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A case-control study of hypocalcemia in high-risk neonates: racial, but no seasonal differences
F Mimouni1, C P Mimouni, J L Loughead
1Department of Pediatrics, University of Cincinnati.
Insights
Neonatal hypocalcemia (NHC) risk factors include low gestational age, low Apgar scores, and white race. Black race and winter births were not found to increase NHC risk in this study.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Nutritional Science
Background:
- Vitamin D's potential role in preventing neonatal hypocalcemia (NHC) has been proposed.
- Race and season are known to influence vitamin D levels, prompting investigation into their impact on NHC.
Purpose of the Study:
- To investigate whether black race and winter birth season are risk factors for neonatal hypocalcemia (NHC).
- To identify key risk factors contributing to low serum calcium concentrations in newborns.
Main Methods:
- Retrospective analysis of 714 infants born between 1984-1987, excluding those with diabetic mothers or congenital anomalies.
- Serum calcium levels were routinely measured in high-risk infants at 24 hours of age.
- Multiple regression and pair-matched analyses were employed to assess the association of gestational age, Apgar score, race, and season of birth with serum calcium levels.
Main Results:
- Low gestational age and low Apgar scores were significantly associated with lower serum calcium levels (p < 0.01).
- White race was identified as a significant risk factor for hypocalcemia (p < 0.01).
- Season of birth, including winter, and black race were not found to be significant risk factors for NHC.
Conclusions:
- Low gestational age, low Apgar score, and white race are identified as risk factors for neonatal hypocalcemia.
- This study suggests that vitamin D deficiency may not play a significant role in NHC within this specific population and climate.
- Further research may be needed to elucidate the multifactorial causes of NHC.
Abstract:
A role for vitamin D in the defense against falling serum calcium (Ca) concentrations following cord clamping has been suggested. Since race and season are known to affect vitamin D status, we theorized that black race and birth in winter are additional risk factors for neonatal hypocalcemia (NHC). We retrospectively studied 13,462 infants born at University Hospital (Cincinnati, OH) between January 1, 1984 and December 31, 1987. Serum Ca was measured at 24 hours of age routinely in infants with low birth weight (less than 2500 g), preterm delivery (less than 2500 g), preterm delivery (less than 37 weeks), neonatal asphyxia, and diabetic mothers. After exclusion of infants of diabetic mothers (to remove maternal diabetes as a major confounder) and infants with major congenital anomalies, 714 infants remained. In multiple regression analysis, low serum Ca values were significantly associated with low gestational age (p less than 0.01), low Apgar score (p less than 0.01), and white race (p less than 0.01) (R2 = 0.457). Season or month of birth was not significant. In pair-matched analysis controlling for factors other than season, season of birth did not affect serum Ca. In pair-matched analysis controlling for factors other than race, white race was once again a risk factor for hypocalcemia. Thus, low gestational age, low Apgar score, and white race, but not black race and delivery in winter, are risk factors for NHC. We speculate that in our climate and with the prevailing diet in pregnancy, vitamin D deficiency does not appear to play a role in NHC.(ABSTRACT TRUNCATED AT 250 WORDS)