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Jomana Al-Sulaiman,MD 8l5l2009
Jomana Al-Sulaiman,MD 8l5l2009
Maternal vitamin D insufficiency is not uncommon.
Infants born to mothers who are deficient in vitamin D, and in addition are breastfed, are at risk of developing vitamin D deficiency and hypocalcemia
Jomana Al-Sulaiman,MD 8l5l2009
The correlation between maternal vitamin D and neonatal vitamin D and
hypocalcemia is not well documented
Jomana Al-Sulaiman,MD 8l5l2009
A 15-days-old, male infant presented to Emergency Department (ED) with generalized seizures.
FTNVD,APGARS were 8 and 9
Exclusively breast fed since birth. Mother was neither taking nutritional, nor vitamin supplements during pregnancy
Jomana Al-Sulaiman,MD 8l5l2009
On the day of presentation :
Tonic-Clonic generalized convulsion lasted for two minutes .
Physical exam including neurological exam was normal .
Jomana Al-Sulaiman,MD 8l5l2009
Laboratory profile:Normal complete blood count
Normal blood urea nitrogen, creatinine, and albumin.
A blood culture and urine culture were negative.
The random blood glucose was 80 mg/dLJomana Al-Sulaiman,MD 8l5l2009
Electroencephalogram (EEG) and Magnetic Resonance Imaging (MRI) of the brain were normal.
Normal thymus shadow and great vessels were shown on chest X-ray.
Ultrasound scan of the renal system was normal.
Jomana Al-Sulaiman,MD 8l5l2009
Serum calcium ,magnesium were low
Screening serum calcium, phosphate, magnesium, 25 hydroxy vitamin D, and intact parathyroid hormone levels were drawn for both the baby and the mother
Jomana Al-Sulaiman,MD 8l5l2009
TimeSerum Ca
(8.8-10.5 )mg/dl
Serum Po4
(3.5-6.7)mg/l
Serum MG
(1.8-2.4)mg/dl
25 Hydroxy
vit D3(25-57 )
mmol/l
Intact PTH
(25-75)pgm/ml
Admission
5.7( low)9.4(high)1.1(low)12(low)30( NL)
48hours9.8(low)7(high)2.1(NL)----------
5th days10.35.9(NL)
2.2(NL)----------
Table1. Infant’s Pertinent Laboratory Data Jomana Al-Sulaiman,MD 8l5l2009
ScreeningSerum Ca
(8.8-10.5 )mg/dl
Serum Po4
(3.5-6.7)mg/l
Serum MG
(1.8-2.4)mg/dl
25 Hydroxy
vit D3(25-
57)mmol/l
Intact PTH
(25-75)pgm/ml
11.62.121040
Table 2. Mother’s Pertinent Laboratory Data
Jomana Al-Sulaiman,MD 8l5l2009
The baby was started on:
Alphacalcidol (100 ng/kg once a day),
Calcium gluconate infusion(1 ml/kg then 500 mg/kg/day)
Jomana Al-Sulaiman,MD 8l5l2009
On day two of admission oral calcium carbonate at 50 mg /kg/day in 4 divided doses alphacalcidol at 0.02 microgram /kg/day in two divided doses were started.
After 5 days the calcium levels had returned to normal.
Jomana Al-Sulaiman,MD 8l5l2009
The baby was discharged home on day seven
Oral calcium and alphacalcidol continued till 10 weeks of age.
The infant’s calcium profile was monitored regularly.
Jomana Al-Sulaiman,MD 8l5l2009
The follow-up serum calcium level, up to 1 year, has been normal .
The infant development was according to his chronological age.
Jomana Al-Sulaiman,MD 8l5l2009
Most cases of neonatal hypocalcemia occur
soon after birth, especially in those high-risk
infants with low birth weight, intrauterine growth restriction , perinatal asphyxia and diabetic
mothers. Jomana Al-Sulaiman,MD 8l5l2009
The hypocalcemic seizures are often generalised
but can also appear focally .
Vitamin D serum levels should be checked
in all cases.
Jomana Al-Sulaiman,MD 8l5l2009
Therapy with anticonvulsants is typically not needed.
Treatment for hypocalcemic seizures is calcium replacement .
Jomana Al-Sulaiman,MD 8l5l2009
It is safer to use calcium gluconate rather than calcium chloride because it is less irritating and less likely to cause tissue necrosis if extravasation occurs.
Neonatologist should be alert to the signs of congenital rickets to start the appropriate treatment and prevent the earliest complications.
Jomana Al-Sulaiman,MD 8l5l2009
Jomana Al-Sulaiman,MD 8l5l2009