Vitamin D Deficiency Prevalence in Late Neonatal Hypocalcemia: A Multicenter Study
Gülcan Seymen-Karabulut1, Ayla Günlemez2, Ayşe Sevim Gökalp2, Şükrü Hatun3, Fatma Kaya Narter4, Mehmet Mutlu5, Şebnem Kader6, Demet Terek7, Deniz Hanta8, Emel Okulu9, Leyla Karadeniz10, H. Gözde Kanmaz Kutman11, Ayşegül Zenciroğlu12, Özmert M. A. Özdemir13, Dilek Sarıcı14, Muhittin Çelik15, Nihat Demir16, Özden Turan17, Kıymet Çelik18, Fatih Kılıçbay2, Sinan Uslu19, Sara Erol20, Sabahattin Ertuğrul21, Ilkay Er22, Hasan Tolga Çelik23, Merih Çetinkaya24, Filiz Aktürk-Acar5, Yakup Aslan5, Gaffari Tunç9, Ömer Güran10, Ayşe Engin Arısoy21University of Health Sciences Turkey, Ümraniye Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey2Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kocaeli, Turkey
3Koç University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
4Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, İstanbul, Turkey
5Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Trabzon, Turkey
6Trabzon Kanuni Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, Trabzon, Turkey
7Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, İzmir, Turkey
8Adana Women and Children Hospital, Clinic of Pediatrics, Division of Neonatology, Adana, Turkey
9Ankara University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
10University of Health Sciences Turkey, Ümraniye Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, İstanbul, Turkey
11Zekai Tahir Burak Maternity Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, Ankara, Turkey
12University of Health Sciences Turkey, Ankara Dr. Sami Ulus Maternity Women and Children Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, Ankara, Turkey
13Pamukkale University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Denizli, Turkey
14Keçiören Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, Ankara, Turkey
15Diyarbakır Children Hospital, Clinic of Pediatrics, Division of Neonatology, Diyarbakır, Turkey
16Van Yüzüncü Yıl University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Van, Turkey
17Başkent University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
18Dr. Behçet Uz Children Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, İzmir, Turkey
19Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, İstanbul, Turkey
20Etlik Zübeyde Hanım Maternity Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, Ankara, Turkey
21Dicle University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Diyarbakır, Turkey
22Derince Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, Kocaeli, Turkey
23Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
24Kanuni Training and Research Hospital, Clinic of Pediatrics, Division of Neonatology, İstanbul, Turkey
Objective: Late neonatal hypocalcemia (LNH) is a common metabolic problem associated with hypoparathyroidism, high phosphate intake and vitamin D deficiency, often presenting with seizures. In this cross-sectional study, we aimed to evaluate the role of vitamin D deficiency in LNH in Turkey and to describe the characteristics of affected newborns.
Methods: Conducted with a cross-sectional design and with the participation of 61 neonatal centers from December 2015 to December 2016, the study included term neonates with LNH (n=96) and their mothers (n=93). Data were registered on the FAVOR Web Registry System. Serum samples of newborns and mothers were analyzed for calcium, phosphate, magnesium, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH) and 25 hydroxyvitamin D [25(OH)D] levels.
Results: The median (range) onset time of hypocalcemia was 5.0 (4.0-8.0) days of age, with a male preponderance (60.4%). The median (range) serum 25(OH)D levels of the neonates and their mothers were 6.3 (4.1-9.05) and 5.2 (4.7-8.8) ng/mL, respectively. The prevalence of vitamin D deficiency (<12 ng/mL) was high in both the neonates (86.5%) and mothers (93%). Serum 25(OH)D levels of the infants and mothers showed a strong correlation (p<0.001). While the majority (93.7%) of the neonates had normal/high phosphorus levels, iPTH levels were low or inappropriately normal in 54.2% of the patients.
Conclusion: Vitamin D deficiency prevalence was found to be high in LNH. Efforts to provide vitamin D supplementation during pregnancy should be encouraged. Evaluation of vitamin D status should be included in the workup of LNH.
Manuscript Language: English
