A study of the prevalence and correlates of early onset neonatal hypocalcaemia in term neonates at Kenyatta National Hospital

Abstract

Introduction: Hypocalcaemia is a major concern in the neonatal period, often associated with metabolic disturbances whose consequences are high morbidity and mortality. Neonatal hypocalcaemia correlates to foetal and maternal calcium level as the neonate depends on the mother to supply all the calcium during foetal life and lactation period. Studies have shown that calcium intake in women during pregnancy and lactation can be quite low. This would reflect as low calcium level in neonates. It is, therefore, important to assess serum calcium level in the term neonate and correlate it to maternal serum calcium levels at birth. Study Design: A hospital based short cohort study was conducted for a period of three months. Study Setting: Kenyatta National Hospital (KNH) labour ward and the designated postnatal wards. Study Population: The study subjects included all pregnant women admitted at the Kenyatta National Hospital labour ward and later their new born babies. Study Procedure: A total of 121 pregnant women and later their newborn babies were recruited for this study. Women were enrolled into study after giving an informed consen. Fisher's formula was used to calculate sample size. Consecutive sampling was applied. Once a pregnant woman was recruited, a questionnaire was administered, her blood pressure was taken, trousseaus and chovtek's signs were elicited and a blood sample was drawn and analysed for levels of calcium, alkaline phosphatase, phosphates and albumin. 24 hours after delivery the baby was assessed for any signs of seizures, its weight, length and head circumference was taken and blood sample drawn and analysed as that of the mother. Results: 121 pregnant women with a mean age of 27.5 years and a median parity of 1.0 were recruited.121 neonates with a mean gestational age of 39.3 weeks were also recruited. The prevalence of maternal hypocalcaemia was 29(24 %) whereas neonatal hypocalcaemia was at 26 (21.5%). Hypocalcaemia in the neonate was significantly associated with maternal hypocalcaemia (p 0.013). Conclusion: Neonatal hypocalcaemia is at 21.5% and it is significantly associated with maternal hypocalcaemia. Recommendations: Routine maternal calcium supplementation during pregnancy should be implemented to prevent maternal and neonatal hypocalcaemia Serum calcium analysis during pregnancy and neonatal serum calcium analysis at birth should be undertaken to facilitate appropriate intervention with supplements for those who are not on supplementation. A nutritional interventional study is recommended to elicit more valuable information on the role of diet on calcium levels.