Phototherapy Induced   Hypocalcaemia   A Prospective Study        Dr vikas moudgilJ 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...
PathophysiologyPhototherapy inhibits pineal secretionof melatonin    Melatonin blocks the hypocalcaemia    effects of endo...
Phototherapy Induced Hypocalcaemia Aims and objectives1. To study effect of phototherapy on serum total   calcium level i...
Materials and MethodsStudy area- J.L.N Hospital & RC BhilaiStudy period- Dec 2009 to March 2010Study design-longitudina...
Materials and MethodsExposed to phototherapy                     Controls Babies having                   Babies with hy...
Materials and MethodsInclusion criteria for cases   Exclusion criteria Icteric stable neonates       Who developed jaund...
Materials and MethodsBabies having hypocalcaemia prior to phototherapy excluded from both study and controls groupsBabie...
Materials and MethodsSerum calcium was done at start and after 48 hours of phototherapySerum calcium in control group wa...
Observations     Total 100 babies exposed to phototherapyHypocalcaemia=43                      43%    Full term 50 babies ...
ObservationsControl group                                  Not exposed to phototherapyDistribution         Hypocalcaemia p...
Observation Phototherapy   inducedhypocalcaemia     43%                       Z value 5.68                      p value<0....
Observation                      Total calcium in                         mg/dl SD                  From total study subje...
ObservationSignificance in fall of     Significance in fall of     calcium in              calcium in controlphototherapy ...
Observation                     Preterm group                  Serum calcium values                      in mg/dl SDCases ...
ObservationSignificance in fall of                          Significance in fall of     calcium in                        ...
Observation                     Serum calcium                   values in full term                   group in mg/dl SD   ...
Observation Significance in fall of                           Significance in fall ofcalcium in phototherapy              ...
Discussion• Total occurrence of                       • Total occurrence of  hypocalcaemia in                            h...
Discussion                  Phototherapy              FoundRomagnoli           induced            hypocalcaemia in        ...
Discussion                         90% preterm and 75%                          full term developed   Sethi et al 1993    ...
Conclusions Phototherapy inducessignificant fall in serum    In Preterm babies higher     calcium levels                oc...
Recommendations  Calcium supplementation in  babies under phototherapy       Serum calcium should be       monitored regul...
References•   Manual of Neonatal Care,6th edition.John P Cloherty•   Nelson text book of Pediatrics ,18th edition•   CARE ...
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Phototherapy induced hypocalcaemia

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a prospective study on Phototherapy induced hypocalcaemia

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Phototherapy induced hypocalcaemia

  1. 1. Phototherapy Induced Hypocalcaemia A Prospective Study Dr vikas moudgilJ L N HOSPITAL AND R C BHILAI
  2. 2. IntroductionJaundice –most common abnormal physical finding in first week of life Physiological jaundice Pathological
  3. 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. 4. PathophysiologyPhototherapy inhibits pineal secretionof melatonin Melatonin blocks the hypocalcaemia effects of endogenous steroids Low serum concentration of melatonin permits unopposed hypocalcaemia effects of endogenous steroids
  5. 5. Phototherapy Induced Hypocalcaemia Aims and objectives1. To study effect of phototherapy on serum total calcium level in icteric newborn2. To compare the effect on serum total calcium values in preterm(>32-<37 weeks) and full term(>37-<40weeks) newborn receiving phototherapy
  6. 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. 7. Materials and MethodsExposed 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 followed1. AAP guidelines 20042. AIIMS phototherapy Protocol
  8. 8. Materials and MethodsInclusion 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. 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. 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. 11. Observations Total 100 babies exposed to phototherapyHypocalcaemia=43 43% Full term 50 babies exposed to phototherapyHypocalcaemia=13 26% Preterm 50 babies exposed to phototherapyHypocalcaemia=30 60%
  12. 12. ObservationsControl group Not exposed to phototherapyDistribution Hypocalcaemia percentag eTerm 50 0 0preterm 50 8 16%total 100 8 8%
  13. 13. Observation Phototherapy inducedhypocalcaemia 43% Z value 5.68 p value<0.005 SignificantControl grouphypocalcaemia 8%
  14. 14. Observation Total calcium in mg/dl SD From total study subjectsCases 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. 15. ObservationSignificance in fall of Significance in fall of calcium in calcium in controlphototherapy 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. 16. Observation Preterm group Serum calcium values in mg/dl SDCases 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. 17. ObservationSignificance in fall of Significance in fall of calcium in calcium in control 50phototherapy 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. 18. Observation Serum calcium values in full term group in mg/dl SD Controls preCases 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. 19. Observation Significance in fall of Significance in fall ofcalcium 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. 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. 21. Discussion Phototherapy FoundRomagnoli induced hypocalcaemia in hypocalcaemia in 12.2% pretermet al 1979 52.3% preterm controlHakanson & Premature infants under going Bergstrom phototherapy have increased incidence 1981 of hypocalcaemia PhototherapyGutcher et produced a significant fall in al 1982 serum calcium after exposure
  22. 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 ictericEghbalian F et al 2002 newborn lowers serum calcium significantly
  23. 23. Conclusions Phototherapy inducessignificant fall in serum In Preterm babies higher calcium levels occurrence of hypocalcaemia induced by phototherapy , Risk is also in full term
  24. 24. Recommendations Calcium supplementation in babies under phototherapy Serum calcium should be monitored regularly under phototherapy
  25. 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

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