Korean J Pediatr.  2017 Apr;60(4):106-111. 10.3345/kjp.2017.60.4.106.

Neonatal indirect hyperbilirubinemia and glucose-6-phosphate dehydrogenase deficiency

• Isa HM
• Mohamed MS
• Mohamed AM
• Abdulla A
• Abdulla F

• KMID: 2377098
• DOI: http://doi.org/10.3345/kjp.2017.60.4.106

Abstract

PURPOSE
This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus.
METHODS
This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed. Data on sex, age at presentation, hospitalization duration, need for ET, hemoglobin (Hb) level, reticulocyte count, direct Coombs test, serum total and indirect bilirubin levels, thyroid function, blood and urine cultures, G6PD status, and blood groups were collected and compared between the G6PD-deficent and G6PD-normal patients.
RESULTS
Of 1,159 NIH patients admitted, 1,129 were included, of whom 646 (57%) were male. Among 1,046 patients tested, 442 (42%) were G6PD deficient, 49 (4%) needed ET, and 11 (1%) had suspected Kernicterus. The G6PD-deficient patients were mainly male (P<0.0001), and had lower Hb levels (P<0.0001) and higher maximum bilirubin levels (P=0.001). More G6PD-deficient patients needed ET (P<0.0001). G6PD deficiency (P=0.006), lower Hb level (P=0.002), lower hematocrit count (P=0.02), higher bilirubin level (P<0.0001), higher maximal bilirubin level (P<0.0001), and positive blood culture result (P<0.0001) were significant risk factors for ET. Maximal bilirubin level was a significant risk factor for kernicterus (P=0.021) and independently related to ET (P=0.03).
CONCLUSION
G6PD deficiency is an important risk factor for severe NIH. In G6PD-deficent neonates, management of NIH should be hastened to avoid irreversible neurological complications.

Keyword

Neonatal hyperbilirubinemia; Glucosephosphate dehydrogenase deficiency; Whole blood exchange transfusion; Kernicterus

MeSH Terms

Bahrain
Bilirubin
Blood Group Antigens
Case-Control Studies
Coombs Test
Glucose-6-Phosphate*
Glucosephosphate Dehydrogenase Deficiency*
Glucosephosphate Dehydrogenase*
Hematocrit
Hospitalization
Humans
Hyperbilirubinemia
Hyperbilirubinemia, Neonatal*
Infant
Infant, Newborn
Kernicterus
Male
Medical Records
Prevalence
Reticulocyte Count
Retrospective Studies
Risk Factors
Thyroid Gland
Bilirubin
Blood Group Antigens
Glucose-6-Phosphate
Glucosephosphate Dehydrogenase