Pathogenesis of Tetany of the New-Born

Abstract

In 1913 Kehrer 1 described a group of new-born infants with convulsions, flexor contractions of the extremities, carpal spasms and positive facial and Trousseau signs. Rapid improvement followed the administration of calcium salts. He believed the condition to be tetany of the new-born. Somewhat earlier Bliss 2 had described an infant of 6 days with electrical reactions pathognomonic of tetany and Yanase 3 had observed two infants, aged 12 and 15 days, respectively, with anodal hyperexcitability, one of whom showed a cathodal opening contraction with less than 5 milliamperes at the age of 29 days. Despite these observations it was generally believed that tetany does not occur in the new-born.Interest in this subject was revived by the reports of Shannon4 and Bass and Karelitz.5 In 1931 the latter described three new-born infants with convulsions, general hyperirritability and exaggerated facial and Trousseau signs who showed dramatic improvement after the intravenous injection of calcium gluconate. Though their cases cannot properly be included as instances of tetany because of the lack of determinations of the serum calcium content (the serum calcium con¬ tent, determined in only one case, was 8.5 mg. per hundred cubic centi¬ meters), their paper served to focus attention on this subject and led to the definite establishment of the syndrome.

Plasma Calcium Fractions during the First Days of Life with Special Reference to Neonatal Hypocalcaemia

“…In creased concentrations of calcitonin in the umbilical vein blood have been re ported by M iller and C o p p [14]. The literature presents different opinions concerning the relation between calcium and phosphorus in plasma after birth: a decrease of calcium combined with an increase of phosphorus [2,12,21] or a parallel decrease of both calcium and phosphorus [1] or no special trend during the first 36 h of life [5].…”

Renal Excretion of Inorganic Phosphate in Newborn Infants 12

“…The serum phosphate concentration is higher in young infants than in adults and especially so in infants receiving cow's milk of high phosphorus content (4). This high serum phosphate concentration in young infants has been attributed to a limitation in renal excretion of phosphate (4)(5)(6)(7) and has been implicated as a factor of importance in hypocalcemic tetany of the newborn (8,9). In addition, it has been suggested that "the paucity of phosphates in infant urines must be a great handicap to them in excreting acids and may explain many of the accepted facts about their susceptibility to an acidosis" (10).…”

“…1 This investigation was supported in part by research grants from the National Institutes of Health, Public Health Service, and Playtex Park Research Institute. 2 Presented in part before the Society for Pediatric Research, French Lick, Indiana, May 8,1950. 8 …”

Serum Calcium in the Newborn

“…Thus, in the first series1 the calcium level at the third and fourth day of life was 1.21 mg. lower than the level of the cord blood of the same infants. In the two series there was the same upward trend toward the tenth day of life, but in the first series the calcium level reached a higher point, 11.5 mg., than in the cases presented here, in which the value rose to 11.37 mg. There were 47 cases in the first series, and the infants were predominantly white; in the present series the infants were predominantly Negro, and 91 cases were studied.…”