Review Article

Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?

Table 1

Causes of early and late onset hypocalcemia in the newborn period and infancy.

Early-onset hypocalcemiaLate-onset hypocalcemia

(i) Prematurity(i) Increased phosphate load (feeding with cow milk, feeding with high-fiber formula, renal failure)
(ii) Intrauterine growth retardation (low birth weight)(ii) Hypomagnesemia
(iii) Preeclampsia(iii) Vitamin D deficiency
(iv) Asphyxia(iv) PTH resistance (pseudohypoparathyroidism)
(v) Sepsis(v) Hypoparathyroidism
(vi) Infants of diabetic mothers (a) Primary hypoparathyroidism
(vii) Severe maternal deficiency of vitamin D  (1) Isolated hypoparathyroidism
(viii) Maternal hyperparathyroidism  (2) CaSR activating mutations (hypercalciuric hypocalcemia)
(ix) Mother using anticonvulsants (phenytoin sodium, phenobarbiturate)  (3) Syndromic hypoparathyroidisms (DiGeorge syndrome, CATCH-22, Kenny-Caffey syndrome, Barakat syndrome, Kearns-Sayre syndrome, Pearson syndrome)
(x) Maternal intake of high-dose antacids (b) Secondary hypoparathyroidism (maternal hyperparathyroidism)
(xi) Use of aminoglycosides and anticonvulsants in the newborn(vi) Iatrogenic
(xii) Iatrogenic (alkalosis, use of blood products, lipid infusions and diuretics, phototherapy) (a) Use of citrate-blood products
 (b) Lipid infusions
 (c) Bicarbonate therapy
 (d) Loop diuretics (furosemide)
 (e) Phosphate therapy

Modified from Root AW, Diamond FB. (2008) Disorders of Mineral Homeostasis in the Newborn, Infant, Child, and Adolescent. In: Sperling MA, editor. Pediatric Endocrinology, 3rd ed. Philadelphia: Saunders/Elsevier. p. 686-769; from Carpenter TO. (2006) Neonatal hypocalcemia. In: Favus MJ, editor. Primer on the Metabolic Disease and Disorders of Mineral Metabolism, 6th ed. Washington, D.C. American Society for Bone and Mineral Research. p. 224-227.