Beyond the Glow: Life-Threatening Diarrhea and Hypovolemic Shock Following Repeated Intensive Phototherapy in a Neonate with ABO Hemolytic Jaundice
Mohamed Sadik, MD1; Ahmed Elmelhat, MD1*
1Department of Pediatrics/Neonatology, HMS Mirdif Hospital, Dubai, UAE.
*Corresponding Author: Ahmed Elmelhat, Department of Pediatrics/Neonatology, HMS Mirdif Hospital, Dubai, UAE.
https://doi.org/10.58624/SVOAPD.2026.05.027
Received: August 15, 2026
Published: September 08, 2026
Citation: Sadik M, Elmelhat A. Beyond the Glow: Life-Threatening Diarrhea and Hypovolemic Shock Following Repeated Intensive Phototherapy in a Neonate with ABO Hemolytic Jaundice. SVOA Paediatrics 2026, 5:5, 173-179. doi: 10.58624/SVOAPD.2026.05.027
Abstract
Phototherapy is the mainstay of treatment for neonatal hyperbilirubinemia and is generally considered safe, with loose stools regarded as a trivial side effect. We describe a late-preterm female infant with ABO hemolytic jaundice who required three separate courses of intensive phototherapy and subsequently developed severe watery diarrhea with hypovolemic shock (pH 7.0, bicarbonate 8 mmol/L, potassium 6.1 mmol/L, sodium 150 mmol/L) at 18 days of life. An exhaustive workup including a comprehensive stool viral PCR panel, plasma amino acids, urine organic acids and amino acids, repeat acylcarnitine profile, abdominal and transcranial ultrasound, echocardiography, and chest radiograph excluded infection, inborn errors of metabolism, and structural disease. She recovered fully after introduction of an amino-acid–based (elemental, lactose-free) elimination formula, which was begun to exclude any possibility of milk protein intolerance or allergy. We propose phototherapy-associated enteropathy, manifesting as secretory diarrhea with transient carbohydrate malabsorption, as the most plausible explanation, supported by a focused literature review. Clinicians should recognize that phototherapy-associated diarrhea, though usually benign, can rarely progress to life-threatening dehydration and shock particularly after repeated or intensive courses.
Keywords: Phototherapy, Neonatal Diarrhea, Dehydration, Hypovolemic Shock, Abo Incompatibility, Hyperbilirubinemia, Secretory Diarrhea, Transient Lactose Intolerance