pediatrics
Neonatal Hypocalcemia
Treatment of Neonatal Hypocalcemia
Early onset: IV 10%calcium gluconate Late onset: Oralcalcitriolor calcium Early-onset hypocalcemiaordinarily resolves in a few days, and asymptomatic neonates with serum calcium levels>7 mg/dL (1.75 mmol/L) or ionized calcium>3.5 mg/dL (0.88 mmol/L) rarely require treatment. Those term infants with levels<7 mg/dL (1.75 mmol/L) and preterm infants with calcium<6 mg/dL (<1.5 mmol/L) should be treated with 200 mg/kg of 10%calcium gluconateby slow IV infusion over 30 minutes. Too-rapid infusion can cause bradycardia, so heart rate should be monitored during the infusion. The IV site should also be watched closely because tissue infiltration by a calcium solution is irritating and may cause local tissue damage or necrosis. Manifestations of calcium infiltration include skin redness, calcification, and necrosis or slough; there can be radial nerve damage at the wrist. After acute correction of hypocalcemia,calcium gluconatemay be mixed in the maintenance IV infusion and given continuously. Starting with 400 mg/kg/day ofcalcium gluconate, the dose may be increased gradually to 800 mg/kg/day, if needed, to prevent a recurrence. When oral feedings are begun, the formula may be supplemented with the same daily dose ofcalcium gluconate, if needed, by adding the 10%calcium gluconatesolution into the day’s formula. Supplementation is usually required for only a few days. Late-onset hypocalcemiatreatment is addition ofcalcitriolor additional calcium to infant formula until normal calcium levels are maintained; a low-mineral formula (including low phosphate) as for infants with impaired renal function may be helpful. Oral calcium preparations have a high sucrose content, which may lead to diarrhea in preterm infants. 