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Neonatal crises have several etiologies. Hypovitaminosis D and hypocalcemia are the most common cause of childhood seizures, but their frequency has been reduced due to vitamin D supplementation and infant formula. Most hypocalcemic crises have an underlying endocrinological origin rather than a deficit in intake. We describe the case of a 41-day-old infant admitted for neonatal seizures for hypocalcemia. Although symptoms and concentrations of calcium and parathyroid hormone (PTH) levels favored isolated congenital hyperparathyroidism after eliminating other differential diagnoses. The course of the disease was favorable with intravenous (IV) calcium gluconate 10%, then orally alfacalcidol and vitd2. The case is presented with a brief review of the pathophysiology, differential diagnosis and treatment of neonatal hypocalcemia.
Oden J, Bourgeois M. Neonatal endocrinology. Indian J Pediatr. 2000;67: 217–223.
Wills MR, Bruns DE, Savory J. Disorders of calcium homeostasis in the fetus and neonate. Ann Clin Lab Sci. 1982;12:79–88.
Jain A, Agarwal R, sankarmj, et al. Hypocalcemia in the newborn. Indian J Pediatr. 2010;77:1123–1128.
Root A, Diamond F. Disorder of mineral homeostasis in the newborn, infant, child and adolescent. In: Sperling: Pediatric Endocrinology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2008.
Holick MF, Lim R, Dighe AS. Case records of the Massachusetts General Hospital. Case 3-2009. A 9-month-old boy with seizures. N Engl J Med. 2009;360:398–407.
Kossoff EH, Silvia MT, Maret A, et al. Neonatal hypocalcemic seizures: Case report and literature review. J Child Neurol. 2002;17:236–239.
Hidalgo HA, Davis SH. Intermittent stridor and hypocalcemia in childhood. Pediatr Pulmonol. 1989;7:110–111.
Mangat JS, Till J, Bridges N. Hypocalcaemia mimicking long qt syndrome: Case report. Eur J Pediatr. 2008;167:233–235.
Maiya S, Sullivan I, Allgrove J, et al. Hypocalcaemia and vitamin D deficiency: An important, but preventable, cause of life-threatening infant heart failure. Heart. 2008;94:581–584.
Chehade H, Girardin E, Rosato L, et al. Acute life-threatening presentation of vitamin D deficiency rickets. J Clin Endocrinol Metab. 2011;96:2681–2683.
Kehrer E. Die geburtshilflich-gynäkologische Bedeutung der Tetanie, Arch. F. Gynäk. 1913;99:372.
Cockburn F, Brown JK, Belton NR, et al. Neonatal convulsions associated with primary disturbance of calcium, phosphorus, and magnesium metabolism. Arch Dis Child. 1973;48:99–108.
Calciolari G, Perlman JM, Volpe JJ. Seizures in the neonatal intensive care unit of the 1980s. Types, etiologies, timing. Clin Pediatr. 1988;27:119–123.
Lynch BJ, Rust RS. Natural history and outcome of neonatal hypocalcemic and hypomagnesemic seizures. Pediatr Neurol. 1994;11:23–27.
Aggarwal R, Upadhyay M, Deorari AK, et al. Hypocalcemia in the newborn. Indian J Pediatr. 2001;68:973–975.
Chikatsu N, Watanabe S, Takeuchi Y, et al. A family of autosomal dominant hypocalcemia with an activating mutation of calcium-sensing receptor gene. Endocr J. 2003;50:91–96.
Nakajima K, Yamazaki K, Kimura H, et al. Novel gain of function mutations of the calcium-sensing receptor in two patients with PTH-deficient hypocalcemia. Intern Med. 2009;48:1951–1956.
Knoers NV. Inherited forms of renal hypomagnesemia: An update. Pediatr Nephrol. 2009;24:697–705.
Rude RK. Magnesium deficiency: A cause of heterogeneous disease in humans. Journal of Bone and Mineral Research. 1998;13(4):749–758.
Geven WB, Monnens LAH, Willems JL. Magnesium metabolism in childhood. Mineral and Electrolyte Metabolism. 1993; 19(4-5):308–313.
Venkataraman PS, Wilson DA, Sheldon RG, Rao R, Andm K. Parker. Effect of hypocalcemia on cardiac function in verylow-birth-weight preterm neonates: studies of blood ionized calcium, echocardiography, and cardiac effect of intravenous calcium therapy. Pediatrics. 1985;76(4):543–550.
Driscoll DA, Budarf ML, Emanuel BS. A genetic etiology for Di George syndrome: Consistent deletions and microdeletions of 22q11. American Journal of Human Genetics. 1992;50(5):924–933.
Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. The Indian Journal of Pediatrics. 2010; 77(10):1123–1128.
Hsu SC, Levine MA. Perinatal calcium metabolism: Physiology and pathophysio-logy. Seminars in Fetal and Neonatal Medicine. 2004;9(1):23–36.