The impact of phototherapy on serum calcium levels in full-term and preterm neonates with unconjugated hyperbilirubinemia: a prospective cohort study

Abstract

Background and objectives. Phototherapy is a standard treatment for neonatal hyperbilirubinemia but has been associated with side effects, including hypocalcemia. The differential effects of phototherapy on calcium metabolism in full-term versus preterm infants are not well established. This study aimed to evaluate and compare the effect of 48-hour phototherapy on serum calcium levels in full-term and preterm neonates with unconjugated hyperbilirubinemia. Materials and methods. This prospective cohort study included 41 neonates (20 full-term and 21 preterm) with unconjugated hyperbilirubinemia admitted to the Neonatal Intensive Care Unit (NICU). Serum calcium levels were measured before and after 48 hours of continuous phototherapy. Data were analyzed using appropriate parametric or non-parametric statistical tests. Results. All neonates presented with hypocalcemia prior to phototherapy. Serum calcium levels significantly decreased in both full-term infants (from 4.54 ± 0.30 to 2.86 ± 0.30 mg/dL; p < 0.001) and preterm infants (from a median of 3.34 mg/dL to 2.68 mg/dL; p < 0.001). The absolute reduction in serum calcium was significantly greater in full-term infants (median decrease of 1.32 mg/dL) compared with preterm infants (median decrease of 0.77 mg/dL; p = 0.037). Conclusions. Phototherapy significantly reduces serum calcium levels in both full-term and preterm neonates with hyperbilirubinemia. Although preterm infants had lower baseline calcium levels, full-term infants experienced a greater absolute decline. These findings support incorporating routine calcium monitoring and considering supplementation as part of standard phototherapy protocols to enhance patient safety.

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