Neonatal hyperparathyroidism secondary to unknown maternal hypoparathyroidism]

Vitamin D or its analogue (calcitriol) is an effective treatment for hypoparathyroidism during pregnancy. Normal babies are delivered and very few cases of associated neonatal hyperparathyroidism are reported. CASE REPORT: We report the case of a baby born to a mother suffering unknown hypoparathyroidism. He was delivered prematurely by cesarean section for birth asphyxia. His mother had had recurrent bouts of impetigo herpetiformis for several months. Severe demineralization associated with decreased plasma calcium level were observed at birth. The PTH level was very high (955 ng/mL) in the baby and very low in the mother, leading to the diagnosis. The baby was given intravenous calcium gluconate, oral 1 alpha-hydroxyvitamin D and mechanical ventilation. Normal plasma calcium level was reached on day 2. PTH level improved by one month of age. Because of impaired respiratory mechanics and bronchopulmonary dysplasia, the baby was kept on ventilation for 58 days. By 20 months of age, he was in good health despite a small height for his age. CONCLUSION: In such cases 1 alpha-hydroxyvitamin D seems to be very effective but plasma and urinary calcium levels need careful monitoring.     

Neonatal hypocalcemia with hyperparathyroidism in the mother (author's transl)

A report on two siblings, on formula feeding, who had fits in the second week of life. Cause of the hypocalcemic cramps was a formerly undetected hyperparathyroidism in the mother.     

Neonatal hypocalcemia in hyperparathyroidism of the mother (author's transl)

Case report of a female neonate with hypocalcemia and spasms. The cause was parathyroid insufficiency due to hyperparathroidism of the mother. The hypocalcemia was treated with a massive dose of Vitamin D; this led to a sharp rise of 25-OH-vitamin D levels in serum. The mother had kidney stones. There was hypercalcemia and a raised parathormone level. Diagnosis was confirmed by surgery. An adenoma weighing 7 g was removed.     

Neonatal primary hyperparathyroidism caused by clear cell hyperplasia

Neonatal primary hyperparathyroidism is rare but must be evoke during respiratory distress with thoracic deformity and hypercalcemia. The plasma immunoreactive parathyroid hormone level allows the diagnostic. This case, with diffuse hyperplasia of water-clear cells type, develops rickets of vitamin D deficiency before surgery. A large parathyroidectomy (7/8) was performed and the child is normo-calcemic 2 years after. The time of surgery is function of calcium level.     

Neonatal sepsis due to vertical transmission from maternal genital tract

High vaginal swabs (HVS) of 1792 expectant mothers were sent for culture at the time of delivery, prior to first vaginal examination. The newborns were followed-up for development of superficial or deep infections. Appropriate cultures of the babies who developed infections were sent. Bacterial growth of predominantly gram-ve organisms was obtained in 1026 (57%) HVS. Infection developed in 48 (27%) babies in 1 st 72 hours of life, of which 28 had deep infection while the rest had superficial infection. Vertical transmission of organisms was documented in 24 (1.3%) mother—baby dyads and the same was 72% in newborns who were at risk of developing sepsis by septicemia scoring, showing a significantly higher incidence of vertical transmission and subsequent sepsis in high risk newborns.     

Myocardial dysfunction due to hypocalcemia

Hypocalcemia is a curable cause of myocardial dysfunction and clinical congestive cardiac failure, with only stray reports available in literature. We describe 15 infants presenting with severe left ventricular dysfunction, who were found to have hypocalcemia with or without hypomagnesemia. Vitamin D deficiency was identified as the main cause of hypocalcemia. These children improved on supplementation of vitamin D and calcium.     

Neonatal hyperparathyroidism

We describe a girl with congenital hyperparathyroidism who presented soon after birth with respiratory distress, hypotonia, feeding difficulties, and bone deformities. Hypercalcaemia, hypophosphataemia, and raised alkaline phosphatase were present and plasma parathyroid hormone levels measured by radioassay and bioassay were raised. X-rays showed gross demineralisation with metaphyseal fractures, erosions, and sub-periostal reaction along the bones. Following surgical removal of four hyperplastic parathyroid glands and subsequent maintainance therapy with 1-alpha-hydroxycholecalciferol there has been virtually complete reversal of her bone abnormalities.