a prospective study on Phototherapy induced hypocalcaemia

1. Phototherapy Induced
Hypocalcaemia
A Prospective Study
Dr vikas moudgil
J L N HOSPITAL AND R C BHILAI

2. Introduction
Jaundice –most common abnormal physical finding
in first week of life
 Physiological jaundice
 Pathological

3. 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.

4. Pathophysiology
Phototherapy 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

5. 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

6. Materials and Methods
Study area- J.L.N Hospital & RC Bhilai
Study period- Dec 2009 to March 2010
Study design-longitudinal observational study
Case selection-on consecutive manner
Total babies studied- 200
Group A preterm 50, Group B full term 50
Each group 50 babies control

7. Materials and Methods
Exposed to phototherapy Controls
 Babies having  Babies with hyperbilirubinemia
hyperbilirubinemia and but not requiring phototherapy
requiring phototherapy as  Total 100 neonates
management  50 term and 50 preterm
 Total 100 neonates
 50 term and 50 preterm
 Guidelines followed
1. AAP guidelines 2004
2. AIIMS phototherapy Protocol

8. Materials and Methods
Inclusion criteria for cases Exclusion criteria
 Icteric stable neonates  Who developed jaundice in first
 On breast feeding and 24 hours, exchange transfusion
standard formula feeding  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

9. 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

10. 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

11. Observations
Total 100 babies exposed to phototherapy
Hypocalcaemia=43 43%
Full term 50 babies exposed to phototherapy
Hypocalcaemia=13 26%
Preterm 50 babies exposed to phototherapy
Hypocalcaemia=30 60%

12. Observations
Control group Not exposed to phototherapy
Distribution Hypocalcaemia percentag
e
Term 50 0 0
preterm 50 8 16%
total 100 8 8%

13. Observation
Phototherapy
induced
hypocalcaemia
43%
Z value 5.68
p value<0.005
Significant
Control group
hypocalcaemia
8%

14. Observation
Total calcium in
mg/dl SD
From total study subjects
Cases pre study Control pre study
8.415 0.461 8.96 0.486
Cases post study Control post study
7.404 0.599 8.79 0.677

15. Observation
Significance in fall of Significance in fall of
calcium in calcium in control
phototherapy exposed
100 cases 100 cases
Z value Z value
13.36 1.98
P value P value
<0.05 >0.05
Significant fall Not significant fall

16. Observation
Preterm group
Serum calcium values
in mg/dl SD
Cases pre study Controls pre
study
8.118 0.169 8.855 0.593
Cases post study Controls post
7.136 0.437 study 8.59 0.88

17. Observation
Significance in fall of
Significance in fall of
calcium in
calcium in control 50
phototherapy exposed
preterm babies
50 preterm cases
Z value 14.78 Z value 1.78
p value >0.05
p value<0.005
Not
Significant
significant

18. Observation
Serum calcium
values in full term
group in mg/dl SD
Controls pre
Cases pre study study
8.712 0.471 9.07 0.306
Cases post study Controls post
7.672 0.622 study 8.986 0.271

19. Observation
Significance in fall of
Significance in fall of
calcium in phototherapy
calcium in 50 term
exposed 50 full term
controls
cases
Z value Z value
9.41 1.44
p value>0.05
p value<0.005
Not
significant
significant

20. Discussion
• Total occurrence of • Total occurrence of
hypocalcaemia in hypocalcaemia in
phototherapy phototherapy
exposed groups exposed preterm
group
43% 60%
Significant
fall with p
26%
• Fall of serum
value
• T Total
calcium after <0.05 occurrence of
phototherapy in hypocalcaemia in
total, preterm and phototherapy
fullterm exposed term
groups

21. Discussion
Phototherapy Found
Romagnoli induced hypocalcaemia in
hypocalcaemia in 12.2% preterm
et al 1979 52.3% preterm control
Hakanson & Premature infants
under going
Bergstrom phototherapy have
increased incidence
1981 of hypocalcaemia
Phototherapy
Gutcher et produced a
significant fall in
al 1982 serum calcium after
exposure

22. Discussion
90% preterm and 75%
full term developed
Sethi et al 1993
hypocalcaemia after
phototherapy exposure
55% preterm and 30%
Jain B K et al full term developed
1998 hypocalcaemia after
phototherapy
Phototherapy in icteric
Eghbalian F et al 2002 newborn lowers serum
calcium significantly

23. Conclusions
Phototherapy induces
significant fall in serum In Preterm babies higher
calcium levels occurrence of
hypocalcaemia induced by
phototherapy , Risk is also
in full term

24. Recommendations
Calcium supplementation in
babies under phototherapy
Serum calcium should be
monitored regularly under
phototherapy

25. 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