The impact of Gluconate calcium on hypocalcaemia after blood exchange in hyperbilirubinemic newborns

Background: Blood exchange is one of therauputic methods for neonatal hyperbilirubinemia.
But this method has some complications. One of these complications is hypocalcemia. In some
studies, for avoiding from this problem, calcium gluconate injection is recomm ended. But in
some studies there was any important difference between calcium treated group and the group
without calcium prescription.
Due to lack of documented evidences about prevalence of this complication, this study was
conducted to compare the result of using calcium gluconate injection in the incidence of
hypocalcemia and hyper calcemia.
Methods and materials: For this purpose in a randomized controlled clinical trial in Ali_
Asghar pediatric hospital in Zahedan, 40 hyperbilirubin neonates that were hospitalized for
blood exchange came into this study. These patients were randomized in two groups so that
they were adjusted in terms and preterm delivery. For 22 patients, 1 ml of calcium
glucdnate%10 was injected in each 100 ml exchanged blood and for 18 patients (control
group), calcium injection wasn’t been done. Calcium serum level was tested before, immediately
after and 6 hours after blood exchange in all patients. Data analysis was been done by means of
fishers exact test, Chi_ Square and Binomial test.
Results: In calcium treated patients, hypocalcaemia wasn’t being present after blood
exchange. But in non _ calcium treated patients hypo calcemia was seen in 4 cases (%22.4) after
blood exchange (P < 0.013). All of these 4 cases were preterm. In calcium treated patients
hypocalcaemia had a significant increase after exchange especially in term neonates (P <
0.028).
Conclusions: On the base of these results, in preterm neonates, calcium gluconate injection
after blood transfusion exchange is recommended. But this procedure isn’t necessary in term
newborns because may result in hyper calcemia.