OBJECTIVE: We noted that age-related normal calcium doses in neonates on venoarterial extracorporeal membrane oxygenation result in hypercalcemia. To avoid hypercalcemia and its potential consequences these infants are given one-half the normal calcium dose. We studied the pathogenesis of hypercalcemia and hypomagnesemia by evaluating calcitriol, intact parathyroid hormone, and calcitonin status during extracorporeal membrane oxygenation. DESIGN AND SETTING: Prospective, observational study in the intensive care unit of a 225-bed tertiary care pediatric hospital. PATIENTS AND PARTICIPANTS: Twelve neonates under 7 days old with severe pulmonary disease requiring extracorporeal membrane oxygenation. MEASUREMENTS AND RESULTS: Blood was obtained for intact parathyroid hormone and calcitriol concentrations before cannulation, during (extracorporeal membrane oxygenation days 2, 4, and predecannulation in those on >6 days), and after decannulation on days 1 and 3. Calcitonin concentrations were measured before cannulation, during, and after decannulation in the last seven patients. Prior to cannulation parathyroid hormone was normal (1.4-5.7 pmol/l) and on day 2 increased to 7.8+/-8.4 pmol/l. Before cannulation calcitriol was 14.5+/-8.21 pmol/l (normal 41-143 pmol/l), and concentrations remained low until after decannulation. In three of the seven infants calcitonin concentrations (normal <73 ng/l) were above the upper limit of the assay (>1150 ng/l) prior to cannulation and during extracorporeal membrane oxygenation. CONCLUSIONS: Regulation of the vitamin D-endocrine system during neonatal venoarterial extracorporeal membrane oxygenation appears to be aberrant compared to normal vitamin D-endocrine system regulation. The pathogenesis of this abnormality remains unclear and requires further study.
OBJECTIVE: We noted that age-related normal calcium doses in neonates on venoarterial extracorporeal membrane oxygenation result in hypercalcemia. To avoid hypercalcemia and its potential consequences these infants are given one-half the normal calcium dose. We studied the pathogenesis of hypercalcemia and hypomagnesemia by evaluating calcitriol, intact parathyroid hormone, and calcitonin status during extracorporeal membrane oxygenation. DESIGN AND SETTING: Prospective, observational study in the intensive care unit of a 225-bed tertiary care pediatric hospital. PATIENTS AND PARTICIPANTS: Twelve neonates under 7 days old with severe pulmonary disease requiring extracorporeal membrane oxygenation. MEASUREMENTS AND RESULTS: Blood was obtained for intact parathyroid hormone and calcitriol concentrations before cannulation, during (extracorporeal membrane oxygenation days 2, 4, and predecannulation in those on >6 days), and after decannulation on days 1 and 3. Calcitonin concentrations were measured before cannulation, during, and after decannulation in the last seven patients. Prior to cannulation parathyroid hormone was normal (1.4-5.7 pmol/l) and on day 2 increased to 7.8+/-8.4 pmol/l. Before cannulation calcitriol was 14.5+/-8.21 pmol/l (normal 41-143 pmol/l), and concentrations remained low until after decannulation. In three of the seven infantscalcitonin concentrations (normal <73 ng/l) were above the upper limit of the assay (>1150 ng/l) prior to cannulation and during extracorporeal membrane oxygenation. CONCLUSIONS: Regulation of the vitamin D-endocrine system during neonatal venoarterial extracorporeal membrane oxygenation appears to be aberrant compared to normal vitamin D-endocrine system regulation. The pathogenesis of this abnormality remains unclear and requires further study.
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerome Pugin; Michael Pinsky; Peter Radermacher; Christian Richard; Robert Tasker Journal: Intensive Care Med Date: 2006-02-18 Impact factor: 17.440