Prevalence of hypocalcemia in term newborns requiring phototherapy


  • Rochelle A. Pereira Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal University, Manipal, Karnataka, India
  • Bhupendra Avasthi Department of Paediatrics, Surya Childrens Medicare Pvt Ltd, Mumbai, Maharashtra, India
  • Sonal Saste Department of Paediatrics, Surya Childrens Medicare Pvt Ltd, Mumbai, Maharashtra, India
  • Sandeep B. Bavdekar Department of Paediatrics, Surya Childrens Medicare Pvt Ltd, Mumbai, Maharashtra, India



Phototherapy, Neonates, Hypocalcemia


Background: Neonatal hyperbilirubinemia in the first week of life is one of the most prevalent clinical entity observed, affecting 60% of term-babies and 80% of preterm newborn babies, many requiring intervention in the form of phototherapy. The effect of phototherapy on serum calcium levels has not been studied much in Indian literature. The objectives of this study was to evaluate the prevalence of hypocalcemia in healthy, term newborn babies receiving phototherapy for unconjugated hyperbilirubinemia and to determine the association, if any between serum calcium and birth weight, postnatal age at start of phototherapy, weight at enrolment, gestational age at birth, maternal age and duration of phototherapy.

Methods: This was a prospective observational study conducted over a period of 10 months among 80 term neonates admitted to the inpatient department at a tertiary care centre in Mumbai. Total serum calcium and ionised calcium levels were measured at the start of phototherapy and on stopping phototherapy/discharge. Data were analysed using statistical package for social sciences (SPSS) version 21 software.

Results: Two (2.5%) out of the 80 neonates were found to have hypocalcemia after phototherapy with serum ionic calcium levels less than 1 mmol/l. Even though a larger proportion of neonates showed a decrease in the serum total calcium (56.25%) and serum ionic calcium (58.75%) levels after phototherapy, none of the neonates developed symptomatic hypocalcemia at those levels. A statistically significant association was found between maternal age in years with the serum total calcium levels after phototherapy and age at starting phototherapy (in hours) with the serum ionic calcium levels after phototherapy.

Conclusions: The present study concludes that there is significant decrease in the levels of ionised calcium after phototherapy, however there was no significant decrease in the total serum calcium levels and none of the neonates were symptomatic. Hence, we do not recommend regular serum calcium monitoring in healthy term neonates receiving phototherapy and find no indication for the prophylactic use of calcium supplementation in these neonates.


Watchko JF. Neonatal indirect hyperbilirubinemia and kernicterus In: Gleason CA, Devaskar SU (Eds). Avery’s disease of the newborn. 9th ed Philadelphia: Saunders. 2012;1123-42.

Xiong T, Qu Y, Cambier S, Mu D. The side effects of phototherapy for neonatal jaundice: What do we know? What should we do? Eur J Pediatr. 2011;170:1247-55.

Gregory ML, Martin CR, Cloherty JP. Neonatal Hyperbilirubinemia In; Cloherty JP, Stork AR, Eichenwald EC, Hansen AR. Manual of neonatal care. 7th ed, Philadelphia: Lippincott Willams and Wilkins. 2012;304-39.

Hakanson D, Penny R, Bergstrom WH. Calcemic responses to photic and pharmacologic manipulation of serum melatonin. Pediatr Res. 1987;22 414-6.

American Academy of Pediatrics, Clinical Practice Guideline; Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2004;114:297-316.

Kim SH, Park JH. Effect of phototherapy on bone metabolism in newborn rats. J Korean Soc Neonatal. 2001;8:206-10.

Hooman N, Honarpisheh A. The effect of phototherapy on urinary calcium excretion in newborns. Pediatric Nephrol. 2005;20:1363-4.

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

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

Nishant P, Monica L, Mahendra. Effect of phototherapy on serum ionic calcium level in neonates with hyperbilirubinemia. Ejpmr. 2016;3:510-4.

Saravanan S, Raghuram AS. Incidence of phototherapy induced hypocalcemia in full term normal newborn. Int J Curr Med Sci. 2017;7:222-4.

Karamifar H, Pishva N, Amirhakimi GH. Prevalence of Phototherapy-Induced Hypocalcemia. Iran J Med Sci. 2002;27:166-8.

Jain SK. Evaluation of effect of phototherapy on serum calcium level. Med Int Med J .2015;2:316-8.

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

Al-Ali MA, Sawma AI, Alshrari NM, Mostafa MR, Salama GS. Phototherapy induced hypocalcemia- a Jordanian and Saudi experience. IJSER. 2017;11:578-81.

Goyal M, Sharma R, Dabi DR. Phototherapy induced hypocalcemia in neonates: A case–control prospective study. Indian J Child Health. 2018;5:208-12.

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

Shrivastava J, Akhil S. Phototherapy induced hypocalcemia in neonates. Sch J App Med Sci. 2015;3:2931-3.






Original Research Articles