Hypocalcaemia Occurring Within Forty-Eight Hours Of Birth In Term Infants With Severe Birth Asphyxia

Abstract

In this cross-sectional study, total serum calcium of 31 term infants with 1-minute Apgar score of 3 or less was measured and compared with those of their counterparts with 1-minute Apgar score of 7 and above. The total serum calcium of severely asphyxiated infants who had sodium bicarbonate administered during resuscitation was compared with those of their counterparts without sodium bicarbonate therapy. Infants with birth asphyxia were examined serially from time of birth and compared with their counterparts without birth asphyxia. Overall prevalence of early-onset neonatal hypocalcaemia (total serum calcium < 1.75 mmol/L) among infants with severe birth asphyxia was 22.6%. Mean total serum calcium at the ages of 12, 24 and 48 hours were significantly lower among asphyxiated compared to non-asphyxiated infants (p<0.001). The mean total serum calcium in bicarbonate treated infants and their counterparts without bicarbonate therapy was 1.65 + 0.07 mmol/L and 1.74 + 0.06 mmol /L (p<0.01) respectively. Asphyxiated infants with normal total serum calcium at the age of 12 and 24 hours did not develop hypocalcaemia at the age of 48 hours. The leading clinical manifestations among infants with birth asphyxia and early-onset neonatal hypocalcaemia were convulsion (57.1%), twitching of one or more extremities (42.9%), high-pitched cry (42.9%) and hypertonia (42.9%). Carpopedal spasm was not a prominent clinical manifestation. In conclusion, early-onset neonatal hypocalcaemia is common among infants with birth asphyxia, particularly among those treated with sodium bicarbonate during resuscitation.

Keywords: Neonatal hypocalcaemia, birth asphyxia, bicarbonate therapy.