What are the other Names for this Condition? (Also known as/Synonyms)

• Calcium Deficiency in Newborn Babies
• Hypocalcemia in Neonates
• Low Calcium Levels in Neonates

What is Neonatal Hypocalcemia? (Definition/Background Information)

• Neonatal Hypocalcemia is a condition characterized by low calcium levels in blood in newborn babies. Both boy babies and girl babies may be affected by this condition
  • If the condition occurs within 48-72 hours of childbirth, it is classified as early-onset Neonatal Hypocalcemia 
  • Alternatively, late-onset Neonatal Hypocalcemia may occur with 7-10 days of childbirth
• Neonatal Hypocalcemia is more common in premature babies, babies with diabetic mothers, low blood oxygen levels, low blood magnesium levels, kidney dysfunction, and with certain genetic conditions
• Neonatal Hypocalcemia may not always present any significant symptoms. If symptoms are observed, they may include shakiness, poor feeding, and lethargy, among others
• In majority of cases, Neonatal Hypocalcemia in Infants is a treatable condition and the outcomes are generally good. Also, in most children, the condition is transient in nature

Who gets Neonatal Hypocalcemia? (Age and Sex Distribution)

• Neonatal Hypocalcemia can affect any newborn child
• However, it is more common in premature babies, or babies born to diabetic mothers
  • About 33% or premature babies develop hypocalcemia within 48 hours of birth
  • Neonatal Hypocalcemia occurs in approximately 10-20% of babies born to diabetic mothers
• This condition occurs without racial, ethnic, or gender bias
• Symptom onset is noted as early as 48 hours after birth, or even after 10 days

What are the Risk Factors for Neonatal Hypocalcemia? (Predisposing Factors)

The risk factors for Neonatal Hypocalcemia may include:

• Premature birth
• Low birthweight babies
• Mothers with gestational diabetes, or diabetes during pregnancy
• Mothers with hyperparathyroidism during pregnancy
• Maternal hypovitaminosis D (low vitamin D levels) during pregnancy
• Being deprived of oxygen for a prolonged period during the birthing process (neonatal asphyxia)
• Congenital abnormalities of the parathyroid gland, such as due to DiGeorge syndrome, which is characterized by poor development of body tissues and organs
• Being fed milk with a high phosphate content, such as baby formula soymilk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Neonatal Hypocalcemia? (Etiology)

Neonatal Hypocalcemia is defined as the depletion of blood calcium in a newborn that may be caused by several factors such as:

• Premature birth and low birth weight, which may be associated with:
  • Improperly functioning parathyroid glands, which regulate calcium levels in the body
  • Increased calcitonin hormone, which regulates calcium metabolism and inhibits calcium leaching from bones
  • Increased loss of calcium in urine
• Diabetes or hyperparathyroidism in the mother during gestation, which may lead to increased suppression of parathyroid gland functioning in the newborn
• Maternal vitamin D deficiency, which can lead to alterations of parathyroid hormone levels 
• Infections that cause frequent diarrhea and loss of calcium
• Stress caused by illness immediately after birth and the use of certain medications may also lead to loss of calcium from blood
• Low oxygen levels during the birthing process, known as neonatal asphyxia, can lead to elevated levels of serum calcitonin, which inhibits calcium leaching from bones and consequential low calcium levels in blood
• Increased phosphate intake via baby formula milk can increase serum phosphate levels, which in turn can lead to a decrease in serum calcium concentration
• Congenital abnormalities in organ and tissue formation from conditions such as DiGeorge syndrome

What are the Signs and Symptoms of Neonatal Hypocalcemia?

The signs and symptoms of Neonatal Hypocalcemia may vary in type and severity among the affected babies. Some babies may be asymptomatic, whereas others may have clinically significant symptoms. The following are some known signs and symptoms of Neonatal Hypocalcemia:

• Twitching
• Vomiting
• Shakiness and jerky movements
• Bloated belly
• Poor feeding
• Difficulty breathing; rapid breathing
• Rapid resting heart rate (tachycardia)
• Lethargy or a lack of energy

How is Neonatal Hypocalcemia Diagnosed?

A diagnosis of Neonatal Hypocalcemia is made based on the following tests and exams:

• A thorough physical examination and an assessment of the presenting signs and symptoms
• Evaluation of the medical history of the mother and family
• Blood test to assess the total and ionized calcium levels. The total calcium test helps measure both the free and bound forms of calcium in blood. The ionized fraction is the free calcium and is considered the active form. A baby is considered hypocalcemic, if the serum calcium concentration is any of the following:
  • Less than 8 mg/dL of total serum calcium in a full-term baby, with ionized calcium levels below 4.4 mg/dL
  • Less than 7 mg/dL of total serum calcium in a prematurely born baby, with ionized calcium between 0.8-0.9mg/dL

The normal values, called the reference range, may vary from lab to lab. Hence, most lab reports come with a reference range, which is used in that particular center. A physician interprets the results based on the reference values provided.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Neonatal Hypocalcemia?

The following are some potential complications of Neonatal Hypocalcemia, if the condition is not diagnosed or treated in a timely manner:

• Inadequate weight gains due to poor feeding
• Delay in achieving developmental milestones
• Sudden cardiac arrest, which can be life-threatening

How is Neonatal Hypocalcemia Treated?

The treatment options for Neonatal Hypocalcemia depend on the severity of symptoms, the newborn’s overall health status, and the child’s tolerance for certain medications and therapies. The treatment measures may include:

• Intravenous (IV) calcium gluconate for early-onset Neonatal Hypocalcemia
• Oral calcium supplements for late-onset Neonatal Hypocalcemia
• Medication for infections, if needed
• Medication for diarrhea, if necessary
• Treatment of the underlying condition, if any

How can Neonatal Hypocalcemia be Prevented?

If Neonatal Hypocalcemia occurs as a consequence of congenital disorders, such as DiGeorge syndrome, and there are currently no methods or guidelines available for its prevention. In other cases, the following may be considered:

• Proper control of blood sugar during pregnancy may help avoid development of Neonatal Hypocalcemia
• Regular medical screening at periodic intervals with tests and physical examinations are strongly recommended for pregnant women with gestational diabetes, hyperparathyroidism, or any other illnesses

What is the Prognosis of Neonatal Hypocalcemia? (Outcomes/Resolutions)

The prognosis of Neonatal Hypocalcemia is typically good; since, in most cases, the condition is transient in nature.

• An appropriate treatment leads to restoration of normal levels of calcium in blood
• However, if life-threatening complications arise, the prognosis may be guarded

Additional Relevant Useful Information for Neonatal Hypocalcemia:

Calcium is an important mineral for several cellular functions, which ultimately impact the whole body. Calcium is involved in the following processes in the body:

• Cell-cell communication
• Muscle contraction
• Conduction of nerve signals
• Activation of enzyme cascades
• Blood clotting, since calcium is also known as coagulation factor IV, and is necessary for the functioning of many enzymes involved in the clotting cascade
• Exocrine secretions such as bile and pancreatic juice