DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20220756
Published: 2022-03-24

Phototherapy induced hypocalcemia in neonatal hyperbilirubinemia and correlation of hypocalcemia with the duration of phototherapy

Subash Basnet, Eva Gauchan, Mukesh Bhatta, Rubi Thapa

Abstract


Background:  Neonatal hyperbilirubinemia is common morbidity in the first week of life. Approximately 5-10% of them requires intervention like phototherapy and even exchange transfusion. Phototherapy has various adverse effects and hypocalcemia is one of them. Thus assessment of serum calcium levels after phototherapy should be done in neonates with jaundice.

 

Background: Neonatal hyperbilirubinemia is common morbidity in the 1st week of life. Approximately 5-10% of them requires intervention like phototherapy and even exchange transfusion. Phototherapy has various adverse effects and hypocalcemia is one of them. Thus, assessment of serum calcium levels after phototherapy should be done in neonates with jaundice. Objectives were to study prevalence of hypocalcemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcemia with duration of phototherapy.

Methods: This was a prospective observational study conducted over a period of 18 months among 75 neonates (both term and preterm) in the neonatal intensive care unit of Manipal teaching hospital, Pokhara. Total serum calcium level was measured at 0 hours (control), 12 hours, and after 48 hours and data were analyzed using statistical package for social sciences version 21.

Results: Hypocalcemia was found only in term neonates (n=8; 14%). Of those who had hypocalcemia, the majority experienced hypocalcemia after 48 hours of starting phototherapy. The mean difference of total serum calcium level before and after phototherapy in preterm and term neonates was found to be statistically significant. Hypocalcemia was not found to be associated with the duration of phototherapy.

Conclusions: The present study concludes that though there is a reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.


Keywords


Hypocalcemia, Jaundice, Neonates, Phototherapy

Full Text:

PDF

References


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

Bahbah MH, ElNemr FM, ElZayat RS, Aziz EA. Effect of phototherapy on serum calcium level in neonatal jaundice. Menoufia Med J. 2015;28(2):426-30.

Jagannath HN. Association between phototherapy and serum calcium levels in newborns: A institutional cross-sectional study. Int J Paediatrics Geriatrics. 2020;3(1):151-4.

Otero Regino W, Velasco H, Sandoval H. The protective role of bilirubin in human beings. Revista colombiana de Gastroenterología. 2009;24(3):293-301.

Kale AV, Jadhao PU, Valecha A, Kethepalli S. The effect of phototherapy on serum calcium level in neonates with hyperbilirubinemia: a cross sectional study. Int J Contemp Pediatr. 2020;7(8):1772-6.

Bhat JA, Sheikh SA, Wani ZA, Ara R. Prevalence of hypocalcemia, its correlation with duration of phototherapy and persistence in healthy term newborns after intensive phototherapy: A prospective observational hospital-based observational study. Imam J Appl Sc. 2019;4(2):57-61.

Tsang RC, Koo WK. Calcium and Magnesium Homeostasis. In: MacDonald MG, Seshia MK, editors. Avery’s Neonatology: Pathophysiology and Management of the Newborn. 7th ed. New Delhi: Wolters Kluwer Pvt Ltd. 2016;653.

Arora S, Narang GS, Singh G. Serum calcium levels in preterm and term neonates on phototherapy. J of Nepal Paediatr Soc. 2014;34(1):24-8.

Prabhakar N, Lazarus M, Ahirwar M. Effect of phototherapy on serum ionic calcium level in neonates with hyperbilirubinemia. EJPMR. 2016;3(4):510-4.

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

Reddy AT, Bai KV, Shankar SU. Electrolyte Changes Following Phototherapy in Neonatal Hyperbilirubinemia. Inter J Sci Res. 2015;4(7):752-8.

Romagnoli C, Polidori G, Cataldi L, Tortorolo G, Segni G. Phototherapy-induced hypocalcemia. J pediatr. 1979;94(5):815-6.

Sethi H, Saili A, Dutta AK. Phototherapy induced hypocalcemia. Indian Pediatr. 1993;30(12):1403-6.

Karamifar H, Pishva N, Amirhakimi GH. Prevalence of Phototherapy-Induced Hypocalcemia. IJMS. 2002;27(4):169-71.

Taheri PA, Sajjadian N, Eivazzadeh B. Prevalence of phototherapy induced hypocalcemia in term neonate. Iran J Pediatr. 2013;23(6):710-1.

Chandrashekar B, Venugopal S, Veeresh SM. Effect of duration of phototherapy on serum calcium level in newborn with neonatal jaundice. Pediatr Rev Int J Pediatr Res. 2014;1:88-92.

Ehsanipoor F, Khosravi N, Jalali S. The effect of hat on phototherapy induced hypocalcemia in icteric newborn. Razi J Med Sci. 2008;15:25-9.

Chandrashekar B. Effect of duration of phototherapy on serum calcium level in newborn with Neonatal Jaundice. Int J Pediatr Res. 2014;1(3):88-92.

Gheshmi AN, Naderi S, Homayrani E, Safari B. Prevalence of hypocalcemia after phototherapy among neonates who underwent phototherapy in Koodakan Hospital in Bandar Abbas in 2013. Electronic Physician. 2015;7(6):1387-90.

Kavehmanesh Z, Mirzaei M, Sabet Z, Tehrani FH. The effect of phototherapy on serum calcium level in full term neonates. J Basic Clin Pathophysiol. 2014;2(2):57-60.

Rozario CI, Pillai PS, Ranamol T. Effect of phototherapy on serum calcium level in term newborns. Int J Contemp Pediatr. 2017;4(6):1975-9.

Dutta S. Phototherapy for neonatal jaundice, recent advances and controversies. J Neonatol. 2001;1(1):39-44.

Jain SK. Evaluation of effect of phototherapy calcium level. Int Med J. 2015;2(6):316-8.

Yadav RK, Sethi RS, Sethi AS, Kumar L, Chaurasia OS. The Evaluation of Effect of Phototherapy on Serum Calcium Level. People’s J Sci Res. 2012;5(2):1-4.

Singh PK, Chaudhuri PK, Chaudhuri AK. Phototherapy Induced Hypocalcemia in Neonatal Hyperbilirubinemia. IOSR-JDMS. 2017;16(4):35-8.