Critical analytical and clinical aspects of ionized calcium in neonates

Clinical diagnosis in neonates is often based primarily on biochemical data, because clinical symptoms are difficult to assess and inconclusive. A knowledge of the validity of the data would therefore seem very important. Practical technical assessments lead me to conclude that measurement of ionized calcium at actual pH in anaerobic capillary samples of whole blood, currently practicable, is an easy and optimal laboratory analysis when biologically significant data are required for assessment of acute disturbances in calcium homeostasis of neonates. Values are given for ionized calcium, describing the relations in cord and maternal blood in uncomplicated pregnancies at term. Recent published cross-sectional and longitudinal reference values for ionized calcium, measured during the first weeks in healthy full-term and preterm neonates, seem to provide a new basis for the diagnosis and management of early neonatal hypocalcemia.