Newborn with Dilated Cardiomyopathy Secondary to Vitamin D Deficiency

Introduction:The Clinical and radiological manifestations of newborns with severe VDD have not been studied well.Materials and Methods:We studied the clinical, biochemical, and radiological manifestations of 10 full-term (FT) newborns (6: M, 4: F) infant presented to with symptomatic hypocalcemia (seizure) secondary to vitamin D deficiency (VDD) during the first 10 days of life are described. All were exclusively breastfed since birth. All their mothers have low 25 hydroxy vitamin D (25OHD) level <10 ng/mL and were not taking vitamin supplements during pregnancy.Results:FT newborns with hypocalcemia secondary to VDD presented with generalized convulsions (10/10) and craniotabes (8/10), but none had rachitic chest rosaries or joint broadening. Cranial ultrasonographic evaluation was normal. Serum 25OHD concentrations were low in these newborns (13.2 ± 3.8 ng/mL) and their mothers (8.1 ± 1.5 ng/mL). A total of 60% of them had increased parathormone (PTH) concentrations (>60 ng/mL) and 60% had decreased magnesium (Mg) concentrations (<0.7 mmol/L). Their alkaline phosphatase (ALP) concentrations were significantly higher than normal newborns. All other laboratory results (liver function tests, urea and electrolytes, C reactive protein, lumbar puncture, blood culture, and lactate) were normal. In all patients, seizures ceased within 2 days of starting treatment with alphacalcidol and calcium. Radiological manifestations included metaphyseal band of relative lucency (osteopenia), just under the line of provisional calcification, within distal radius (7/10), femur (4/10), and tibia (3/10), mild cupping and haziness of distal radius (2/10).Discussion:Newborns with VDD had significantly lower serum calcium, ALP and PTH and higher phosphate concentrations, compared to older infants with VDD rickets. In newborns with VDD, serum calcium levels were correlated significantly with 25OHD (r = 0.597, P < 0.001), Mg concentrations (r = 0.436, P < 0.001) and negatively with ALP concentrations (r = −0.451, P < 0.001). Serum PTH concentrations were correlated significantly with serum Mg (r = 0.78, P < 0.0001) but not with serum calcium (r = −0.103, P = 0.3) or 25OHD (r = −0.03, P = 0.7) concentrations.Conclusion:The clinical, biochemical, and radiological manifestations of VDD in newborns indicate that they are less adapted to VDD compared to older infants. VD supplementation for mothers and newborns should be considered to avoid short-term complications of VDD in the neonatal period and on the growing infants especially in countries with high prevalence of VDD.

show abstract

“…[111213] Rarely, hypocalcemia secondary to VDD deficiency presents as reversible cause of dilated cardiomyopathy in newborns. [14]…”

Section: Introductionmentioning

confidence: 99%

Clinical, biochemical, and radiological manifestations of vitamin D deficiency in newborns presented with hypocalcemia

Soliman¹,

Salama²,

Alomar³

et al. 2013

Indian J Endocr Metab

View full text Add to dashboard Cite

show abstract

“…7,8 Hypocalcemia is a rare etiology of reversible dilated cardiomyopathy. 9 Twenty-one patients under 3 months of age with late-onset hypocalcemia were reported in Taiwan by Lee et al 10 over a period of 12 years, five of whom had transient pseudohypoparathyroidism. However, none of these patients had congestive heart failure nor dilated cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening Dilated Cardiomyopathy Induced by Late-onset Neonatal Hypocalcemia

Chou

Lin

Hsu

et al. 2016

Pediatrics & Neonatology

View full text Add to dashboard Cite

Neonatal seizures caused by hypocalcemia may be associated with cardiopulmonary dysfunction and may require specific management other than calcium supplementation. Severe dilated cardiomyopathy is an extremely rare complication in neonatal hypocalcemia and often results in high morbidity and mortality. We report here a 14-day-old neonate presenting with a gradually increasing frequency of tonic seizures. After admission, arterial desaturation was found despite supplying oxygen (4 L/min) through nasal prongs and the patient developed life-threatening respiratory distress and heart failure secondary to dilated cardiomyopathy. His critical cardiopulmonary derangements rapidly improved after respiratory support, the administration of diuretic and inotropic drugs, and the correction of his hypocalcemia and hypomagnesemia. The patient responded to treatment and was well during the 1-year follow-up period. We present this unique case history of seizure, respiratory distress, and heart failure induced by transient hypocalcemia to remind clinicians about the importance of this rare, life-threatening, but reversible, disorder.

show abstract

“…On correcting this the baby improved rapidly and survived. 2,3 Hypocalcaemia associated with Kwashiorkor, and malnutrition should be thought of. patient has been reported to cause a dilated cardiomyopathy that improved with treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The correct method is likely to the method of Lepeschkin et al 21 The various intervals were measured by the technique of Lepeschkin and Surawicz"' with the following modifications (1) both the initiation and termination of the T wave were measured by the tangential method and (2) the points at which the tangents are drawn to the ascending and descending limbs of the T wave are intersected by a line drawn parallel to the baseline through the S-T junction. The intervals measured were as follows (1) beginning of QRS to the end of T(Q-T), (2) beginning of QRS to the beginning of T(Q-oT), (3) beginning of QRS to apex of T(Q-aT), (4) beginning of T to the end of T(T), (e) beginning of QRS to end of U(Q-U) and (5) the P-R, QRS, and R-R intervals by standard definition. The Q-T, Q-oT, and T intervals were corrected, as outlined by Lepeschkin and Surawicz, 'using the formula of Bazett.…”

Section: Some Endocrine/metabolic Causes Of Reversible Cardiomyopathymentioning

confidence: 99%

A Reversible Cardiomyopathy?

Gupta¹

2016

MOJCR

View full text Add to dashboard Cite

Dilated cardiomyopathy is a diagnosis that usually carries a grave prognosis. However among the numerous cases of dilated cardiomyopathy lurk a few that are acute, fulminant and potentially reversible. It is a challenge for a cardiologist to suspect this and successfully treat one .It is gratifying when the patient recovers and goes home. Similarly myopathies are chronic debilitating diseases that are associated with considerable morbidity .It has been observed that some myopathies are reversible. The hall mark of such a myopathy is it's acute fulminant onset. Researchers have recommended that whenever an acute onset myopathy is found a reversible cause should be looked for.

show abstract

Newborn with Dilated Cardiomyopathy Secondary to Vitamin D Deficiency

Cited by 9 publications

References 15 publications

Clinical, biochemical, and radiological manifestations of vitamin D deficiency in newborns presented with hypocalcemia

Clinical, biochemical, and radiological manifestations of vitamin D deficiency in newborns presented with hypocalcemia

Life-threatening Dilated Cardiomyopathy Induced by Late-onset Neonatal Hypocalcemia

A Reversible Cardiomyopathy?

Contact Info

Product

Resources

About