Phototherapy Induced Hypocalcemia in Term and Preterm Neonates with Hyperbilirubinemia: A Cross-Sectional Study

Abstract

Introduction: Neonatal jaundice is a common condition affecting 60% of term and 80% of preterm neonates within the first week of life. Phototherapy, though the standard treatment for neonatal hyperbilirubinemia, may cause complications such as hypocalcemia, a significant but lesser-known side effect. This study compared phototherapy-induced hypocalcemia in late preterm and term neonates with unconjugated hyperbilirubinemia, after 48 hours of phototherapy.

Methods: This hospital-based descriptive cross-sectional study was conducted in the Neonatal Intensive Care Unit of a tertiary care Hospital from 16th August 2022 to 10th July 2023. A total of 150 neonates, both term and preterm,with hyperbilirubinemia requiring at least 48 hours of phototherapy were
 enrolled. After ethical approval and informed consent, data were collected using a structured questionnaire and analyzed using SPSS version 23.

Results: After 48 hours of phototherapy, calcium decreased in both groups. In term neonates, it decreased from 9.44±0.59 to 8.57±0.73 mg/dL (mean change 0.87 mg/ dL, 95% CI 0.77–0.97) and in preterm neonates from 9.10±0.43 to 7.94±0.79 mg/ dL (mean change 1.16 mg/dL, 95% CI 1.01–1.31). The between group difference was 0.29 mg/dL (95% CI: 0.11–0.47), Cohen’s d = 0.55. Hypocalcemia occurred in 19(21.30%) term and 21(34.40%) preterm neonates (RR 1.61, 95% CI 0.95–
2.73; RD 13.1%, 95% CI-7.2% to 32.8%).

Conclusions: There is a reduction in serum calcium levels in both term and preterm neonates after phototherapy. While exploratory analyses suggested a higher risk of hypocalcemia in preterm neonates, subgroup comparisons were underpowered and should be interpreted cautiously.