Neonatal Hypocalcaemia

Neonatal hypocalcaemia may occur early, particularly in prematurity, perinatal hypoxia, infants of diabetic mothers and critical illness, or later due to high phosphate intake, vitamin D deficiency or hypoparathyroidism.

• Jitteriness
• Tremors
• Irritability
• Poor feeding
• Apnoea
• Laryngospasm
• Seizures
• Prolonged QT interval

Measure:

• Total and preferably ionized calcium
• Magnesium
• Phosphate
• Glucose

Persistent disease may require parathyroid hormone and vitamin D assessment.

Symptomatic hypocalcaemia requires IV calcium.

10% calcium gluconate 0.5 to 1 mL/kg IV slowly over approximately 10 minutes, with continuous cardiac monitoring.

Extravasation can cause severe tissue necrosis. Ensure secure venous access.

Correct coexisting hypomagnesaemia because hypocalcaemia may remain refractory until magnesium is corrected.