Effect of Phototherapy on Various Biochemical Parameters in Neonatal Hyperbilirubinaemia: A Clinical Insight

Abstract

Introduction: Neonatal Hyperbilirubinaemia (NH) is a very common complication in newborns. It occurs due to excessive formation of unconjugated (indirect) bilirubin and inability of neonatal liver to rapidly clear it from blood. Phototherapy is the first and most common treatment for jaundice in newborns and in most cases is the only treatment required. Aim: To assess the changes in various other biochemical parameters including proteins, enzymes, lipids, urea, creatinine and uric acid levels in plasma/serum of pre and post phototherapy treated in full term jaundiced neonates. Materials and Methods: This prospective hospital based comparative study was conducted in the Department of Biochemistry and Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, from November 2016 to March 2017, after obtaining ethical clearance from institutional ethical committee and informed consent from parents or guardians of neonates. The study included 119 neonates (64 males and 55 females) who were receiving phototherapy and their data was recorded on a predesigned proforma. Biochemical assay was measured using commercially available system pack kits on Fully Automated Clinical Chemistry Analyser, ADVIA -2400 for the biochemical parameters. The significance of the difference between the groups was assessed by student’s ‘t’-test for pair matched samples. The p-value of <0.05 were considered statistically significant. Results: Levels of bilirubin profile were elevated significantly in patients prior to phototherapy and returned to normal generally after 48 hours to 96 hours of phototherapy. Levels of hepatic enzyme markers namely AST, ALP and LDH were also elevated significantly in the pre phototherapy group which declined significantly after phototherapy (p<0.05). Levels of total cholesterol, triglycerides and VLDL showed significant decline in our study (p<0.05, <0.005 and <0.001 respectively), however no significant changes were observed in LDL and HDL levels in the patients treated for phototherapy. Our study also observed significant decline in uric acid (p<0.001), creatinine (p<0.005), total serum proteins (p<0.001) and albumin levels (p<0.001). There was also significant decline in the levels of electrolytes including sodium, potassium, chloride and calcium (p<0.001 in each case). Conclusion: Though, it is well known that phototherapy has a beneficial effect in treatment of NH but its effect on other biochemical parameters is also noteworthy and therefore the neonate should be assessed accordingly while on treatment with phototherapy

Keywords

• bilirubin profile
• neonatal jaundice
• unconjugataed hyperbilirubinaemia