Citation Information :
Rambaud J, Guellec I, Guilbert J, Renolleau S. Calcium homeostasis disorder during and after neonatal extracorporeal membrane oxygenation. Indian J Crit Care Med 2015; 19 (9):513-517.
Background and Aims: Extracorporeal membrane oxygenation (ECMO) is used during pediatric resuscitation in case of refractory hypoxemia or septic shock under maximum therapy. Previous studies describe calcium homeostasis dysregulation. The aim of this study was to confirmed of calcium homeostasis dysregulation in neonates under ECMO and supposed news explanation.
Subjects and Methods: From November 2012 to July 2013, we performed a prospective single center observational study. Eleven neonatal patients were included. Blood was obtained before and during ECMO (day 7, 14 and 21) for parathyroid hormone (PTH), protein adjusted serum calcium, ionized calcium, magnesium, and calcitriol levels. All surviving patients underwent a consultation up to 6 months after ECMO weaning.
Results: During ECMO PTH was inadequately high with normal serum calcium on day 7 (PTH: 73.54 ± 40 ng/l; calcemia: 2.33 ± 0.21 mmol/l), day 14 (PTH: 57.63 ± 29.57 ng/l; calcemia: 2.44 ± 0.43 mmol/l) and day 21 (PTH: 54.93 ± 8.43 ng/l; calcemia: 2.13 ± 0.09 mmol/l). The absence of correlation between serum calcium and PTH levels seem to confirm the dysregulation of PTH - serum calcium metabolism during ECMO. Six months after ECMO weaning, we noticed hypercalcemia with normal PTH.
Conclusions: We confirmed the existence of severe disturbances of calcium homeostasis in neonates on ECMO and supposed the possible damage of calcium regulation. We did not succeed in finding clear explanations of these disturbances.
Lequier L. Extracorporeal life support in pediatric and neonatal critical care: A review. J Intensive Care Med 2004;19:243-58.
Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev 2008;16:CD001340.
Hervey-Jumper SL, Annich GM, Yancon AR, Garton HJ, Muraszko KM, Maher CO. Neurological complications of extracorporeal membrane oxygenation in children. J Neurosurg Pediatr 2011;7:338-44.
Niebler RA, Punzalan RC, Marchan M, Lankiewicz MW. Activated recombinant factor VII for refractory bleeding during extracorporeal membrane oxygenation. Pediatr Crit Care Med 2010;11:98-102.
Fridriksson JH, Helmrath MA, Wessel JJ, Warner BW. Hypercalcemia associated with extracorporeal life support in neonates. J Pediatr Surg 2001;36:493-7.
Hak EB, Crill CM, Bugnitz MC, Mouser JF, Chesney RW. Increased parathyroid hormone and decreased calcitriol during neonatal extracorporeal membrane oxygenation. Intensive Care Med 2005;31:264-70.
Kenny J, Lees MM, Drury S, Barnicoat A, Van′t Hoff W, Palmer R, et al. Sotos syndrome, infantile hypercalcemia, and nephrocalcinosis: A contiguous gene syndrome. Pediatr Nephrol 2011;26:1331-4.
Canpolat N, Özdil M, Kurugoglu S, Çaliskan S, Sever L. Nephrocalcinosis as a complication of subcutaneous fat necrosis of the newborn. Turk J Pediatr 2012;54:667-70.
Léger PL, Guilbert J, Isambert S, Le Saché N, Hallalel F, Amblard A, et al. Pediatric single-lumen cannula venovenous extracorporeal membrane oxygenation: A French center experience. Artif Organs 2013;37:57-65.
Rambaud J, Guilbert J, Guellec I, Renolleau S. A pilot study comparing two polymethylpentene extracorporeal membrane oxygenators. Perfusion 2013;28:14-20.
Gauthier B, Trachtman H, Di Carmine F, Urivetsky M, Tobash J, Chasalow F, et al. Hypocalcemia and hypercalcitoninemia in critically ill children. Crit Care Med 1990;18:1215-9.
Tsang RC, Steichen JJ, Chan GM. Neonatal hypocalcemia mechanism of occurrence and management. Crit Care Med 1977;5:56-61.
Hyman SJ, Novoa Y, Holzman I. Perinatal endocrinology: Common endocrine disorders in the sick and premature newborn. Endocrinol Metab Clin North Am 2009;38:509-24.
Serret-Montoya J, Villegas-Silva R, Muro-Flores R, Peña LA, Villasís-Keever MA. Evaluation of diagnostic tests for hypocalcemia in critically ill newborns. Rev Invest Clin 1998;50:471-6.
Broner CW, Stidham GL, Westenkirchner DF, Tolley EA. Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients. Crit Care Med 1990;18:921-8.
Ruiz Magro P, Aparicio López C, López-Herce Cid J, Martínez Campos M, Sancho Pérez L. Metabolic changes in critically ill children. An Esp Pediatr 1999;51:143-8.
Skarsgard ED, Salt DR, Lee SK; Extracorporeal Life Support Organization Registry. Venovenous extracorporeal membrane oxygenation in neonatal respiratory failure: Does routine, cephalad jugular drainage improve outcome? J Pediatr Surg 2004;39:672-6.
Johnson MR, Boerckel JD, Dupont KM, Guldberg RE. Functional restoration of critically sized segmental defects with bone morphogenetic protein-2 and heparin treatment. Clin Orthop Relat Res 2011;469:3111-7.
Urban P, Scheidegger D, Buchmann B, Skarvan K. The hemodynamic effects of heparin and their relation to ionized calcium levels. J Thorac Cardiovasc Surg 1986;91:303-6.
Soong WJ, Wang HZ, Hwang B. Heparinization of blood decreases ionized calcium concentration. Zhonghua Yi Xue Za Zhi (Taipei) 1991;47:331-5.
Haverstick DM, Brill LB 2 nd, Scott MG, Bruns DE. Preanalytical variables in measurement of free (ionized) calcium in lithium heparin-containing blood collection tubes. Clin Chim Acta 2009;403:102-4.
Breitwieser GE, Miedlich SU, Zhang M. Calcium sensing receptors as integrators of multiple metabolic signals. Cell Calcium 2004;35:209-16.