title: Calcium homeostasis disorder during and after neonatal extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Rambaud
authors.affiliation: Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Guellec
authors.affiliation: Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Guilbert
authors.affiliation: Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France.
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Léger
authors.affiliation: Paediatric Intensive Care Unit, Armand-Trousseau Hospital APHP (Paris Hospitals Public Assistance), UPMC (Pierre and Marie Curie University, Paris VI), Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Renolleau
keywords: Calcium; extracorporeal membrane oxygenation; neonates; parathyroid; phosphorus