Phototherapy-induced hypocalcemia and hypoparathyroidism in icteric term newborns

Esra Beser; Ufuk Cakir; Nazmiye Bengu Karacaglar; Merve Kucukoglu Keser; Burak Ceran; Ali Ulas Tugcu; Cuneyt Tayman

doi:10.1515/jpem-2022-0284

Article

Phototherapy-induced hypocalcemia and hypoparathyroidism in icteric term newborns

Esra Beser , Ufuk Cakir , Nazmiye Bengu Karacaglar , Merve Kucukoglu Keser , Burak Ceran , Ali Ulas Tugcu and Cuneyt Tayman

Published/Copyright: November 21, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 1

Abstract

Objectives

Phototherapy is demonstrated to cause hypocalcemia by decreasing melatonin levels and increasing cortisol levels. However, the relationship between parathyroid hormone (PTH) level and calcium has not been previously evaluated in patients receiving phototherapy. Our study aimed to evaluate the effect of phototherapy on ionized calcium (iCa), total calcium (tCa), corrected calcium (cCa), magnesium (Mg), phosphorus (P), 25-hydroxyvitamin D (25(OH)D), and PTH levels.

Methods

Infants who were born at term and received inpatient phototherapy for indirect hyperbilirubinemia were included in our study. The patients’ gestational age, birth weight, and phototherapy durations were recorded. Total bilirubin, albumin, iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels before and after phototherapy were compared. Laboratory results were also compared between patients who received phototherapy for ≤24 h, 25–47 h, and ≥48 h.

Results

A total of 166 term infants were included in the study. The mean duration of phototherapy was 31.9 ± 9.2 h. Albumin levels before and after phototherapy were similar (p=0.246). However, there were significant decreases in iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels after phototherapy (p<0.001), while P level was significantly increased after phototherapy (p<0.001). In addition, P levels increased with >24 h of phototherapy, while iCa, tCa, cCa, Mg, 25(OH)D, and PTH levels decreased significantly with ≥48 h of phototherapy (p=0.002, p=0.008, p=0.001, p=0.012, and p<0.001, respectively).

Conclusions

This study demonstrates that PTH suppression is one of the causes of phototherapy-induced hypocalcemia.

Keywords: calcium; parathyroid hormone vitamin D; phototherapy; term neonates

Corresponding author: Esra Beser, MD, Division of Neonatology, Health Science University, Ankara Bilkent City Hospital, Universiteler &1604, 06800, Cankaya Ankara, Turkey, Phone: +90 533 579 93 92, Fax: +90 312 306 52 71, E-mail: esra5er@hotmail.com

Research funding: None declared.
Author contributions: Concept, design and data collection or processing: Esra Beser, Nazmiye Bengu Karacaglar, and Merve Kucukoglu Keser. Data analysis and interpretation: Ufuk Cakir, Burak Ceran and Ali Ulas Tugcu. Literature search: Esra Beser, Burak Ceran, Ufuk Cakir, and Ali Ulas Tugcu. Writing: Esra Beser, Ufuk Cakir, and Cuneyt Tayman. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals’ parents or guardians included in this study.
Ethical approval: Ethical approval from the local Ethics Committee (date: 02.09.2020, ethic no: E1/170/2019).

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Received: 2022-05-30

Accepted: 2022-10-31

Published Online: 2022-11-21

Published in Print: 2023-01-27

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0284

Keywords for this article

calcium; parathyroid hormone vitamin D; phototherapy; term neonates