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Parathormone and perinatal calcium homeostasis
Insights
Newborns show varying parathyroid hormone (PTH) and calcium levels, with infants of diabetic mothers and preterm infants experiencing delayed PTH increases. Hypocalcemia is prevalent in infants of diabetic mothers and those with birth asphyxia.
Area of Science:
- Neonatal endocrinology
- Pediatric mineral metabolism
Background:
- Parathyroid hormone (PTH) and calcium homeostasis are critical for neonatal adaptation.
- Understanding early life hormonal and mineral profiles is essential for identifying at-risk infants.
Purpose of the Study:
- To investigate the dynamic changes in plasma parathormone (PTH) and calcium concentrations during the first week of life in various newborn populations.
- To compare these profiles in term, preterm, infants of diabetic mothers (IDM), and asphyxiated infants.
Main Methods:
- Analysis of 309 plasma specimens from 190 newborns within the first 7 days of life.
- Measurement of plasma parathormone (PTH) and calcium levels.
- Stratification of infants by gestational age, maternal diabetes status, and presence of asphyxia or hypocalcemia.
Main Results:
- PTH was detectable in cord blood, even with high calcium. Term infants showed increased PTH from day 3. Preterm and IDM infants had delayed PTH increases until day 4.
- Hypocalcemia was frequent in IDM and asphyxiated infants. IDM infants displayed a unique, persistently depressed plasma calcium profile.
- Asphyxiated infants had low calcium despite significantly higher PTH levels compared to term infants.
Conclusions:
- Neonatal PTH and calcium dynamics differ significantly based on gestational age, maternal health, and birth complications.
- Early identification and monitoring of calcium and PTH are crucial for managing hypocalcemia in vulnerable newborns.
- This study highlights distinct endocrine and metabolic challenges faced by preterm infants, IDM, and those experiencing birth asphyxia.
Abstract:
Plasma parathormone (PTH) and calcium concentrations were measured in 309 specimens collected from 190 newborns during the first 7 days of life. The patient material consisted of 51 preterm, 130 term, and 9 postterm infants, including 22 infants of diabetic mothers (IDM), 38 infants with hypocalcemia, and 25 asphyxiated infants. PTH was detectable, although in low concentrations, in cord blood samples despite the presence of elevated calcium concentrations. Postpartum, PTH concentrations in term, appropriate for gestational age (AGA) infants remained low during the first 2 days of life; a significant (P less than 0.05) and sustained increase in plasma hormone levels was noted starting on day 3. PTH concentrations in IDM and preterm infants remained low for 3 days and a significant hormone increase did not occur until day 4. Hypocalcemia was common in IDM and asphyxiated infants; these infants accounted for two-thirds of all hypocalcemic infants. The profile of plasma calcium in IDM during the first week of life was different than that of any other group of infants. Plasma calcium concentrations remained depressed over this period of time and exhibited a temporary drop on day 4 accompanied by an increase in plasma PTH levels. Asphyxiated infants exhibited low plasma calcium concentrations, despite PTH levels that were significantly (P less than 0.007) higher than those of age-matched term AGA newborns.