> 7 mg / dL or ionized calcium> 3.5 mg / dL rarely require treatment. Full-term infants with mirrors of <7 mg / dl and premature babies with a Kalziumert i.v. <6 mg / dl (<1.5 mmol / l) should be at 2 ml / kg of 10% calcium gluconate (200 mg / kg) in a slow Infusion over 30 min are treated. Since it can come at too rapid infusion of bradycardia, the heart rate monitoring is required. The surroundings of the i.v. Cannula must be repeated controlled because irritation with local tissue damage and necrosis are possible by infiltration of the tissue with a calcium solution. Among the manifestations of calcium infiltration include skin redness, scaling, necrosis or slough, it can be observed on the wrist and radial nerve damage. After the acute treatment of hypocalcemia calcium gluconate can be mixed in the maintenance infusion solution and administered continuously. The starting dose is 400 mg / kg / day calcium gluconate and can, if required for the prevention of relapse to 800 mg / kg / day can be increased. Once the food intake is oral, the food with the same total daily dose of calcium gluconate in the form of 10% calcium gluconate can be supplemented. The supply of calcium gluconate is usually required only for a few days. The treatment of hypocalcemia late onset by the administration of calcitriol or addition of calcium to the food so that a molar calcium to phosphate ratio of 4: 1 is achieved, to resume normal calcium levels are reached. Oral calcium preparations have a high content of sucrose and can v. a. result in premature babies diarrhea. Important points hypocalcemia in neonates usually occurs within the first two days of life and is mostly due to prematurity, SGA, maternal diabetes mellitus or causes hyperparathyroidism and perinatal asphyxia. In newborns can cause hypotension, tachycardia, tachypnea, apnea, refusing food, tremors, tetany and seizures. Diagnosis through measurement of the total or ionized serum calcium; Measurement of the glucose level in order to avoid hypoglycemia. Treat early onset hypocalcemia with i.v. 10% calcium gluconate, followed by several days of oral calcium supplementation.

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