Natural history and outcome of neonatal hypocalcemic and hypomagnesemic seizures

Area of Science:

• Neonatal Neurology
• Pediatric Endocrinology
• Cardiology

Background:

• Neonatal seizures are a critical concern, with hypocalcemia and hypomagnesemia being significant causes.
• Congenital heart disease (CHD) is frequently associated with these metabolic disturbances in newborns.
• Previous studies suggested favorable neurologic outcomes for neonatal seizures due to these deficiencies, often linked to nutritional etiologies.

Purpose of the Study:

• To investigate the clinical characteristics and neurologic outcomes of newborn infants experiencing seizures due to hypocalcemia and hypomagnesemia.
• To explore the association between these metabolic derangements and severe congenital heart disease.
• To re-evaluate the neurologic prognosis in this specific patient population, considering modern etiologies.

Main Methods:

• Retrospective study of 15 newborn infants with seizures attributed to hypocalcemia and hypomagnesemia.
• Exclusion of other potential seizure etiologies.
• Clinical data collection, including associated diagnoses, mortality, and neurologic follow-up.

Main Results:

• Severe congenital heart disease was present in 47% of patients.
• No formula feeding abnormalities were identified as a cause.
• Five patients (36%) died from causes unrelated to seizures.
• Follow-up in 9 patients revealed neurologic abnormalities in 2 (22%), both with endocrine-related hypocalcemia.

Conclusions:

• Infants with severe congenital heart disease warrant investigation for hypocalcemia and hypomagnesemia.
• The favorable neurologic outcomes previously reported may not apply to current populations where nutritional deficiencies are rare.
• Neurologic prognosis in this cohort is likely influenced by associated medical conditions rather than the seizures themselves.