Title: Tertiary Care Hospital of Western Maharashtra

Authors: Dr Pratik Yadav, Dr G G Joag2 Dr C D Aundhakar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i3.65

Abstract

Introduction: Hypocalcemia is a frequently observed clinical and laboratory abnormality in neonates. Magnesium and calcium metabolism are closely related. The intestinal absorption and the renal excretion of the two ions are interdependent. Association of hypomagnesemia with calcium deficiency is a known disorder in neonates which needs immediate attention. While most cases occur along with calcium deficiency, there are a sizeable number of cases which have primary magnesium deficiency.

Aim and Objectives: To estimate the prevalence of hypomagnesemia and hypocalcemia, study the correlation of hypomagnesemia and hypocalcemia with clinical status of the baby and study the risk factors associated with hypomagnesemia and hypocalcemia in a tertiary care hospital.

Materials and Methodology: This was an analytical observational cross sectional study conducted in Krishna hospital, Karad. 400 babies who were born consecutively in Obstetrics department of Krishna Hospital, and who fulfilled the eligibility criteria were studied. Babies were grouped according to Weight, Maturity, Illness and Treatment. The data was analysed using Student t-test.

Result and Conclusion: Of the 400 neonates studied: On Day 1 of life, Hypocalcemia occurred in 0.5%, Hypomagnesemia occurred in 1%. On Day 4 of life, Hypocalcemia occurred in 10.5%, Hypomagnesemia occurred in 0%. Clinical symptoms of Hypocalcemia observed were: lethargy (2%), high pitched cry (1%), poor feeding (0.75%), apnoea (0.75%) and jitteriness (0.5%). The risk factors for Hypocalcemia observed were: Prematurity, Formula feeding, Infant of Diabetic Mother and Birth asphyxia. Hypomagnesemia was not associated with any clinical symptoms nor risk factor in the study.

Keywords: Hypocalcemia, Hypomagnesemia, Neonates.

References

1.      Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr. 2010 Oct;77(10):1123-8.

2.      Steven A. Abrams. Abnormalities of Serum Calcium and Magnesium. Manual of neonatal care. 7th edition, p 297.

3.      Viering, Daan H. H. M.; Baaij, Jeroen H. F. de; Walsh, Stephen B.; Kleta, Robert; Bockenhauer, Detlef (2016-0527). Genetic causes of hypomagnesemia, a clinical overview. Pediatric Nephrology: 1–13.

4.      Paunier L. Effect of magnesium on phosphorus and calcium metabolism. Pubmed.gov, article 1331782

5.      Matsumoto T. Magnesium deficiency and parathyroid function. Intern Med 1995;34:603-4 (Editorial; Comment).

6.      Stephanie C. Hsu, Michael A. Levine. Perinatal calcium metabolism: physiology and pathophysiology. Seminars in neonatology (2004) 9, 23-26. Elsevier- review article

7.      Heaton FW, Fourman P. Magnesium deficiency and hypocalcaemia in intestinal malabsorption. Lancet 1965; 2:50.

8.      K E Elizabeth. Nutrition and Child Development. 5th edition (2015). Section 1: Infant and young child feeding. Table 1.2b, page 23.

9.      F.Cockburn, J.K.Brown, N.R.Belton and J.O.Forfar (1973) - Neonatal convulsions associated with primary disturbance of calcium, phosphorus, and magnesium metabolism - Archives of disease in childhood, 1973, 48, 99

10.  Jain B K, Daljit Singh, Harmesh Singh. Serum ionised calcium in birth asphyxia.   Indian journal of Biochemistry, 2000, 15 (1), 36-39.

11.  Chow WI et al (2015). Clinical and laboratory characteristics of neonatal Hypocalcemia. (www.ncbi.nlm.gov/PMC/article/PMC4504995/)

12.  P Ghai. Essential Pediatrics.7th edition. Chapter 7: Newborn Infants, Table 7.16, page 129.

13.  Andrea N hacker, Ellen B Fung, Janet C King. Role of calcium during pregnancy: maternal and fetal needs. Nutrition Reviews Vol 70(7): 397-409

14.  Amar.M. Taksande, Krishna Vilhekar, Manish Jain, Mahaveer Lakra (2005) - Clinico - Biochemical Profile Of Neonatal Seizures - Pediatric on call ; Vol 2 Issue 10:46

15.  Ashish Jain. Ramesh Agarwal. Hypocalcemia in the Newborn. Indian Journal Of Pediatrics (2010) 77: 1123-1128.

16.  Steven A Abrams. Abnormalities of serum calcium and magnesium. ( Manual of neonatal care: John P Cloherty, 7th edition, p. 297, 298

17.  Aviva Lee-Parritz and John P. Cloherty. Diabetes Mellitus. Manual of Neonatal care. 7th edition (2014). Page 17,20.

Corresponding Author

Dr Pratik Yadav

Post Graduate Student, Department of Pediatrics