DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20184306

Evaluation of incidence of phototherapy induced hypocalcaemia in term newborns with neonatal hyperbilirubinemia and its clinical significance: a cross sectional study with controls

Raksha Gupta, Davinder Singh, Meetu Yadav, Prateek Kumar Panda, Niranjan Nagaraj, Sailen Kumar Bana

Abstract


Background: Neonatal hyperbilirubinemia in many of the cases is only in physiological range, but quite often it requires phototherapy and even exchange transfusion for proper management. Although hypocalcemia is often proposed to be associated with phototherapy in term and preterm newborns, its exact incidence and clinical significance still remains to be elucidated.

Methods: Current study was carried out in a tertiary care center in North India with 29 term neonates in test group receiving single surface phototherapy and 29 age, sex and gestational age matched neonates in control group, who did not receive phototherapy. Serum calcium levels at 0 and 48 hours of starting phototherapy were determined in both the groups and compared.

Results: Mean difference of Serum ionized calcium between two groups was statistically significant at 48 hours with mean for test group was 4.58 mg/dl compared to 4.94 mg/dl for control group (p <0.001). 10 newborns (47%) in test group had hypocalcemia according to standard definitions and 3 out of them (30%) had were clinically symptomatic with jitteriness and poor feeding, which resolved after calcium supplementation

Conclusions: Term neonates undergoing phototherapy are at increased risk for hypocalcemia. A universal recommendation regarding calcium supplementation in neonates undergoing photherapy is yet to be established but seems like a reasonable intervention.

 


Keywords


Hyperbilirubinemia, Hypocalcemia, New Delhi, Phototherapy, Term

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References


Jaundice and hyperbilirubinemia in the newborn. In: Kliegman RM, Stanton BF, Schor N, Behrman RE, St. Geme III JW, eds. Nelson Textbook of paediatrics. India: Elsevier; 2012;19(96):603-7.

Abrol P, Sankarasubramanian R. Effect of phototherapy on behaviour of jaundiced neonates. Indian J Pediatr. 1998;65(4):603-7.

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of Gestation. Pediatr. 2004;114(4):1138.

Hansen TW. Twists and turns in phototherapy for neonatal Jaundice. Acta Paediatric. 2010;99(8):1117-111

Indian Academy of paediatrics. National Neonatal Forum. Neonatal care. 3rd ed. India: Jypee; 2006;3;67-69.

Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the Newborn. Indian J Pediatr. 2010;77(10):1123-8.

Maisels MJ, McDonough AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358(9):920-8.

Sethi P. Light emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: a multi center randomized controlled trial. Indian Pediatr. 2010;47(2):131-7.

Jain BK, Singh H, Singh D, Singh N. Hypocalcemic effect of phototherapy-replay. Indian Pediatr. 1999;36(2):208-9.

Habibzadeh F, Karamizadeh Z. Phototherapy-induced hypocalcemia. Iran J Med Sci. 2002;27(4):324-6.

Medhat FB. Assessment of phototherapy induced hypocalcemia [MSc Thesis]. Giza: Cairo University; 2006;7:45-7.

Karamifar H, Pishva N. Prevalence of phototherapy in Hypocalcemia. Iran J Med Sci. 2002;27:166-8.

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.

Hooman N, Honarpisheh A. The effect of phototherapy on Urinary calcium excretion in newborns. Pediatr Nephrol. 2005;20(9):1363-4.

Zarkesh M, Safaei-Asl A, Hajikhani K. The effect of phototherapy on urinary calcium excretion term neonates with hyperbilirubinaemia. 24th International Congress on Pediatrics. 2012;24:61

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

Hunter KM. Hypocalcemia. In: Cloherty JP, Eichenwald CE, Stark AR, editors. Manual of Neonatal Care, Philadelphia: Lippincott Williams and Wilkins; 2004;5:579-88.

Kim SH, Park JH. Effect of phototherapy on bone metabolism in newborn rats. J Korean Soc Neonatal. 2001;8(2):206-10.