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. 1974 Aug;54(2):287–296. doi: 10.1172/JCI107764

Calcium Metabolism in Newborn Infants THE INTERRELATIONSHIP OF PARATHYROID FUNCTION AND CALCIUM, MAGNESIUM, AND PHOSPHORUS METABOLISM IN NORMAL, “SICK,” AND HYPOCALCEMIC NEWBORNS

Louis David 1,2, Constantine S Anast 1,2
PMCID: PMC301556  PMID: 4858778

Abstract

Serum immunoreactive parathyroid hormone (iPTH) and plasma total calcium, ionized calcium, magnesium, and phosphorus levels were determined during the first 9 days of life in 137 normal term infants, 55 “sick” infants, and 43 hypocalcemic (Ca <7.5 mg/100 ml; Ca++<4.0 mg/100 ml) infants.

In the cord blood, elevated levels of plasma Ca++ and Ca were observed, while levels of serum iPTH were either undetectable or low. In normal newborns during the first 48 h of life there was a decrease in plasma Ca and Ca++, while the serum iPTH level in most samples remained undetectable or low; after 48 h there were parallel increases in plasma Ca and Ca++ and serum iPTH levels. Plasma Mg and P levels increased progressively after birth in normal infants.

In the sick infants, plasma Ca, Ca++ and P levels were significantly lower than in the normal newborns, while no significant differences were found in the plasma Mg levels. The general pattern of serum iPTH levels in the sick infants was similar to that observed in the normal group, though there was a tendency for the increase in serum iPTH to occur earlier and for the iPTH levels to be higher in the sick infants.

In the hypocalcemic infants, plasma Mg levels were consistently lower than in the normal infants after 24 h of age, while no significant differences were found in the plasma P levels. Hyperphosphatemia was uncommon and did not appear to be a contributing factor in the pathogenesis of hypocalcemia in most infants. Most of the hypocalcemic infants, including those older than 48 h, had inappropriately low serum iPTH levels.

Evidence obtained from these studies indicates that parathyroid secretion is normally low in the early new born period and impaired parathyroid function, characterized by undetectable or low serum iPTH, is present in most infants with neonatal hypocalcemia. Additional unknown factors appear to contribute to the lowering of plasma Ca in the neonatal period. The net effect of unknown plasma hypocalcemic factor(s) on the one hand and parathyroid activity on the other may account for differences in plasma Ca levels observed between normal, sick, and hypocalcemic infants. Depressed plasma Mg is frequently present in hypocalcemic infants. To what degree the hypomagnesemia reflects parathyroid insufficiency or the converse, to what degree parathyroid insufficiency and hypocalcemia are secondary to hypomagnesemia, is uncertain.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anast C. S., Mohs J. M., Kaplan S. L., Burns T. W. Evidence for parathyroid failure in magnesium deficiency. Science. 1972 Aug 18;177(4049):606–608. doi: 10.1126/science.177.4049.606. [DOI] [PubMed] [Google Scholar]
  2. BOYD J. D. Development of the thyroid and parathyroid glands and the thymus. Ann R Coll Surg Engl. 1950 Dec;7(6):455–471. [PMC free article] [PubMed] [Google Scholar]
  3. CONNELLY J. P., CRAWFORD J. D., WATSON J. Studies of neonatal hyperphosphatemia. Pediatrics. 1962 Sep;30:425–432. [PubMed] [Google Scholar]
  4. CRAIG W. S. Clinical signs of neonatal tetany: with especial reference to their occurrence in newborn babies of diabetic mothers. Pediatrics. 1958 Aug;22(2):297–308. [PubMed] [Google Scholar]
  5. Canterbury J. M., Reiss E. Multiple immunoreactive molecular forms of parathyroid hormone in human serum. 1. Proc Soc Exp Biol Med. 1972 Sep;140(4):1393–1398. doi: 10.3181/00379727-140-36681. [DOI] [PubMed] [Google Scholar]
  6. Conaway H. H., Anast C. S. Double-antibody radioimmunoassay for parathyroid hormone. J Lab Clin Med. 1974 Jan;83(1):129–138. [PubMed] [Google Scholar]
  7. Cushard W. G., Jr, Creditor M. A., Canterbury J. M., Reiss E. Physiologic hyperparathyroidism in pregnancy. J Clin Endocrinol Metab. 1972 May;34(5):767–771. doi: 10.1210/jcem-34-5-767. [DOI] [PubMed] [Google Scholar]
  8. Dubowitz L. M., Dubowitz V., Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr. 1970 Jul;77(1):1–10. doi: 10.1016/s0022-3476(70)80038-5. [DOI] [PubMed] [Google Scholar]
  9. Estep H., Shaw W. A., Watlington C., Hobe R., Holland W., Tucker S. G. Hypocalcemia due to hypomagnesemia and reversible parathyroid hormone unresponsiveness. J Clin Endocrinol Metab. 1969 Jun;29(6):842–848. doi: 10.1210/jcem-29-6-842. [DOI] [PubMed] [Google Scholar]
  10. GITTLEMAN I. F., PINCUS J. B., SAITO M., SCHMERZLER E. Hypocalcemia occurring on the first day of life in mature and premature infants. Pediatrics. 1956 Nov;18(5):721–729. [PubMed] [Google Scholar]
  11. GRAHAM G. G., BARNESS L. A., GYORGY P. Serum calcium and inorganic phosphate in the newborn infant, and their relation to different feedings. J Pediatr. 1953 Apr;42(4):401–408. doi: 10.1016/s0022-3476(53)80452-x. [DOI] [PubMed] [Google Scholar]
  12. Garel J. M. Effet de l'injection d'un sérum "anti-parathormone" chez le foetus de rat. C R Acad Sci Hebd Seances Acad Sci D. 1970 Dec 21;271(25):2364–2366. [PubMed] [Google Scholar]
  13. Goldsmith R. S., Furszyfer J., Johnson W. J., Fournier A. E., Sizemore G. W., Arnaud C. D. Etiology of hyperparathyroidism and bone disease during chronic hemodialysis. 3. Evaluation of parathyroid suppressibility. J Clin Invest. 1973 Jan;52(1):173–180. doi: 10.1172/JCI107161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Graham R. W., Porter G. P. Fetal-maternal plasma calcium relationships in the rabbit. Q J Exp Physiol Cogn Med Sci. 1971 Jul;56(3):160–168. doi: 10.1113/expphysiol.1971.sp002115. [DOI] [PubMed] [Google Scholar]
  15. Graham R. W., Scothorne R. J. Calcium homeostasis in the foetal guinea pig. Q J Exp Physiol Cogn Med Sci. 1970 Jan;55(1):44–53. doi: 10.1113/expphysiol.1970.sp002049. [DOI] [PubMed] [Google Scholar]
  16. Habener J. F., Powell D., Murray T. M., Mayer G. P., Potts J. T., Jr Parathyroid hormone: secretion and metabolism in vivo. Proc Natl Acad Sci U S A. 1971 Dec;68(12):2986–2991. doi: 10.1073/pnas.68.12.2986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones K. H., Fourman P. Effects of infusions of magnesium and of calcium in parathyroid insufficiency. Clin Sci. 1966 Feb;30(1):139–150. [PubMed] [Google Scholar]
  18. Keen J. H. Significance of hypocalcaemia in neonatal convulsions. Arch Dis Child. 1969 Jun;44(235):356–361. doi: 10.1136/adc.44.235.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Linarelli L. G. Newborn urinary cyclic AMP and developmental renal responsiveness to parathyroid hormone. Pediatrics. 1972 Jul;50(1):14–23. [PubMed] [Google Scholar]
  20. MOSES L. E. Statistical theory and research design. Annu Rev Psychol. 1956;7:233–258. doi: 10.1146/annurev.ps.07.020156.001313. [DOI] [PubMed] [Google Scholar]
  21. Moore E. W. Ionized calcium in normal serum, ultrafiltrates, and whole blood determined by ion-exchange electrodes. J Clin Invest. 1970 Feb;49(2):318–334. doi: 10.1172/JCI106241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Muldowney F. P., McKenna T. J., Kyle L. H., Freaney R., Swan M. Parathormone-like effect of magnesium replenishment in steatorrhea. N Engl J Med. 1970 Jan 8;282(2):61–68. doi: 10.1056/NEJM197001082820203. [DOI] [PubMed] [Google Scholar]
  23. Paunier L., Radde I. C., Kooh S. W., Conen P. E., Fraser D. Primary hypomagnesemia with secondary hypocalcemia in an infant. Pediatrics. 1968 Feb;41(2):385–402. [PubMed] [Google Scholar]
  24. SCOTHORNE R. J. FUNCTIONAL CAPACITY OF FETAL PARATHYROID GLANDS WITH REFERENCE TO THEIR CLINICAL USE AS HOMOGRAFTS. Ann N Y Acad Sci. 1964 Nov 30;120:669–676. doi: 10.1111/j.1749-6632.1964.tb34761.x. [DOI] [PubMed] [Google Scholar]
  25. Shami Y., Radde I. C. Calcium-stimulated ATPase of guinea pig placenta. Biochim Biophys Acta. 1971 Dec 3;249(2):345–352. doi: 10.1016/0005-2736(71)90113-1. [DOI] [PubMed] [Google Scholar]
  26. Smith F. G., Jr, Alexander D. P., Buckle R. M., Britton H. G., Nixon D. A. Parathyroid hormone in foetal and adult sheep: the effect of hypocalcaemia. J Endocrinol. 1972 Jun;53(3):339–348. doi: 10.1677/joe.0.0530339. [DOI] [PubMed] [Google Scholar]
  27. Suh S. M., Tashjian A. H., Jr, Matsuo N., Parkinson D. K., Fraser D. Pathogenesis of hypocalcemia in primary hypomagnesemia: normal end-organ responsiveness to parathyroid hormone, impaired parathyroid gland function. J Clin Invest. 1973 Jan;52(1):153–160. doi: 10.1172/JCI107159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Tan C. M., Raman A., Sinnathyray T. A. Serum ionic calcium levels during pregnancy. J Obstet Gynaecol Br Commonw. 1972 Aug;79(8):694–697. doi: 10.1111/j.1471-0528.1972.tb12902.x. [DOI] [PubMed] [Google Scholar]
  29. Tsang R. C., Kleinman L. I., Sutherland J. M., Light I. J. Hypocalcemia in infants of diabetic mothers. Studies in calcium, phosphorus, and magnesium metabolism and parathormone responsiveness. J Pediatr. 1972 Mar;80(3):384–395. doi: 10.1016/s0022-3476(72)80494-3. [DOI] [PubMed] [Google Scholar]
  30. Tsang R. C., Oh W. Neonatal hypocalcemia in low birth weight infants. Pediatrics. 1970 May;45(5):773–781. [PubMed] [Google Scholar]

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