Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Neonatal Late-onset Hypocalcemia: Is There Any Relationship with Maternal Hypovitaminosis D?

  • Do, Hyun Jeong (Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Park, Ji Sook (Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Seo, Ji-Hyun (Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Lee, Eun Shin (Department of Rehabilitation Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Park, Chan-Hoo (Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Woo, Hyang-Ok (Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine) ;
  • Youn, Hee-Shang (Department of Pediatrics, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine)
  • Received : 2013.11.26
  • Accepted : 2013.12.31
  • Published : 2014.03.30
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Abstract

Purpose: Neonatal late-onset hypocalcemia is defined as hypocalcemia developed after postnatal 3 days and associated with hypoparathyroidism, high phosphate diets and vitamin D deficiency. We experienced the increment of neonatal late onset hypocalcemia over 1 year. We tried to evaluate the relationship between late onset hypocalcemia and maternal hypovitaminosis D. Methods: The medical records in the neonates with late-onset hypocalcemia during January 2007 to July 2008 were retrospectively reviewed. Among those patients, 17 paired sera of mothers and neonates had collected. The levels of 25-OH vitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured and were compared with neonate and the mother. Results: The mean gestational age was $38^{+1}$ weeks, and the mean body weight was 2,980 g. The onset time of hypocalcemia was 5.9 days of age. Most of them (88.2%) were feeding with formula and no one was only breast milk feeding. Of the 17 patients, 13 were born in spring or in winter. The median levels of calcium, phosphorus, alkaline phosphatase, iPTH and 25OHD were 7.0 mg/dL, 8.6 mg/dL, 191.0 U/L, 57.2 pg/mL and 24.0 ng/mL in neonates. The levels of 25OHD of 6 neonates were <20 ng/mL. A total of 16 mothers were considered vitamin D-deficient (<20 ng/mL), and vitamin D insufficient (20<25OHD<30 ng/mL). Conclusion: Neonatal late-onset hypocalcemia in our study seems to be influenced by maternal vitamin D deficiency and insufficiency. Sun tanning and vitamin D supplements from winter to spring would be helpful to prevent maternal vitamin D deficiency, one of the causes of neonatal late-onset hypocalcemia.

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References

  1. Salle BL, Delvin E, Glorieux F, David L. Human neonatal hypocalcemia. Biol Neonate 1990;58(Suppl 1):22-31. https://doi.org/10.1159/000243297
  2. Lee CT, Tsai WY, Tung YC, Tsau YK. Transient pseudohypoparathyroidism as a cause of late-onset hypocalcemia in neonates and infants. J Formos Med Assoc 2008;107:806-10. https://doi.org/10.1016/S0929-6646(08)60194-1
  3. Thomas TC, Smith JM, White PC, Adhikari S. Transient neonatal hypocalcemia: presentation and outcomes. Pediatrics 2012;129:e1461-7. https://doi.org/10.1542/peds.2011-2659
  4. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 2007;92:3517-22. https://doi.org/10.1210/jc.2007-0718
  5. Thomas SD, Fudge AN, Whiting M, Coates PS. The correlation between third-trimester maternal and newborn-serum 25-hydroxy-vitamin D in a selected South Australian group of newborn samples. BMJ Open 2011;1:e000236.
  6. Specker BL, Valanis B, Hertzberg V, Edwards N, Tsang RC. Sunshine exposure and serum 25-hydroxyvitamin D concentrations in exclusively breast-fed infants. J Pediatr 1985;107:372-6. https://doi.org/10.1016/S0022-3476(85)80509-6
  7. Greer FR. 25-Hydroxyvitamin D: functional outcomes in infants and young children. Am J Clin Nutr 2008;88:529S-33S.
  8. Bowyer L, Catling-Paull C, Diamond T, Homer C, Davis G, Craig ME. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Clin Endocrinol (Oxf) 2009;70:372-7. https://doi.org/10.1111/j.1365-2265.2008.03316.x
  9. Halicioglu O, Aksit S, Koc F, Akman SA, Albudak E, Yaprak I, et al. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatr Perinat Epidemiol 2012;26:53-60. https://doi.org/10.1111/j.1365-3016.2011.01238.x
  10. Khalesi N, Bahaeddini SM, Shariat M. Prevalence of maternal vitamin D deficiency in neonates with delayed hypocalcaemia. Acta Med Iran 2012;50:740-5.
  11. Dawodu A, Saadi HF, Bakdache G, Altaye M, Hollis BW. Extraordinarily high prevalence and lack of seasonal variationof vitamin D deficiency in pregnant Arab women. Vancouver, 1-4 May 2010: Pediatric Academic Societies Annual Meeting; E-PAS 2010:1451.
  12. Kim HS. Calcium and phosphate metabolism and disorders in the newborn. Korean J Pediatr 2007;50:230-5. https://doi.org/10.3345/kjp.2007.50.3.230
  13. Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr 2010;77:1123-8. https://doi.org/10.1007/s12098-010-0176-0
  14. Holick MF. The vitamin D epidemic and its health consequences. J Nutr 2005;135:2739S-48S. https://doi.org/10.1093/jn/135.11.2739S
  15. Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004;80(6 Suppl):1706S-9S.
  16. Rovner AJ, O'Brien KO. Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Arch Pediatr Adolesc Med 2008; 162:513-9. https://doi.org/10.1001/archpedi.162.6.513
  17. Lewis PR. Disorders of calcium and phosphorus metabolism. In: Gleason CA, Devaskar SU, eds. Avery's diseases of the newborn. 9th ed. Philadelphia: Saunders, 2012:1257.
  18. Park SY, Park SW, Kang SK, Jun YH, Kim SK, Son BK, et al. Subclinical rickets in breastfed infants. Korean J Pediatr 2007;50:1188-93. https://doi.org/10.3345/kjp.2007.50.12.1188

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