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ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 3  |  Page : 1004-1008

Effect of phototherapy on serum magnesium level in newborn with hyperbilirubinemia


1 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Pediatrics, Ministry of Health, Menoufia, Egypt

Date of Submission03-Aug-2020
Date of Decision27-Sep-2020
Date of Acceptance08-Oct-2020
Date of Web Publication18-Oct-2021

Correspondence Address:
Mahmoud L Shehata
Department of Pediatrics, Ministry of Health, Birkat EL Saba, Menoufia 32652
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_250_20

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  Abstract 


Objective
To screen neonates with hyperbilirubinemia who received phototherapy to determine the effect of phototherapy on the serum magnesium level.
Background
Hyperbilirubinemia is one of the most prevalent problems in neonates. Phototherapy remains the main primary management in neonatal jaundice. However, it has many adverse effects, and hypomagnesemia is one of them.
Patients and methods
A prospective hospital-based comparative study was conducted on 70 eligible neonates admitted in Neonatal Intensive Care Units of Menoufia University Hospital receiving phototherapy from May 2019 to February 2020. Serum bilirubin and magnesium (total and ionized) were determined before starting phototherapy, and it was considered as control. Then serum bilirubin and magnesium were measured after 48 h of phototherapy and after termination of phototherapy. The plasma magnesium level was measured spectrophotometrically using ready-for-use kit supplied by Quimica Clinica Aplicada S.A. Company.
Results
The total serum magnesium level before phototherapy was 2.7 ± 0.3, 2.1 ± 0.30 mg/dl 48 h after phototherapy, and 1.85 ± 0.28 mg/dl after termination of phototherapy. Serum ionized magnesium level before phototherapy was 0.58 ± 0.02, 0.53 ± 0.02 mmol/l 48 h after phototherapy, and 0.51 ± 0.01 mmol/l after termination of phototherapy. So, there was a significant decrease in serum magnesium level (total and ionized) after phototherapy.
Conclusion
Our study concluded that there was a significant negative correlation between the duration of phototherapy and serum magnesium level (total and ionized).

Keywords: hyperbilirubinemia, magnesium, phototherapy


How to cite this article:
Khatab AA, Ashour NM, Shehata ML. Effect of phototherapy on serum magnesium level in newborn with hyperbilirubinemia. Menoufia Med J 2021;34:1004-8

How to cite this URL:
Khatab AA, Ashour NM, Shehata ML. Effect of phototherapy on serum magnesium level in newborn with hyperbilirubinemia. Menoufia Med J [serial online] 2021 [cited 2024 Mar 29];34:1004-8. Available from: http://www.mmj.eg.net/text.asp?2021/34/3/1004/328322




  Introduction Top


Neonatal jaundice is defined as a total serum bilirubin level above 5 mg per dl (86 μmol/l) or total serum bilirubin more than 95th percentile [1]. Jaundice affects at least 60% of full-term and 80% of preterm neonates [2]. Magnesium plays a role in protecting the neural system against hypoxia and neurotoxic effects of bilirubin, through blocking N-methyl-D-aspartate (NMDA) receptor. Magnesium ion is one of the most important complex antagonist regulators of bilirubin molecule/ionic canal/NMDA receptor in humans. Bilirubin leads to hyperactivity of the NMDA receptor and exerts neurotoxic effects through binding to NMDA, which has a key role in synaptic physiologic functions and memory [3]. There was a positive relation between serum magnesium and bilirubin levels, and it was propounded that rising of magnesium in hyperbilirubinemia might be a compensatory mechanism against toxic effects of bilirubin [4]. Therefore, measurement of ionized magnesium provides an accurate assessment of the unbound form of magnesium [5]. Phototherapy is the safest and commonly used treatment option for neonatal jaundice. Phototherapy leads to some adverse complications, but the potential complications of phototherapy are hypocalcemia and hypomagnesemia [6].

The mechanism of hypomagnesemia following phototherapy has been explained as unconjugated bilirubin gets deposited on the outer membrane of the neurons and causes bilirubin toxicity. To prevent the deposition of bilirubin in the outer membrane, intracellular magnesium goes out from the neurons, erythrocytes, and cardiocytes and gets deposit in the outer membrane. Cells get damage as intracellular magnesium goes out from the cells and plasma ionized magnesium goes up. So, this protective mechanism itself causes neuronal and cardiac damage. Phototherapy reduces bilirubin. As a result of this, the movement of magnesium from intracellular to extracellular is stopped, and this leads to decrease in the plasma ionized magnesium and serum magnesium also [7]. Inhibition of pineal gland because of transcranial illumination due to phototherapy decreases melatonin levels. One of the functions of melatonin is to inhibit the action of corticosterone. Corticosterone increases calcium absorption by bone. Hence, the increase in the level corticosterone leads to hypocalcemia and hypomagnesemia [8].

The aim of the study was to screen neonates with hyperbilirubinemia who received phototherapy to determine the effect of phototherapy on the serum magnesium level.


  Patients and methods Top


A prospective hospital-based comparative study was conducted on 70 eligible neonates admitted in Neonatal Intensive Care Units of Menoufia University Hospital receiving phototherapy from May 2019 to February 2020. After approval of the ethical committee, informed consent was obtained from the parents of the selected neonates. This study included 70 full-term neonates who were subjected to phototherapy for treating neonatal hyperbilirubinemia according to the guidelines of the American Academy of Pediatrics [9].

We excluded from the study neonates who had direct bilirubin more than 20%, exchange transfusion cases, neonates with cephalohematoma, congenital malformation, inborn errors of metabolism and sepsis, neonates whose mothers received magnesium sulfate or oxytocin at any time during gestation, intrauterine growth retardation, infants of diabetic mothers, neonates on intravenous fluid, hypocalcemia or hypomagnesemia before starting phototherapy, and hemolytic hyperbilirubinemia.

Each neonate was subjected to detailed history taking (gestational age, mode of delivery, detailed prenatal, natal history, age on admission, and day of onset of jaundice, family history of neonatal jaundice) and clinical examination.

Before starting phototherapy, we sent venous blood sample for serum magnesium (total and ionized), and it was considered as control. Serial measurements of (total–ionized) serum magnesium levels were done at 48 h after phototherapy and after termination of phototherapy.

Laboratory investigations included serial measurements of total serum bilirubin levels (at admission, 48 h after phototherapy and at discharge), blood groups and rhesus factor to infant and mother, reticulocytic count, serum calcium, complete blood count, C-reactive protein, liver function test, and Coombs test. Thereafter, all data were tabulated and analyzed statistically to detect the effect of phototherapy on the serum magnesium level.

Statistical analysis

The collected data were revised, coded, tabulated, and introduced to a computer software using (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, New York: IBM Corp.) for social science, version 25. Data were presented, and suitable analysis was done according to the type of data obtained for each parameter. Shapiro test was done to test the normality of data distribution. Data were expressed in frequency and percentage as well as mean and SD. Paired sample t test was used to assess changes over time. Correlation analysis is used to assess the strength of association between two quantitative variables. The correlation coefficient defines the strength and direction of the linear relationship between two variables. P value is significant if less than 0.05 at confidence interval 95%.


  Results Top


Our study included 70 full-term neonates with jaundice who received phototherapy for treating neonatal indirect hyperbilirubinemia, comprising 42 (60%) males, and 28 (40%) females, with the mean gestational age of 39 ± 0.7 weeks and mean postnatal age of 5.1 ± 1.1 days. There were 25 (35.7%) neonates delivered by normal vaginal delivery and 45 (45.6%) neonates delivered by cesarean section. Mean birth weight was 3.2 kg [Table 1].
Table 1: The demographic data of the studied neonates

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The complete blood count of all studied cases showed that mean hemoglobin of the studied neonates was 15.8 g/dl, mean hematocrit was 48.1%, mean platelet count was 270.9 × 109/l, mean white blood cell was 12.5 × 109/l, and the C-reactive protein was negative. The mean reticulocytes count was 2.4%, mean alanine aminotransferase was 32.1 U/l, mean aspartate aminotransferase was 56.6 U/l, mean total bilirubin was 16.5 mg/dl, and mean of serum calcium was 9.34 mg/dl before starting phototherapy. None of all studied cases had a positive Coombs test [Table 2].
Table 2: Laboratory criteria of all studied neonates before starting phototherapy

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The total serum bilirubin level before starting phototherapy was 16.48 ± 1.36 mg/dl, 48 h after phototherapy was 12.5 ± 1.0 mg/dl, whereas after termination of phototherapy was 8.73 ± 0.70 mg/dl. There was a significant decrease in the total serum bilirubin level after phototherapy compared with before starting phototherapy (P < 0.001). With respect to the serum magnesium levels, the total serum magnesium level before starting phototherapy was 2.7 ± 0.3 mg/dl, 48 h after phototherapy was 2.1 ± 0.30 mg/dl, whereas after termination of phototherapy was 1.85 ± 0.28 mg/dl. The ionized serum magnesium level before starting phototherapy was 0.58 ± 0.02 mmol/l, 48 h after phototherapy was 0.53 ± 0.02 mmol/l, whereas after termination of phototherapy was 51 ± 0.01 mmol/l. There was a significant decrease in serum magnesium (total and ionized) after phototherapy compared with before starting phototherapy (P < 0.001) [Table 3].
Table 3: Comparison between bilirubin and magnesium (total, ionized) at admission, 48 h after phototherapy, and after termination of phototherapy for all studied neonates

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There was a statistically significant positive correlation between total bilirubin and magnesium (total and ionized) before starting phototherapy, 48 h after phototherapy, and after termination of phototherapy in all studied neonates [Table 4].
Table 4: Correlations between total bilirubin and (total, ionized) magnesium at admission, 48 h after phototherapy, and after termination of phototherapy for all studied neonates

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There was a statistically significant negative correlation between (total and ionized) magnesium and duration of phototherapy, and there was a positive correlation between (total and ionized) magnesium and serum calcium. However, there was no statistically significant correlation between magnesium (total and ionized) and other laboratory investigations in all studied neonates after termination of phototherapy [Table 5] and [Figure 1].
Table 5: Correlations between (total and ionized) magnesium and other measured variables after termination of phototherapy of all studied neonates

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Figure 1: Correlations between magnesium (total and ionized) and duration of phototherapy in all studied neonates.

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  Discussion Top


Jaundice is the most common condition that requires medical attention and hospital readmission in newborns. The yellowish coloration of the skin and sclera in newborns with jaundice is the result of the accumulation of unconjugated bilirubin [10].

Our study included 70 jaundiced neonates with a bilirubin level of 16.5 ± 1.36 mg/dl treated with phototherapy, comprising 42 (60%) boys and 28 (40%) girls, with a mean gestational age of 39 ± 0.7 weeks and mean postnatal age of 5.1 ± 1.1 days. There were 25 (35.7%) neonates delivered by normal vaginal delivery and 45 (45.6%) neonates delivered by cesarean section.

Our study showed that there was a statistically significant positive correlation between total bilirubin and magnesium (total and ionized) in all studied neonates. This agreed with the study done by Sapkota [4].

Our study showed that there was a significant decrease in serum bilirubin level after phototherapy than before starting phototherapy, and there was a significant decrease in serum magnesium (total and ionized) level after phototherapy than before starting phototherapy. This was in agreement with the following studies.

The study by Meghana[11] concluded that average magnesium value noted before phototherapy was 2.8 mg/dl and after phototherapy was 1.7 mg/dl, showing a significant difference. Subhashini et al.[12] observed that serum magnesium levels before phototherapy in newborns were increased. There was a significant decrease in the level of magnesium after phototherapy, but none reached hypomagnesemia. Bezboruah and Majumder[13] discovered only a significant reduction of mean serum magnesium value following phototherapy. In term neonates, mean total magnesium was 2.29 ± 0.304 mg/dl before phototherapy and 2.08 ± 0.353 mg/dl after phototherapy. Shahriarpanah et al.[14] found that the serum level of magnesium decreased through relieving hyperbilirubinemia, and the increase in the plasma level of magnesium might be owing to synchronization with hyperbilirubinemia too. Hence, after the decrease in bilirubin, the level of magnesium decreased. The average serum magnesium was 2.06 ± 0.39 mg/dl after phototherapy, which was less than that of the hospitalization time (2.21 ± 0.57 mg/dl), and the difference was statistically significant (P = 0.047). Moreover, Sapkota[4] reported that phototherapy decreases the serum magnesium level and serum bilirubin level. The mean total magnesium level was 2.3 ± 0.7 mg/dl before phototherapy and 2.0 ± 0.5 mg/dl after phototherapy. Mean ionized magnesium level was 0.57 ± 0.03 mmol/l before phototherapy and 0.54 ± 0.02 mmol/l after phototherapy.


  Conclusion Top


Hyperbilirubinemia can cause damage to the brain and other tissues owing to increased bilirubin levels. This results in a compensatory increase in magnesium levels to counter the effects of high bilirubin levels. Phototherapy decreases the bilirubin level with a simultaneous decrease in magnesium level. There is a positive correlation between serum bilirubin and serum magnesium levels. The value of magnesium treatment in the therapy of neonatal hyperbilirubinemia deserves further studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Olusanya BO, Osibanjo FB, Slusher TM. Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries: a systematic review and meta-analysis. PLoS ONE 2015; 10: 0117229.  Back to cited text no. 1
    
2.
Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, et al. Neonatal hyperbilirubinemia and Rhesus disease of the newborn. Pediatr Res 2013; 74(S1):86–100.  Back to cited text no. 2
    
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Imani M, Rezaee-Pour M, Mohamdi M, Shiri M, Noroozifar M, Mahmodi N. Study of relationship between total Magnesium and total bilirubin levels in neonates' sera before and after phototherapy. Razi J Med Sci 2012; 19:54–61.  Back to cited text no. 3
    
4.
Sapkota NK. Effect of phototherapy on serum bilirubin and ionized magnesium level in hyperbilirubinemic neonates. Innovare J Med Sci 2017; 5:10–11.  Back to cited text no. 4
    
5.
Izzedine H, Bahleda R, Khayat D, Massard C, Magné N, Spano JP, et al. Electrolyte disorders related to EGFR-targeting drugs. Crit Rev Oncol Hematol 2010; 73:213–219.  Back to cited text no. 5
    
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Khan M, Malik KA, Bai R. Hypocalcaemia in jaundiced neonates receiving phototherapy. Pak J Med Sci 2016; 32:1449–1452.  Back to cited text no. 6
    
7.
Mohsen AHA, Afify MF, Allam E, Abdelkarem H. Role of magnesium ion in neonatal jaundice. Life Sci J 2012; 9:2274–2278.  Back to cited text no. 7
    
8.
Karamifar H, Pishva N, Amirhakimi GH. Prevalence of phototherapy-induced hypocalcemia. Iran J Pediatr 2002; 4:166–168.  Back to cited text no. 8
    
9.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114:297–316.  Back to cited text no. 9
    
10.
Mitra S, Rennie J. Neonatal jaundice: aetiology, diagnosis and treatment. Br J Hosp Med (Lond) 2017; 78:699–704.  Back to cited text no. 10
    
11.
Meghana N. A study to assess the effect of phototherapy on serum magnesium levels in late preterm neonates with hyperbilirubinemia present at 29th Neonatology and Primary Care Congress, Paris, France, December 02-03, 2019.  Back to cited text no. 11
    
12.
Subhashini B, Das P, Niranjjan R. Adverse effects of phototherapy on calcium, magnesium and electrolytes levels in neonatal jaundice. Int J Clin Biochem Res 2019; 6:275–278.  Back to cited text no. 12
    
13.
Bezboruah G, Majumder AK. Electrolyte imbalances resulting from phototherapy in neonatal hyperbilirubinemia. J Dent Med Sci 2019; 18:51.  Back to cited text no. 13
    
14.
Shahriarpanah S, Tehrani FHE, Davati A, Ansari I. Effect of phototherapy on serum level of calcium, magnesium and vitamin D in infants with hyperbilirubinemia. Iran J Pathol 2018; 13:357–362.  Back to cited text no. 14
    


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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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