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Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Effect of Phototherapy on Calcium, Magnesium, and Vitamin D Levels in Neonates with Hyperbilirubinemia: A Systematic
Rasol Molatefi1, Mehrdad Mirzarahimi2, Mojgan Mirghafourvand3
1Cancer Immunology and Immunotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
Insights
Phototherapy significantly lowers serum calcium and magnesium in term neonates, but its effect on vitamin D is unclear. Monitoring electrolytes is advised, though routine supplementation is not yet supported by evidence.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Clinical Biochemistry
Background:
- Phototherapy is a common treatment for neonatal jaundice.
- Potential impacts on mineral and vitamin levels require thorough investigation.
Purpose of the Study:
- To systematically evaluate the effects of phototherapy on serum calcium, magnesium, and vitamin D in term neonates.
- To synthesize evidence regarding electrolyte and vitamin D level changes post-phototherapy.
Main Methods:
- A comprehensive meta-analysis adhering to PRISMA guidelines.
- Searched multiple databases (PubMed, Scopus, Web of Science, Cochrane, SID) up to August 2025.
- Employed random-effects models for pooled effect sizes and assessed heterogeneity and study quality using established tools (I2, GRADE, Newcastle-Ottawa, ROBINS-I, RoB 2).
Main Results:
- Phototherapy significantly decreased serum calcium (Hedges' g = -0.67) and magnesium (Hedges' g = -1.09) levels, with considerable heterogeneity.
- Pooled prevalence of hypocalcemia and hypomagnesemia post-phototherapy was 26.1% and 23.8%, respectively.
- Vitamin D levels showed a non-significant trend towards increase (Hedges' g = 0.40), with very low certainty of evidence for vitamin D and low for calcium/magnesium.
Conclusions:
- Phototherapy is linked to significant reductions in serum calcium and magnesium in term neonates.
- The effect on vitamin D levels is inconclusive, and the evidence for calcium and magnesium changes is of low certainty.
- High-quality randomized controlled trials are needed to guide clinical practice regarding electrolyte monitoring and supplementation.
Introduction:
This study aimed to evaluate the impact of phototherapy on serum calcium, magnesium, and vitamin D levels in term neonates.
Methods:
This study was conducted in accordance with the PRISMA statement. A comprehensive search of PubMed, Scopus, Web of Science, the Cochrane Library, and the Scientific Information Database (SID) was performed up to August 20, 2025. Pooled effect sizes were calculated as Hedges' g and mean differences (MD) with 95% Confidence Intervals (CIs) using random-effects models. Heterogeneity was assessed using the I2 statistic. Study quality was appraised using the Newcastle- Ottawa Scale, ROBINS-I, and RoB 2 tools, and the certainty of evidence was evaluated per GRADE methodology.
Results:
Twenty-seven studies were included. Phototherapy was associated with a significant decrease in serum calcium (Hedges' g = -0.67; 95% CI: -0.89 to -0.45; MD: -0.57 mg/dL; 95% CI: - 0.75 to -0.40; 22 studies; 2,406 participants) and magnesium levels (Hedges' g = -1.09; 95% CI: - 1.54 to -0.63; MD: -0.21 mg/dL; 95% CI: -0.33 to -0.10; 10 studies; 863 participants), with considerable heterogeneity observed for both outcomes. Vitamin D levels showed a non-significant overall increase (Hedges' g = 0.40; 95% CI: -0.06 to 0.87; MD: 5.86 nmol/L; 95% CI: -2.06 to 13.77; 7 studies; 517 participants; p = 0.091). The pooled prevalence of hypocalcemia and hypomagnesemia following phototherapy was 26.1% (95% CI: 20.8% to 32.3%) and 23.8% (95% CI: 18.6% to 30.0%), respectively. The certainty of evidence was rated as low for calcium and magnesium, and very low for vitamin D.
Discussion:
This meta-analysis indicates that phototherapy in term neonates is associated with significant decreases in serum calcium and magnesium, while its effect on vitamin D remains inconclusive. These findings highlight the need for monitoring electrolyte balance in at-risk neonates, although routine supplementation is not currently supported by the evidence.
Conclusion:
Phototherapy is associated with a significant decrease in calcium and magnesium levels in term neonates. Given the low certainty of evidence, high-quality randomized controlled trials with standardized protocols are warranted to guide clinical practice. PROSPERO registration number: CRD42025638904.
