Neonatal Hypercalcemia

ByKevin C. Dysart, MD, Nemours/Alfred I. duPont Hospital for Children
Reviewed/Revised Mar 2021 | Modified Sept 2022
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Hypercalcemia is total serum calcium > 12 mg/dL (> 3 mmol/L) or ionized calcium >

(See also general discussion of hypercalcemia.)

Etiology of Neonatal Hypercalcemia

The most common cause of neonatal hypercalcemia is

  • Iatrogenic

Other causes of neonatal hypercalcemia include

  • Maternal hypoparathyroidism

  • Subcutaneous fat necrosis

  • Parathyroid hyperplasia

  • Abnormal renal function

  • Williams syndrome

  • Idiopathic

Maternal hypoparathyroidism or maternal hypocalcemia may cause secondary fetal hyperparathyroidism, with changes in fetal mineralization (eg, osteopenia).

Subcutaneous fat necrosis may occur after major trauma and causes hypercalcemia that usually resolves spontaneously.

Neonatal hyperparathyroidism is very rare.

Williams syndrome's key features include supravalvular aortic stenosis, pulmonary valvular or peripheral pulmonary artery stenosis, atrial septal defect and/or ventricular septal defect, renal artery stenosis, aortic anomalies, elfin facies, and hypercalcemia of unknown pathophysiology; infants may also be small for gestational age, and hypercalcemia can be noted early in infancy, usually resolving by age 12 months.

Idiopathic neonatal hypercalcemia is a diagnosis of exclusion and is difficult to differentiate from Williams syndrome and often requires genetic testing.

Symptoms and Signs of Neonatal Hypercalcemia

Symptoms and signs of neonatal hypercalcemia may be noted when total serum calcium is > 12 mg/dL (> 3 mmol/L). These signs can include anorexia, gastroesophageal reflux, nausea, vomiting, lethargy or seizures or generalized irritability, and hypertension. Other symptoms and signs include constipation, abdominal pain, dehydration, feeding intolerance, and failure to thrive. Some neonates have weakness. With subcutaneous fat necrosis, firm purple nodules may be observed on trunk, buttocks, or legs.

Diagnosis of Neonatal Hypercalcemia

  • Total or ionized serum calcium level

Diagnosis of neonatal hypercalcemia is made by measuring the total or ionized serum calcium level.

Treatment of Neonatal Hypercalcemia

Fetal hypercalcemia caused by maternal hypoparathyroidism can be treated expectantly, because it usually resolves spontaneously within a few weeks.

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