Neonatal Hypocalcemia Due to Maternal Hyperparathyroidism Mimicking Hypoxic-ischemic Encephalopathy: A Case Report

Background In this era of proficient antenatal care, fetal distress/neonatal encephalopathy needs evaluation for etiology beyond presumed intrauterine asphyxia. Case Description A late-preterm neonate was delivered for an incidentally detected pathological fetal-heart pattern, required resuscitation, had neonatal encephalopathy, and presented with late-onset seizures at 2 weeks. Severe hypocalcemia was detected. Management Seizure control required intravenous calcium and 1,25(OH) 2 vitamin D 3 supplementation. The chart review revealed a high serum calcium level in the first sample. This prompted a detailed work-up. Hyperphosphatemia, hypomagnesemia, and hypoparathyroidism were detected. The mother’s investigation revealed hyperparathyroidism. Fetal hypercalcemia and neonatal suppressed parathyroid glands explain all the clinical symptomatology, commencing from fetal health compromise and encephalopathy to late-onset seizures. The baby was discharged with a normal neurological examination on tapering doses of calcitriol and calcium. Conclusion It would be prudent to seek out associated pathology when there are atypical clinical presentations or unusual laboratory results in neonatal encephalopathy.