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Early Neonatal Hypocalcemia in Extremely Preterm Infants: High Incidence, Early Onset, and Refractoriness to Supraphysiologic Doses of Calcitriol

Early Neonatal Hypocalcemia in Extremely Preterm Infants: High Incidence, Early Onset, and... Abstract • Nineteen preterm infants born at or before 32 weeks of gestation were studied to determine the dose of calcitriol that would be effective in the prophylaxis of early neonatal hypocalcemia (serum calcium level, <7.0 mg/dL [<1.75 mmol/L]). In these infants the course of early neonatal hypocalcemia was not modified by calcitriol administration. Serum 1,25-dihydroxyvitamin D level rose in response to intramuscular administration of calcitriol. The incidence of hypocalcemia in these infants was 37% by 12 hours, 83% by 24 hours, and 89% by 36 hours. Thus, in extremely preterm infants, the incidence of early neonatal hypocalcemia is higher and the onset earlier than in larger preterm infants; furthermore, in these infants the hypocalcemia is refractory even to high doses of calcitriol. (AJDC 1986;140:1004-1008) References 1. Tsang RC, Light JJ, Sutherland JM, et al: Possible pathogenetic factors in neonatal hypocalcemia of prematurity . J Pediatr 1973;82:423-429.Crossref 2. David L, Anast CS: Calcium metabolism in newborn infants: The interrelationship of parathyroid function and calcium, magnesium and phosphorus metabolism in normal, 'sick' and hypocalcemic newborns . J Clin Invest 1974;54:287-296.Crossref 3. Hillman LS, Rojanasathit S, Slatopolsky E, et al: Serial measurements of serum calcium, magnesium, parathyroid hormone, calcitonin and 25-hydroxyvitamin D in premature and term infants during the first week of life . Pediatr Res 1977;11:739-744.Crossref 4. Chan GM, Tsang RC, Chen I-W, et al: The effect of 1,25-dihyroxyvitamin D3 supplementation in premature infants . J Pediatr 1978;93:91-96.Crossref 5. Ballard J, Karxmaier K, Driver M: A simplified score for assessment of fetal maturation of newly born infants . J Pediatr 1979;95:579. 6. Tsang RC, Chen I-W, Hayes W, et al: Neonatal hypocalcemia in infants with birth asphyxia . J Pediatr 1974;84:428-433.Crossref 7. Tsang RC, Kleinman L, Sutherland JM, et al: Hypocalcemia in infants of diabetic mothers: Studies in calcium, phosphorus and magnesium metabolism and parathyroid responsiveness . J Pediatr 1972;80:284-305. 8. Wald A: Sequential Analysis . New York, John Wiley & Sons Inc, 1947. 9. Sunderman FW Jr, Carroll JE: Measurements of serum calcium and magnesium by atomic absorption spectrometry . Am J Clin Pathol 1965;43;302-310. 10. Natelson S: Techniques of Clinical Chemistry , ed 3. Springfield, Ill, Charles C Thomas Publishers, 1971, pp 576-579. 11. Chen I-W, Park HM, King LR, et al: Radioimmunoassay of parathyroid hormone: Peripheral plasma immunoreactive parathyroid hormone response to ethylenediaminetetra-acetate . J Nucl Med 1974;15:763-769. 12. Minton SD, Steichen JJ, Tsang RC: Decreased bone mineral content in SGA compared with AGA infants: Normal serum 25-hydroxyvitamin D and decreasing parathyroid hormone in SGA and AGA infants . Pediatrics 1983;71:383-388. 13. Eisman JA, Hamstra AJ, Kream BE, et al: 1,25-dihydroxyvitamin D in biological finds: A simplified and sensitive assay . Science 1976;193:1021.Crossref 14. Snedecor GW, Cochran WG (eds): Statistical Methods , ed 6. Ames, Iowa, Iowa State University Press, 1967, pp 91-116. 15. Scott SM, Ladenson JH, Aguana JJ, et al: Effect of calcium therapy in the sick preterm infant with early neonatal hypocalcemia . J Pediatr 1984;104:747-751.Crossref 16. Tsang RC, Chen I-W, Friedman MA, et al: Neonatal parathyroid function: Role of gestational age and postnatal age . J Pediatr 1973;83:728-738.Crossref 17. Venkataraman PS, Wilson DA, Sheldon RE, et al: Effect of hypocalcemia on cardiac function in very low birth weight preterm neonates: Studies of blood ionized calcium, echocardiography and assessment of cardiac effects of intravenous calcium therapy . Pediatrics 1985;76:543-550. 18. Barak Y, Milbauer B, Weisman Y, et al: Response of neonatal hypocalcemia to 1-hydroxyvitamin D3 . Arch Dis Child 1979;54:642-643.Crossref 19. Kooh SW, Fraser D, Toon R: Response of protracted neonatal hypocalcemia to 1,25-dihydroxyvitamin D3 . Lancet 1976;2:1105-1107.Crossref 20. Salle BL, David L, Glorieux FG, et al: Early oral administration of vitamin D and its metabolites in preterm neonates: Effect on mineral homeostasis . Pediatr Res 1982;16:75-78.Crossref 21. Halloran BP, DeLuca HF: Appearance of the intestinal cytosolic receptor for 1,25-dihydroxyvitamin D3 during neonatal development in the rat . J Biol Chem 1981;256:7338-7342. 22. Venkataraman PS, Blick KE, Fry HD, et al: Postnatal changes in calcium-regulating hormones in very-low-birth-weight infants: Effect of early neonatal hypocalcemia and intravenous calcium infusion on serum parathyroid hormone and calcitonin homeostasis . AJDC 1985;139:913-916. 23. Slatopolsky E, Weerts C, Thielan J, et al: Marked suppression of secondary hyperparathyroidism by intravenous administration of 1,25-dihydroxycholecalciferol in uremic patients . J Clin Invest 1984;74:2136-2143.Crossref 24. Brumbaugh PF, Hughes MR, Haussler MR: Cytoplasmic and unclear binding components for 1,25-dihydroxyvitamin D3 in chick parathyroid glands . Proc Natl Acad Sci USA 1975;72:4871-4875.Crossref 25. Venkataraman PS, Tsang RC, Chen I-W, et al: Elevated calcitonin in birth asphyxia and prematurity: Role in the pathogenesis of early neonatal hypocalcemia , abstracted. Pediatr Res 1984;18:352A.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Early Neonatal Hypocalcemia in Extremely Preterm Infants: High Incidence, Early Onset, and Refractoriness to Supraphysiologic Doses of Calcitriol

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1986.02140240050025
Publisher site
See Article on Publisher Site

Abstract

Abstract • Nineteen preterm infants born at or before 32 weeks of gestation were studied to determine the dose of calcitriol that would be effective in the prophylaxis of early neonatal hypocalcemia (serum calcium level, <7.0 mg/dL [<1.75 mmol/L]). In these infants the course of early neonatal hypocalcemia was not modified by calcitriol administration. Serum 1,25-dihydroxyvitamin D level rose in response to intramuscular administration of calcitriol. The incidence of hypocalcemia in these infants was 37% by 12 hours, 83% by 24 hours, and 89% by 36 hours. Thus, in extremely preterm infants, the incidence of early neonatal hypocalcemia is higher and the onset earlier than in larger preterm infants; furthermore, in these infants the hypocalcemia is refractory even to high doses of calcitriol. (AJDC 1986;140:1004-1008) References 1. Tsang RC, Light JJ, Sutherland JM, et al: Possible pathogenetic factors in neonatal hypocalcemia of prematurity . J Pediatr 1973;82:423-429.Crossref 2. David L, Anast CS: Calcium metabolism in newborn infants: The interrelationship of parathyroid function and calcium, magnesium and phosphorus metabolism in normal, 'sick' and hypocalcemic newborns . J Clin Invest 1974;54:287-296.Crossref 3. Hillman LS, Rojanasathit S, Slatopolsky E, et al: Serial measurements of serum calcium, magnesium, parathyroid hormone, calcitonin and 25-hydroxyvitamin D in premature and term infants during the first week of life . Pediatr Res 1977;11:739-744.Crossref 4. Chan GM, Tsang RC, Chen I-W, et al: The effect of 1,25-dihyroxyvitamin D3 supplementation in premature infants . J Pediatr 1978;93:91-96.Crossref 5. Ballard J, Karxmaier K, Driver M: A simplified score for assessment of fetal maturation of newly born infants . J Pediatr 1979;95:579. 6. Tsang RC, Chen I-W, Hayes W, et al: Neonatal hypocalcemia in infants with birth asphyxia . J Pediatr 1974;84:428-433.Crossref 7. Tsang RC, Kleinman L, Sutherland JM, et al: Hypocalcemia in infants of diabetic mothers: Studies in calcium, phosphorus and magnesium metabolism and parathyroid responsiveness . J Pediatr 1972;80:284-305. 8. Wald A: Sequential Analysis . New York, John Wiley & Sons Inc, 1947. 9. Sunderman FW Jr, Carroll JE: Measurements of serum calcium and magnesium by atomic absorption spectrometry . Am J Clin Pathol 1965;43;302-310. 10. Natelson S: Techniques of Clinical Chemistry , ed 3. Springfield, Ill, Charles C Thomas Publishers, 1971, pp 576-579. 11. Chen I-W, Park HM, King LR, et al: Radioimmunoassay of parathyroid hormone: Peripheral plasma immunoreactive parathyroid hormone response to ethylenediaminetetra-acetate . J Nucl Med 1974;15:763-769. 12. Minton SD, Steichen JJ, Tsang RC: Decreased bone mineral content in SGA compared with AGA infants: Normal serum 25-hydroxyvitamin D and decreasing parathyroid hormone in SGA and AGA infants . Pediatrics 1983;71:383-388. 13. Eisman JA, Hamstra AJ, Kream BE, et al: 1,25-dihydroxyvitamin D in biological finds: A simplified and sensitive assay . Science 1976;193:1021.Crossref 14. Snedecor GW, Cochran WG (eds): Statistical Methods , ed 6. Ames, Iowa, Iowa State University Press, 1967, pp 91-116. 15. Scott SM, Ladenson JH, Aguana JJ, et al: Effect of calcium therapy in the sick preterm infant with early neonatal hypocalcemia . J Pediatr 1984;104:747-751.Crossref 16. Tsang RC, Chen I-W, Friedman MA, et al: Neonatal parathyroid function: Role of gestational age and postnatal age . J Pediatr 1973;83:728-738.Crossref 17. Venkataraman PS, Wilson DA, Sheldon RE, et al: Effect of hypocalcemia on cardiac function in very low birth weight preterm neonates: Studies of blood ionized calcium, echocardiography and assessment of cardiac effects of intravenous calcium therapy . Pediatrics 1985;76:543-550. 18. Barak Y, Milbauer B, Weisman Y, et al: Response of neonatal hypocalcemia to 1-hydroxyvitamin D3 . Arch Dis Child 1979;54:642-643.Crossref 19. Kooh SW, Fraser D, Toon R: Response of protracted neonatal hypocalcemia to 1,25-dihydroxyvitamin D3 . Lancet 1976;2:1105-1107.Crossref 20. Salle BL, David L, Glorieux FG, et al: Early oral administration of vitamin D and its metabolites in preterm neonates: Effect on mineral homeostasis . Pediatr Res 1982;16:75-78.Crossref 21. Halloran BP, DeLuca HF: Appearance of the intestinal cytosolic receptor for 1,25-dihydroxyvitamin D3 during neonatal development in the rat . J Biol Chem 1981;256:7338-7342. 22. Venkataraman PS, Blick KE, Fry HD, et al: Postnatal changes in calcium-regulating hormones in very-low-birth-weight infants: Effect of early neonatal hypocalcemia and intravenous calcium infusion on serum parathyroid hormone and calcitonin homeostasis . AJDC 1985;139:913-916. 23. Slatopolsky E, Weerts C, Thielan J, et al: Marked suppression of secondary hyperparathyroidism by intravenous administration of 1,25-dihydroxycholecalciferol in uremic patients . J Clin Invest 1984;74:2136-2143.Crossref 24. Brumbaugh PF, Hughes MR, Haussler MR: Cytoplasmic and unclear binding components for 1,25-dihydroxyvitamin D3 in chick parathyroid glands . Proc Natl Acad Sci USA 1975;72:4871-4875.Crossref 25. Venkataraman PS, Tsang RC, Chen I-W, et al: Elevated calcitonin in birth asphyxia and prematurity: Role in the pathogenesis of early neonatal hypocalcemia , abstracted. Pediatr Res 1984;18:352A.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Oct 1, 1986

References