A 2-day-old neonate born at 38 weeks gestation presents with jitteriness and lethargy. The mother has type 1 diabetes mellitus. Serum calcium is 6.5 mg/dL. What is the most likely cause of hypocalcemia in this neonate?

• A Maternal hyperparathyroidism
• B High phosphate load from formula feeds
• C DiGeorge syndrome
• D Transient neonatal hypoparathyroidism ✓

Explanation

Infants of diabetic mothers often develop early neonatal hypocalcemia due to a relative transient hypoparathyroidism in the neonatal period, exacerbated by increased calcitonin levels. DiGeorge syndrome causes hypocalcemia but is usually associated with other features like cardiac defects.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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