1. Bradycardia in one day old neonate secondary to Maternal Hypo-vitaminosis D
NEERAJ AGGARWAL; MRIDUL AGARWAL; REENA K JOSHI; RAJA JOSHI
PEDIATRIC CARDIAC SCIENCES, SIR GANGA RAM HOSPITAL; NEW DELHI
INTRODUCTION
ECG AT ADMISSION AND AFTER TREATMENT
DISCUSSION
Hypocalcemia occurring during the first 3 days of life is termed early onset hypocalcemia. Late onset neonatal hypocalcemia typically occurs in term neonate after 3 days of life. Maternal Vitamin D deficiency is commonly known to cause late onset hypocalcemia. Early onset hypocalcemia is not a common feature in maternal hypovitaminosis D
Early onset hypocalcemia is associated with prematurity, growth retardation,hypo-parathyroidism,birth asphyxia or maternal Diabetes. This newborn was full term with no features of growth retardation, birth asphyxia or maternal diabetes.
Serum Parathyroid hormone (PTH) levels were normal , ruling out the possibility of congenital hypoplasia of parathyroid glands.
Further investigation suggested low vitamin D levels in baby and mother. Severe maternal vitamin D deficiency was attributed as a cause for symptomatic early onset hypocalcemia in this neonate.
CASE HISTORY
A 10 hours old male neonate was referred with complains of low heart rate. Electrocardiogram (ECG) was suggestive of long QT interval (QTc interval = 0.54 sec). Echocardiogram showed structurally normal heart with ventricular dysfunction (Left ventricular ejection fraction (LVEF= 45%).Initial Investigations suggested low ionized calcium, normal phosphorus and borderline low magnesium levels. ECG of parents and elder sibling showed normal QTc intervals.
CLINICAL IMPLICATIONS
Early onset hypocalcemia presenting as neonatal bradycardia with prolong QT interval is a rare presentation of severe maternal hypovitaminosis D, which should be suspected after ruling out other causes of early onset hypocalcemia
MANAGEMENT
Baby was treated with parenteral calcium along with vitamin D. Heart rate improved (heart rate=125/min) and QTc interval normalized (QTc=0.38 sec) in 48 hrs. Repeat Echo after 48 hrs showed normal Left ventricular function.
25 OH vitamin D level in neonate (11.5 ng/mL)and mother (4.2 ng/ml) were low {normal range 30 to 74 ng/mL}