Correlation of Total Serum Calcium and Ionic Calcium Levels with Severity of Birth Asphyxia

Abstract

Background: Birth asphyxia is a leading cause of morbidity and mortality among neonates in India.
Common complications of birth asphyxia are cerebral palsy, persistent pulmonary hypertension of newborn,
cardiogenic shock, irreversible renal cortical necrosis, hypotension, and heart failure. The risk of hypoxicischemic
encephalopathy (HIE) increases with increasing severity of birth asphyxia. Hypocalcemia occurs
with increased frequency in neonates with birth asphyxia. In our present study, we measured both ionized and
total serum calcium levels in neonates with birth asphyxia and compared these levels with normal healthy
neonates. Among cases, serum and ionic calcium levels were compared among neonates with different
stages of HIE to find co-relation of calcium levels with the severity of birth asphyxia.
Method: Total serum calcium and ionic calcium levels obtained at birth were compared among neonates
with and without birth asphyxia. Among asphyxiated neonates, total and ionic calcium levels were compared
among neonates with different staging of HIE.
Results: Total serum calcium and ionic calcium levels at birth were significantly lower in cases (8.04 ± 0.89
mg/dl, 3.62 ± 0.46 mg/dl) as compared to controls (9.32 ± 0.72 mg/dl, 4.79 ± 0.49 mg/dl). In the case group
level of Total serum calcium and ionic calcium levels showed a decreasing trend with increasing stage of
HIE. Level of total serum calcium and ionic calcium were 8.88±0.290, 4.03±0.178 mg/dl among babies who
had no HIE, 8.07±0.675,3.61±0.354 mg/dl among babies who had HIE-1, 7.78±0.572, 3.54 ±0.572 mg/dl
among babies who had HIE-2 and 7.03±0.596, 3.12±0.342 mg/dl among babies who had HIE-3.
Conclusion: Total serum calcium and ionic calcium levels are decreased in birth asphyxia. Total serum and
ionic calcium levels are also decreased with increasing severity of HIE.