Laryngospasm and neonatal seizure due to hypocalcaemia and vitamin D deficiency: an emergency condition in NICU and challenge to the neonatologist.

To cite: Sharma D, Pandita A, Pratap OT, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-206795 A term male infant, 8 days old, was admitted to our neonatal intensive care unit with abnormal movements of the upper limbs. The infant was born in our hospital with birth weight of 3.2 kg and had an Apgar score of 8/9/9 at 1, 5 and 10 min, respectively. The infant was breastfed and also formula fed. The physical examination did not reveal any malformation or abnormal facies. The infant was investigated for neonatal seizure, the results of which showed serum sodium of 138 mg/dL, potassium of 3.8 mg/ dL, sugar of 87 mg/dL, serum calcium of 4.6 mg/dL (1.15 mmol/dL) and serum magnesium of 1.6 mg/dL (0.65 mmol/L). The ECG showed a prolonged QTc interval (0.52 s). Head ultrasound showed no significant abnormality. The baby was given stat injectable calcium for symptomatic hypocalcaemia and was taken up on a maintenance dosage of calcium at 80 mg/kg/day. On morning rounds he had seizure in the form of fisting of upper limbs with increase in tone of limbs. He had laryngeal spasms with stridor leading to cyanosis of limbs (video 1). The infant was again given a stat dose of calcium, which led to cessation of the laryngeal spasms and there was no recurrence of seizure. The infant was further evaluated for causes of hypocalcaemia, which showed serum phosphorus of 4.2 mg/dL (1.355 mmol/L), ionised calcium 0.62 mmol/L (normal 1.14–1.29 mmol/L) and serum alkaline phosphate was 436 U/L (normal 110–300 U/L). The endocrine evaluation showed an elevated serum parathyroid level of 108 ng/L (normal 10 to 65 ng/L) and a very low 25-hydroxyvitamin D level of 5.59 ng/mL (normal 20–80 ng/mL). EEG study showed a normal electrical wave pattern for gestation. The mother was also evaluated for vitamin D deficiency, which showed results of a vitamin D3 level of 12.09 ng/mL (normal 20–80 ng/cc), which was also low. There was no recurrence of seizure after therapeutic calcium supplementation. The baby was discharged on calcium and vitamin D supplementation and is now on regular follow-up. The mother was also treated with calcium and vitamin D supplementation.