Randomized controlled trial of prophylactic intravenous calcium therapy for post–exchange blood transfusion hypocalcaemia in the newborn: A preliminary report

Background: Exchange Blood Transfusion (EBT) is a form of massive blood transfusion mostly used to treat severe hyperbilirubinaemia and  anaemia in the newborn period. Hypocalcaemia is a known complication of EBT hence the practice of prophylactic administration of intravenous calcium. Objective: To compare the prevalence of post-EBT hypocalcaemia among babies who received prophylactic intravenous calcium and babies who received a placebo. Materials and Methods: A randomized placebo-controlled trial among hospitalized babies who required EBT for hyperbilirubinaemia in a Nigerian tertiary facility was done. Following strict methods of randomization, some babies received prophylactic calcium (calcium group) while the others received sterile water (placebo group) during EBT. Serum calcium was measured pre- EBT and at six and 24 hours post- EBT. Results: All the 16 and 13 babies recruited into the calcium and placebo groups had double volume  EBT. Babies in both arms of the study were comparable in terms of age, body weight and EGA. The mean serum calcium levels pre- EBT and at six hours and 24 hours post-EBT were 8.1 ± 1.6mg/dl, 8.2 ± 1.1mg/dl and 8.4 ± 1.1mg/dl respectively for the calcium group and 8.6 ± 2.6mg/dl, 9.0 ± 1.6mg/dl and 9.1 ± 1.7mg/dl for the placebogroup. The prevalence of hypocalcaemia at six hours post-EBT was 37.5% and 15.4% in the calcium and placebo groups respectively. Conclusion: The study did not demonstrate a clear role of prophylactic intravenous calcium therapy during EBT in the prevention of hypocalcaemia. It may be safer to screen for hypocalcaemia and treat it appropriately. Keywords: Calcium, Exchange Blood Transfusion, Hyperbilirubinaemia, Hypocalcaemia, Prophylaxis