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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