Incidence of early onset hypocalcaemia in newborns admitted in level III NICU

Background: Metabolic derangements like hypoglycaemia, hypocalcaemia, hyponatremia are common in newborns especially at risk babies like immature babies, infants of diabetic mother (IDM), babies with perinatal asphyxia1-3 . Hypocalcaemia can manifest as seizures, apnoea, jitteriness and stridor. (4) But majority of hypocalcaemia in early neonatal period (<72 Hrs.) are asymptomatic, which cannot be picked up easily. No study has been conducted to know the incidence of early onset hypocalcemia in babies admitted in neonatal intensive care unit. Hence we did this study in Baby Memorial Hospital, a tertiary referral hospital, in Calicut; Incidence of early onset hypocalcaemia is more common in high risk neonates (immature babies, infants of diabetic mothers, babieswith perinatal asphyxia). Aims of the study: To know the incidence of early onset hypocalcaemia in neonates admitted in NICU. To know the incidence of asymptomatic and symptomatic early onset hypocalcaemia. To know the high risk period of early onset hypocalcaemia. Materials and Methods: A hospital based prospective observational study with a sample size of 150 consecutive babies admitted inNICU.Aftertaking informed consent each babyin NICU underwent serialserumcalciumestimation at 24, 48&72 hours and serum magnesium & serum albumin estimation at 24 hours. It was decided that if the baby develops symptoms of hypocalcaemia any time before 72 hours; serum calcium, magnesium and albumin estimationwould be done again. Observation and results: The overall incidence of early onset hypocalcaemia in Baby Memorial Hospital was 26.7%. This study shows that 24-48 hours of life has highest risk of early onset hypocalcaemia and 80% of hypocalcaemia were asymptomatic. The incidence of early onset hypocalcaemia among infants of diabetic mothers was found to be 52%.The incidence of early onset hypocalcaemiaamong perinatalasphyxiababies was 35%. Conclusions: Early onset hypocalcaemia is commonly seen in premature babies, infants of diabetic mothers and perinatal asphyxia. Majority of early onset hypocalcaemia are asymptomatic. Hence it is advisable to do routine serum calcium estimation in babies admitted in NICU within 72 hours oflife, preferably at 24,48 and 72 hours oflife.