Alterations in Serum Magnesium Levels in Hyperbili-rubinemic Neonates Before and After Phototherapy

Document Type: Original Article

Authors

1 Maternal-Fetal and Neonatal Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2 Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

3 Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Bilirubin binds to cell membrane phospholipids, including N-methyl D-aspartate receptor, and causes excessive activation that can lead to neurotoxic effects. Since magnesium is an important inhibitor of this receptor, a comparison can be made between the physiological effects of magnesium and the neurological effects of bilirubin. This study aimed to compare changes in serum magnesium levels before and after phototherapy in hyperbilirubinemic newborns.
Methods: This retrospective cross-sectional study examined full-term newborns with hyperbilirubinemia. These newborns were admitted between 2012 and 2014 to the Neonatal Unit of Children’s Medical Center in Tehran, Iran. Based on the amount of bilirubin upon admission, participants were divided into three groups of mild (20 mg/dl). The total serum magnesium levels were measured before and 12-24 h after phototherapy.
Results: A total of 143 newborns were included in this study. A significant difference was observed between serum magnesium levels before (2.42±0.46 mg/dl) and after (2.07±0.32 mg/dl) phototherapy (P<0.001). This difference was observed in all etiologies of icterus.
Conclusion: The magnesium level decreased significantly after the completion of jaundice treatment for all causes of the condition. These findings raise the hypothesis that an increase in the level of extracellular magnesium is a defense mechanism that reduces the neurotoxic effects of bilirubin.

Keywords


1. Badeli HR, Sharafi R, Sajedi SA. The effect of clofibrate on neonatal hyperbilirubinemia in uncomplicated jaundice. Iran J Pediatr. 2008; 18(1):20-4.
2. Qaisiya MA. Unconjugated Bilirubin mediated oxidative stress, ER stress, and activation of Nrf2 pathway. Trieste, Italy: University of Trieste; 2014. P. 13-21.
3. Khosravi N, Aminian A, Taghipour R. Total serum 

magnesium level in icteric neonates before and after phototherapy. Tehran Univ Med J. 2011; 69(7):432-7.
4. Cohen RS, Wong RJ, Stevenson DK. Understanding neonatal jaundice: a perspective on causation. Pediatr Neonatol. 2010; 51(3):143-8.
5. Cheng SW, Chiu YW, Weng YH. Etiological analyses of marked neonatal hyperbilirubinemia in a single institution in Taiwan. Chang Gung Med J. 2012; 35(2):148-54.
6. Siyah Bilgin B, Altun Koroglu O, Yalaz M, Karaman S, Kultursay N. Factors affecting bilirubin levels during first 48 hours of life in healthy infants. BioMed Res Int. 2013; 2013:316430.
7. Mehta Y, Shitole C, Setia MS. Factors associated with changes in magnesium levels in asymptomatic neonates: a longitudinal analysis. Iran J Pediatr. 2016; 26(1):e2662.
8. Kliegman RM, Bonita MD. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011. P. 1576-7.
9. Shahriarpanah S, Haji Tehrani F, 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(3): 357-62.
10. 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(100):54-61.
11. Sarici SU, Serdar MA, Erdem G, Alpay F. Evaluation of plasma ionized magnesium levels in neonatal hyperbilirubinemia. Pediatr Res. 2004; 55(2):243-7.
12. Ip S, Chung M, Kulig J, Sege R, Glicken S, Maisels MJ, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004; 114(1):e130-53.
13. El Frargy MS, El-sharkawy HM, Attia GF. Study of serum magnesium levels in neonatal jaundice: the effect of phototherapy. Curr Pediatr Res. 2016; 20(1-2):273-6.
14. Karambin MM, Heidarzadeh A, Norouzi H, Dalili S. New insight into the effect of phototherapy on serum magnesium level. Iran J Neonatol. 2017; 8(3):44-7.
15. Afify MF, Mohsen AH, Allam E, Abdelkarem H. Role of Magnesium ion in neonatal jaundice. Life Sci J. 2012; 9(3):2276-77.
16. Hasan EJ. Evaluation of Copper, zinc, manganese, and magnesium levels in newborn jaundice in Baghdad. Ibn AL-Haitham J Pure Appl Sci. 2017; 24(3):22.
17. Choudhury A, Borkotoki S. Study of serum magnesium level in neonatal hyperbilirubinemia-a hospital based study. Indian J Appl Res. 2018; 8(5):40-1.