Neonatal hypocalcaemia associated with maternal hyperparathyroidism. New pathogenetic observations

Area of Science:

• Pediatrics
• Endocrinology
• Neonatology

Background:

• Neonatal hypocalcemia is a critical condition requiring prompt diagnosis and management.
• Maternal hyperparathyroidism can impact fetal calcium homeostasis.
• Vitamin D metabolism plays a crucial role in calcium regulation.

Purpose of the Study:

• To investigate the relationship between maternal hyperparathyroidism and neonatal hypocalcemia.
• To explore the role of vitamin D metabolism in a case of neonatal hypocalcemic convulsions.
• To determine the optimal treatment strategy for such cases.

Main Methods:

• Case study of a 32-day-old male infant presenting with hypocalcemic convulsions.
• Analysis of serum calcium, phosphate, parathyroid hormone (PTH), and 25-hydroxycholecalciferol (25-OHD3) levels.
• Monitoring of biochemical parameters during treatment with calcium and vitamin D.

Main Results:

• The infant presented with severe hypocalcemia and hyperphosphatemia, alongside normal maternal parathyroid hormone and 25-hydroxycholecalciferol.
• Post-treatment, a marked increase in PTH and 25-OHD3 was observed before calcium normalization.
• This suggests a potential impairment in the conversion of 25-hydroxycholecalciferol to 1,25-dihydroxyvitamin D3 during hyperphosphatemia.

Conclusions:

• Neonatal hypocalcemic convulsions can be associated with asymptomatic maternal hyperparathyroidism.
• Impaired vitamin D metabolism, specifically the conversion to the active form, may contribute to hypocalcemia in the neonatal period.
• Treatment with 1,25-dihydroxyvitamin D3 or its analogues is recommended for persistent or severe cases.