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a prospective study on Phototherapy induced hypocalcaemia
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Phototherapy Induced Hypocalcaemia
A Prospective Study Dr vikas moudgil
J L N HOSPITAL AND R C BHILAI
Introduction
Jaundice –most common abnormal physical finding in first week of life
Physiological jaundice Pathological
Introduction
Common side effects of phototherapy are loose stools, hyperthermia, dehydration and fluid losses, skin rashes and skin burns, photo retinitis, Bronze Baby syndrome, DNA damage.
A lesser known but potential complication of phototherapy is hypocalcaemia.
PathophysiologyPhototherapy inhibits pineal secretion of melatonin
Melatonin blocks the hypocalcaemia effects of endogenous steroids
Low serum concentration of melatonin permits unopposed hypocalcaemia effects of endogenous steroids
Phototherapy Induced Hypocalcaemia
Aims and objectives
1. To study effect of phototherapy on serum total calcium level in icteric newborn
2. To compare the effect on serum total calcium values in preterm(>32-<37 weeks) and full term(>37-<40weeks) newborn receiving phototherapy
Materials and Methods
Study area- J.L.N Hospital & RC BhilaiStudy period- Dec 2009 to March 2010Study design-longitudinal observational
studyCase selection-on consecutive mannerTotal babies studied- 200Group A preterm 50, Group B full term 50Each group 50 babies control
Materials and MethodsExposed to phototherapy
Babies having hyperbilirubinemia and requiring phototherapy as management
Total 100 neonates 50 term and 50 preterm
Guidelines followed1. AAP guidelines 20042. AIIMS phototherapy
Protocol
Controls Babies with
hyperbilirubinemia but not requiring phototherapy
Total 100 neonates 50 term and 50 preterm
Materials and MethodsInclusion criteria for cases Icteric stable neonates On breast feeding and
standard formula feeding
Exclusion criteria Who developed jaundice in
first 24 hours, exchange transfusion
Suffering from birth asphyxia
Congenital malformation Sepsis, hypothyroidism Infant of diabetic mother Newborn on I.V. Therapy Infant of mothers with
anticonvulsants ABO/Rh incompatibility G6PD, PKD.LFD,IUGR
Materials and Methods
Babies having hypocalcaemia prior to phototherapy excluded from both study and controls groups
Babies having hypoproteinemia prior to therapy and developing during therapy excluded from study
Materials and Methods
Serum calcium was done at start and after 48 hours of phototherapy
Serum calcium in control group was also done at starting and after 48 hours of study
Hypocalcaemia was defined as serum values of calcium less than 7mg/dl . (Cloherty)
Babies with hypocalcaemia were treated with IV calcium
Observations
Observations
Control groupDistribution
Hypocalcaemia
percentage
Term 50 0 0
preterm 50 8 16%
total 100 8 8%
Not exposed to phototherapy
Total 8%
Observation
Phototherapy induced hypocalcaemia 43%
Control group
hypocalcaemi
a8%
Z value 5.68p
value<0.005
Significant
Observation
Total calcium in mg/dl±SDFrom total
study subjects
Control post study
8.79±0.677
Cases pre study
8.415±0.461
Observation
Significance in fall of calcium in phototherapy exposed 100 cases
Z value 13.36
P value<0.05
Significant fall
ObservationPreterm groupSerum calcium
values in mg/dl±SD
Controls pre study
8.855±0.593
Controls post study 8.59±0.88
Cases post study
7.136±0.437
Cases pre study
8.118±0.169
Observation
Significance in fall of calcium in phototherapy exposed 50 preterm
cases
Z value 14.78
p value<0.005Significant
Observation
Serum calcium values in full term group in
mg/dl±SD
Controls post study
8.986±0.271
Cases pre study
8.712±0.471
Observation
Significance in fall of calcium in phototherapy exposed 50 full term cases
Z value9.41
p value<0.005significant
Discussion
• Total occurrence of hypocalcaemia in phototherapy exposed groups
• Total occurrence of hypocalcaemia in phototherapy exposed preterm group
• T Total occurrence of hypocalcaemia in phototherapy exposed term groups
• Fall of serum calcium after phototherapy in total, preterm and fullterm
43% 60%
26%Significant fall with p
value <0.05
Discussion
Romagnoli et al 1979 Phototherapy induced
hypocalcaemia in 52.3% preterm
Found hypocalcaemia in 12.2% preterm control
Hakanson & Bergstrom 1981 Premature infants under going phototherapy have increased incidence of hypocalcaemia
Gutcher et al 1982 Phototherapy produced a significant fall in serum calcium after exposure
Discussion
Sethi et al 1993 90% preterm and 75% full term developed hypocalcaemia after
phototherapy exposure
Jain B K et al1998
55% preterm and 30% full term developed hypocalcaemia after
phototherapy
Eghbalian F et al 2002 Phototherapy in icteric newborn lowers serum calcium significantly
Conclusions
Phototherapy induces significant fall in serum calcium levels In Preterm babies higher occurrence of hypocalcaemia induced by
phototherapy , Risk is also in full term
Recommendations
Calcium supplementation in babies under phototherapy
Serum calcium should be monitored regularly under phototherapy
References• Manual of Neonatal Care,6th edition.John P Cloherty• Nelson text book of Pediatrics ,18th edition• CARE of the NEWBORN ,sixth edition Meharban singh• Romagnoli CG, Polidori L, Cataldi G et al. Phototherapy
induced hypocalcaemia. J Pediatr 1979;94:813-816• Hakanson DO, Bergstrom WH. Phototherapy Induced
hypocalcaemia in newborn infants; Prevention by melatonin. Science 1981;214:807-809
• Gutcher GR et al. Hypocalcaemia associated with phototherapy newborn rats:Light source dependance. Photochem photobiol 1983;37(2):177-180
• Jain BK, Singh H, Toor NS (1998) Phototherapy induced hypocalcaemia. Indian Pediatrics.35:566-567.
• Eghbalian F, Monosef A (2002)Phototherapy Induced Hypocalcaemia in icteric newborns.IJMS 27:169-171