[P2-146] A Case of Neonatal Hypocalcaemic Seizures Related to Maternal Vitamin D Deficiency
Vitamin D deficiency in infants and mothers is a re-emerging public health issue recently. The American Academy of Pediatrics (AAP) has recommended a dose of 400 IU of Vitamin D supplement per day to breast-fed and partially breast-fed infants. We present a breast-fed baby of neonatal hypocalcaemia seizures secondary to maternal vitamin D deficiency that was uncommon in Taiwan with subtropical climate.
An 18-day-old breast-fed male neonate born by a 37 years old G1P1 mother was admitted with new-onset focal seizures. He had been noted eye left-upward gaze; left-sided head turning and right upper arm extension with lip smacking followed by tonic-clonic movement. The seizure duration was from 30s to 145s and the frequency increased from each hour to every 1~2 minutes. There was no history of fever, trauma, or neonatal sepsis risk factors. Physical as well as neurological examinations were unremarkable. Magnetic resonance imaging of the brain was normal. Electroencephalography showed multifocal epileptiform phenomenon. Laboratory investigations in blood revealed low calcium 6.2mg/dL, normal parathyroid hormone level (intact PTH) 67pg/mL, and low VitD (25-OH), total level (15.87ng/mL). The Fluorescence in situ hybridization (FISH) study for chromosome 22q11.2 deletion showed normal signal pattern. Maternal intact PTH was 36.9pg/mL, 25-hydroxyvitamin D3 was 30.8 pg/mL and her total VitD (25-OH) level was low to 9.42ng/mL. The mother was a PhD student and was studying hard for her paper, hardly going to outdoors to have enough sun exposure. The infant was treated with oral calcium, calcitriol and vitamin D. His seizure was free with normal development and growth. We emphasize the importance of vitamin D supplementation for pregnant and breast-feeding mothers and newborns.
An 18-day-old breast-fed male neonate born by a 37 years old G1P1 mother was admitted with new-onset focal seizures. He had been noted eye left-upward gaze; left-sided head turning and right upper arm extension with lip smacking followed by tonic-clonic movement. The seizure duration was from 30s to 145s and the frequency increased from each hour to every 1~2 minutes. There was no history of fever, trauma, or neonatal sepsis risk factors. Physical as well as neurological examinations were unremarkable. Magnetic resonance imaging of the brain was normal. Electroencephalography showed multifocal epileptiform phenomenon. Laboratory investigations in blood revealed low calcium 6.2mg/dL, normal parathyroid hormone level (intact PTH) 67pg/mL, and low VitD (25-OH), total level (15.87ng/mL). The Fluorescence in situ hybridization (FISH) study for chromosome 22q11.2 deletion showed normal signal pattern. Maternal intact PTH was 36.9pg/mL, 25-hydroxyvitamin D3 was 30.8 pg/mL and her total VitD (25-OH) level was low to 9.42ng/mL. The mother was a PhD student and was studying hard for her paper, hardly going to outdoors to have enough sun exposure. The infant was treated with oral calcium, calcitriol and vitamin D. His seizure was free with normal development and growth. We emphasize the importance of vitamin D supplementation for pregnant and breast-feeding mothers and newborns.