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Calcium homeostasis disorder during and after neonatal extracorporeal membrane oxygenation

Jerome Rambaud1, Isabelle Guellec1, Julia Guilbert1

  • 1Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|October 3, 2015
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) in neonates causes calcium homeostasis dysregulation, with high parathyroid hormone and normal serum calcium during treatment. Post-ECMO, hypercalcemia with normal parathyroid hormone suggests impaired calcium regulation.

Area of Science:

  • Neonatal intensive care
  • Pediatric critical care medicine
  • Endocrinology

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates with refractory hypoxemia or septic shock.
  • Previous research indicates calcium homeostasis is disrupted during ECMO.
  • The precise mechanisms of this dysregulation require further investigation.

Purpose of the Study:

  • To confirm calcium homeostasis dysregulation in neonates undergoing ECMO.
  • To explore potential new explanations for these calcium balance disturbances.

Main Methods:

  • A prospective, single-center observational study included eleven neonatal patients.
  • Blood samples were collected pre-ECMO and on days 7, 14, and 21 for analysis of parathyroid hormone (PTH), serum calcium, ionized calcium, magnesium, and calcitriol.
  • Surviving patients were followed up for six months post-ECMO weaning.

Main Results:

  • During ECMO, parathyroid hormone (PTH) levels were inappropriately high, while serum calcium remained within the normal range.
  • A lack of correlation between serum calcium and PTH levels was observed, indicating dysregulated calcium-PTH metabolism.
  • Six months after ECMO cessation, patients exhibited hypercalcemia with normalized PTH levels.

Conclusions:

  • The study confirms significant calcium homeostasis disturbances in neonates treated with ECMO.
  • Evidence suggests potential damage to the calcium regulatory system during ECMO.
  • The exact causes of these calcium disturbances remain unclear and warrant further research.
Abstract

Keywords:
Calciumextracorporeal membrane oxygenationneonatesparathyroidphosphorus

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