Detection Of Dynamic Changes Of Serum 25-（OH）D₃ And Ca²⁺ In Hyperbilirubinemia Neonates With Phototherapy

Objective:By detecting the levels of serum 25-（OH）D₃,total Ca and free Ca²⁺before and after light therapy in neonates with hyperbilirubinemia,this study will discuss the effect of light therapy on levels of serum 25-（OH）D₃,total Ca and free Ca²⁺so as to provide a theoretical basis for the treatment of neonatal hyperbilirubinemia.Methods:60 term infants with hyperbilirubinemia were randomly selected from October 2017 to March 2018 in the NICU ward of the Yijishan Hospital of Wannan Medical College.By using random method of random number were collected and was randomly divided into 3 groups,20 cases in each group.Group A received intravenous infusion of calcium gluconate 10%in combination with phototherapy.Group B received light therapy only,without other intervention.Group C was given 25-（OH）D₃ orally throughout the phototherapy.The way of phototherapy is double-sided.2 ml of peripheral venous blood was collected from the children of each group before and after the light therapy was stopped to detect the serum total bilirubin,serum 25（OH）D₃,serum albumin and total Ca²⁺levels.To calculate the level of free Ca²⁺,the formula^[1]:free calcium=[0.9+（0.55*total calcium mg/d L）-（0.3*albumin g/dL）]÷4 was adopted;in order to provide theoretical basis for the treatment of hyperbilirubinemia,the levels of total bilirubin,serum 25-（OH）D₃,total Ca and free Ca²⁺in the three groups were compared after different treatment.Results:1.There were 52 children successfully completed the whole experiment finally while 8 cases of children failed to complete the experiment including 2 cases in group A,3 cases in group and 3 cases in group C.In group A,1 withdraw case was caused by the appearance of systemic rash and 1 case exited the experiment because the bilirubin value was high enough to reach the index of exchange transfusion.In group B,2 cases were treated with antibiotics because of infection;one case was withdrawn because the bilirubin value was high enough to reach the index of exchange transfusion.In group C there were 3 cases,in which 2 cases were treated with antibiotics because of infection and 1 case was excluded because of bronze disease.2.52 children including 18 cases（8 males and 10 females）in Group A,17 cases in Group B（8 males and 9 females）,17 cases in Group C（8 males,9 females）successfully completed the whole experiment.None of them suffered from hypocalcemia.However,the difference in sex,delivery mode,gestational age,birth weight,admission weight,day age and time of phototherapy in each group was not statistically significant（P>0.05）.3.The levels of serum total bilirubin in group A were significantly lower than those before treatment,and the difference was statistically significant（P>0.05）,but the levels of serum calcium,VitD3 and serum albumin had no difference before and after treatment（P>0.05）.The levels of serum calcium,total bilirubin and serum free calcium in group B were significantly lower than those before treatment,and the difference was statistically significant（P<0.05）,but the levels of VitD₃ and serum albumin had no difference before and after treatment（P>0.05）.The levels of serum calcium,total bilirubin and serum free calcium in group C were significantly lower than those before treatment,and the difference was statistically significant（P<0.05）and the serumVitD₃level in group C after treatment was significantly higher than that before treatment,and the difference was statistically significant（P>0.05）,though there was no significant change in serum albumin level before and after treatment（P>0.05）.The changes of serum VitD₃ were statistically significant（P<0.05）and the serum VitD₃ level in Group C was significantly higher than group A and B,showing that the difference was statistically significant（P<0.05）.There was no significant difference between group A and group B（P>0.05）.4.The difference of serum total calcium,serum total bilirubin and serum free calcium in the three groups was not statistically significant before and after treatment（P>0.05）.Conclusions:1.The serum calcium and free calcium levels of term neonates with hyperbilirubinemia were lower than those before phototherapy,but they did not reach the level of hypocalcemia.Prophylactic use of calcium during phototherapy had no significant effect on serum calcium and free calcium levels.2.Prophylactic use of VitD₃ during phototherapy did not reach the level of hypocalcemia due to the increase of 25-（OH）D₃.