Prevalence of hypocalcemia in neonates receiving phototherapy: a systematic review and meta-analysis.

Abstract

Background: Although phototherapy is the standard treatment for neonatal hyperbilirubinemia, its adverse effects cause electrolyte disturbances. Aggregated evidence regarding the prevalence of phototherapy-induced hypocalcemia remains inconsistent across studies. Therefore, this systematic review and meta-analysis aimed to determine the pooled incidence hypocalcemia in neonates receiving phototherapy.

Methods: This systematic review and meta-analysis were conducted in compliance with the 2020 PRISMA guidelines. Relevant databases were searched to retrieve observational studies reporting hypocalcemia among neonates with hyperbilirubinemia through February 2026. The retrieved articles were cleaned for duplicates and selected based on the eligibility criteria. STATA 17.0 software was used to compute the pooled hypocalcemia with 95% confidence intervals via a random effects model. Heterogeneity was assessed via the I² statistic and Cochran's Q test, whereas robustness was evaluated via leave-one-out sensitivity analysis and subgroup analysis. Furthermore, publication bias was assessed by Egger's regression test, Begg's rank correlation test, and trim-and-fill correction.

Results: In total, 25 studies involving 2673 neonates were included in the meta-analysis. The pooled prevalence of hypocalcemia in neonates undergoing phototherapy was estimated to be 20.68% (95% CI: 15.75-25.60%). There was significant heterogeneity (I² = 94.15%, p < 0.001). In the subgroup analysis, there was a greater hypocalcemia in studies with preterm (23.03%, 95% CI: 14.18% - 31.88%) and low birth weight (22.57%, 95% CI: 14.99% - 30.16%) neonates than in those with term (18.51%, 95% CI: 12.39% - 24.63%) and normal birth weights (13.97%, 95% CI: 8.72% - 19.17%). The hypocalcemia was higher in Africa (36.00%, 95% CI: 7.52% - 64.47%) than in Asia (18.89%, 95% CI: 14.02% - 23.76%). Egger's test revealed significant publication bias (p < 0.0001), with no significant change in the original effect size after trim-and-fill analysis.

Conclusion: Hypocalcemia is a frequent electrolyte disorder in neonates under phototherapy with neonatal hyperbilirubinemia. Thus, regular monitoring is essential, particularly for those who are at high risk.