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The many etiologies of neonatal hypocalcemic seizures
Yael Levy-Shraga1, Keren Dallalzadeh, Keren Stern
1From the *Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Ramat Gan; †Sackler School of Medicine, Tel-Aviv University, Tel-Aviv; and ‡Department of Pediatric Intensive Care, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.
Insights
Neonatal seizures due to hypocalcemia are rare in developed nations due to improved infant nutrition. Underlying endocrine disorders are now the primary cause of these seizures in infants.
Area of Science:
- Pediatrics
- Neonatology
- Endocrinology
Background:
- Neonatal seizures present a diagnostic challenge with diverse causes.
- Historically, hypovitaminosis D and hypocalcemia were common in infantile seizures, particularly in developing countries.
- Improvements in infant formulas and vitamin D supplementation have reduced dietary causes in developed nations.
Observation:
- This report details three distinct cases of neonatal seizures attributed to hypocalcemia.
- All infants exhibited similar symptoms and initial calcium levels.
- However, their clinical courses and ultimate diagnoses varied significantly.
Findings:
- In developed countries, hypocalcemic seizures in neonates often stem from underlying endocrinological issues rather than nutritional deficiencies.
- The presented cases highlight the varied etiologies and clinical trajectories of neonatal hypocalcemia.
Implications:
- Recognizing endocrinological etiologies is crucial for managing neonatal hypocalcemic seizures in developed healthcare settings.
- Understanding the pathophysiology, differential diagnosis, and treatment of neonatal hypocalcemia remains essential for pediatricians and neonatologists.
Abstract:
Seizures during the neonatal period have a broad differential diagnosis. Unlike in developing countries where hypovitaminosis D and hypocalcemia constitutes a major cause of infantile seizures, the number of neonatal seizures attributed to hypocalcemia in developed countries has decreased dramatically due to the improvement of infant formulas and vitamin D supplementation. In these countries, most infants that present with hypocalcemic seizures have underlying endocrinological etiologies rather than dietary insufficiencies. Here, we describe 3 cases of neonatal seizures due to hypocalcemia. Although the symptoms and calcium concentrations at presentation were similar in all 3 cases, the course of the disease and the final diagnosis for each were distinct. The cases are presented along with a brief review of the pathophysiology, differential diagnosis, and treatment of neonatal hypocalcemia.
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