Neonatal Hypocalcemic Seizures Associated With Maternal Vitamin D deficiency

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Neonatal Hypocalcemic Seizures Associated With
Maternal Vitamin D deficiency
Jomana Al-Sulaiman,MD 8l5l2009
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1Wadah M. KHRIESAT, MD, CHSM. 2Isam M. LATAIFEH.
MD, CGO. 1Sirin Alzoubi, M.D. 1Jomana
Al-Sulaiman, MD
Jomana Al-Sulaiman,MD 8l5l2009
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• 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
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• The correlation between maternal vitamin D and
  neonatal vitamin D and hypocalcemia is not well
  documented
  

Jomana Al-Sulaiman,MD 8l5l2009
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Case Report

• 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
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• 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
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• 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/dL

Jomana Al-Sulaiman,MD 8l5l2009
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• 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
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• 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
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Intact PTH (25-75)pgm/ml 25 Hydroxy vit D3 (25-57) mmol/l Serum MG (1.8-2.4)mg/dl Serum Po4 (3.5-6.7)mg/l Serum Ca (8.8-10.5) mg/dl Time
30 (NL) 12(low) 1.1(low) 9.4(high) 5.7 (low) Admission
----- ----- 2.1(NL) 7(high) 9.8(low) 48hours
----- ----- 2.2(NL) 5.9(NL) 10.3 5th days
Table1. Infants Pertinent Laboratory Data
Jomana Al-Sulaiman,MD 8l5l2009
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Intact PTH (25-75)pgm/ml 25 Hydroxy vit D3 (25-57)mmol/l Serum MG (1.8-2.4)mg/dl Serum Po4 (3.5-6.7)mg/l Serum Ca (8.8-10.5) mg/dl Screening
40 10 2 2.1 11.6
Table 2. Mothers Pertinent Laboratory Data
Jomana Al-Sulaiman,MD 8l5l2009
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• 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
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• 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
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• The baby was discharged home on day seven
• Oral calcium and alphacalcidol continued till 10
  weeks of age.
• The infants calcium profile was monitored
  regularly .

Jomana Al-Sulaiman,MD 8l5l2009
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• 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
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Discussion

• 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
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• 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
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• Therapy with anticonvulsants is typically not
  needed.
• Treatment for hypocalcemic seizures is calcium
  replacement.

Jomana Al-Sulaiman,MD 8l5l2009
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• 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
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THANK YOU
Jomana Al-Sulaiman,MD 8l5l2009