Is calcium a concern in neonates undergoing phototherapy?

Authors

  • N. L. Sridhar Department of Paediatrics, Chelmada Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India
  • Sreeram S. AIIMS, Consultant, NeoBBC children's hospital, Paramitha children's hospital, Hyderabad, Telangana, India
  • Madoori Srinivas Department of Paediatrics, Chelmada Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20181527

Keywords:

Asymptomatic, Hyperbilirubinemia, Hypocalcemia, Neonatal jaundice, Phototherapy

Abstract

Background: Neonatal hypocalcemia is defined as total serum calcium concentration of < 7 mg/dl or ionized calcium concentration of <4 mg/dl (<1 mmol/L). The current aim was to look the effect of phototherapy on ionized calcium levels before and after phototherapy in otherwise healthy term and late preterm (35 to 37 weeks) neonates.

Methods: The study group included 50 neonates. Measurement of serum ionized calcium levels was done before and at the end of phototherapy.

Results: At the end of phototherapy in study group, a significant fall in calcium level in 64% of term and 76% of late preterm neonates was observed, but almost all except one remained asymptomatic.

Conclusions: The efficacy of phototherapy in the prevention and treatment of hyperbilirubinemia in newborn infants has been well established. The mean duration of phototherapy in our study was 32 hours. Duration of phototherapy may influence the severity of hypocalcaemia. The regulation of calcium homeostasis in the newborn period has been of considerable interest. Phototherapy increases calcium absorption by the bones and leads to the reduction of melatonin levels. Changes in melatonin levels affect the incidence of hypocalcaemia-induced phototherapy. The mechanism of hypocalcaemia effect of phototherapy was reported by inhibition of pineal gland via transcranial illumination, resulting to decline of melatonin secretion; which blocks the effect of cortisol on bone calcium. It is suggested that serum calcium levels be assessed in neonates treated with phototherapy. Neonatal Jaundice is one of the most common problems that can occur in the newborn. Hypocalcaemia during phototherapy has been reported in literature.

References

Rennie J, Burman-Roy S, Murphy MS. Neonatal jaundice: summary of NICE guidance. Br Med J. 2010;340:2409.

Kliegman M. The fetus and the neonatal infant, In: Behrman R, Nelson textbook of pediatrics. 19th ed. Saunders, Philadelphia; 2011:603-612.

Hunter KM. Hypocalcaemia. In: Manual of Neonatal Care, Eds. Cloherty JP, Eichenwald EC, Stark AR. 5th edn. Lippincott Williams and Wilkins, Philadelphia; 2004:579-588.

Alizadeh-Taheri P, Sajjadian N, Eivazzadeh B. Prevalence of phototherapy induced hypocalcemia in term neonate. Iran J Pediatr. 2013;23:710-8.

Altirkawi K, Rozycki HJ. Hypocalcemiais common in the first 48 h of life in ELBW infants. J Perinatal Med. 2008;36:348-53.

Sethi H, Saili A, Dutta AK. Phototherapy induced hypocalcemia. Indian Pediatr. 1993;30:1403-6.

Medhat FB. Assessment of phototherapy induced hypocalcaemia. Thesis submitted for M.Sc. Pediatrics in Cairo University. Classification Number. 2006.

Yadav RK, Sethi RS, Anuj. The evaluation of effect of phototherapy on serum calcium level. People’s J Sci Res. 2012;5(2).

Jain BK, Singh H, Singh D, Toor NS. Phototherapy induced hypocalcemia. Indian Pediatr. 1998;35(6):566-7.

Yadav RK, Sethi RS, Sethi AS. The evaluation of the effect of phototherapy on serum calcium level. People’s J Sci Res. 2012;5:1-4.

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Published

2018-04-20

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Original Research Articles