A rare cause of neonatal hypercalcaemia

1
A rare cause of neonatal hypercalcaemia

• Carolyn Williams
• Angela Gbegbaje
• Royal Bolton Hospital

2
Patient

• Boy (JJ)
• Born 416
• 3560g
• Meconium aspiration

3
Delivery

• Emergency C- section- due to foetal distress
• Resuscitation
• Arterial cord pH 6.86
• Transfer to NNU

4
Mother

• 35 yr old primigravida
• A ve
• Hypothyroid
• H/O Glandular fever, genital warts

5
Progress

• Bolton SCBU
• -Meconium Aspiration
• -Perinatal Asphyxia
• -Acidotic
• -Hypoglycaemia
• Ventilated
• Condition deteriorated

6
Progress

• Aged 2 days
• Transfer to Regional Hospital for
• High frequency Oscillation Ventilation nitric
  oxide

7
Progress at Regional Hospital

• Improved
• Day 15- noted to have areas of cellulitis with
  multiple small areas of induration and some
  fluctuant.
• Day 19- V settled, feeding well, transferred back
  to Bolton SCBU

8
Bolton SCBU

• Day 27
• Baby irritable, feeding poorly
• Calcium 4.25mmol/l
• Phosphate 1.90mmol/l
• ALP 203 IU/l
• Albumin 38g/l

9
Further tests

• PTH 7pg/ml (11-35)
• Vitamin D
• 25OH VitD 24.7ng/ml (5-30)
• 1,25 OH VitD 45 pg/ml (20-50)

10
Further tests

• Urine calcium- 1.9mmol/l
• Urine creat-0.67mmol/l
• CaCr2.84 (0.06-0.74)

11
? Cause of hypercalcaemia

• Onset at 3-4 weeks
• General improvement in health
• Hyperparathyroidism
• Vitamin D toxicity
• FHH
• Malignancy

12
? Cellulitis
13
(No Transcript)
14
SUBCUTANEOUS FAT NECROSIS OF THE NEWBORN
15
(No Transcript)
16
SCFN

• Uncommon
• Erythematous nodules and plaques over trunk,
  buttocks and thighs
• Presents in first few weeks of life
• Self-limiting condition

17
SCFN

• Full term newborns
• History of obstetric trauma, meconium aspiration,
  asphyxia or hypothermia
• Rarely complicated by hypercalcaemia

18
Pathophysiology

• Theories
• 1)Increased saturated fatty acids due to
  defective fat metabolism.
• 2)Hypothermia- Injury to immature fat is induced
  by cold stress.

19
Pathophysiology

• 3) Crystallisation of neonatal fat.
• 4) Trauma during delivery

20
Fat cells with needle-like crystals and mixed
inflammatory cells
21
High Calcium?

• Increased prostaglandins? osteoclast activity
• Calcium release from necrotic fat cells

22
High Calcium- Vitamin D?

• Unregulated production of 1,25 OH Vit D by
  macrophages in granulomatous cells of fat
  necrosis.

23
Treatment

• Self limiting
• If hypercalcaemic- fluid loading with frusemide
• Low calcium and Vit D diet
• Steroids
• Bisphosphonates
• Calcium may be elevated for many months

24
Progress

• JJ discharged around 3 months old
• Regular calcium measurements
• Calcium now normal
• Infant doing well

25
Summary

• Term child with foetal distress and meconium
  aspiration
• Developed SCFN with associated life threatening
  hypercalcaemia
• SCFN should be considered in all neonates with
  raised calcium
• Calcium monitoring is essential

26
Thank you. Questions?