Glucose-6-Phosphate Dehydrogenase Deficiency and Neonatal Hyperbilirubinemia

Khodashenas, Ezzat; Kalani-Moghaddam, Farnaz; Araghi, Zohreh; Khodaparast, Mahvan; Yazdani, Zahra

doi:10.22038/ijn.2015.4897

Glucose-6-Phosphate Dehydrogenase Deficiency and Neonatal Hyperbilirubinemia

Document Type : Original Article

Authors

¹ Assistant Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

² Resident of Pediatrics, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

³ Graduate Student of Neonatal Intensive Care nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/ijn.2015.4897

Abstract

Background: Jaundice is affecting over 60-80 percent of neonates in the first week of life. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is an important cause of pathologic hyperbilirubinemia, can lead to hemolytic anemia, jaundice and kernicterus. The present study was performed to determine the prevalence of G6PD deficiency among icteric neonates in Shirvan, Iran.
Methods: This descriptive, analytical study was performed by evaluating the medical records of neonates with jaundice, admitted to the neonatal ward of Imam Khomeini Hospital of Shirvan in 2012-2013. All neonates, who were evaluated in terms of G6PD, were included in this study. Data including the clinical signs and symptoms, laboratory test results and maternal history during pregnancy were recorded in the questionnaires. The patients were divided into two groups: with and without G6PD deficiency. The recorded data were compared between the two groups, using t-test and Chi-square test. P-value less than 0.05 was considered statistically significant.
Results: Among 452 admitted neonates, 16 (3.5%) presented with G6PD deficiency. There was no significant difference between the two groups in terms of birth weight, weight on admission, Coombs’ test results, hematocrit level, length of hospital stay and total bilirubin level. However, there was a significant difference between the two groups regarding reticulocyte count.
Conclusion: Based on the findings, establishment of an early G6PD screening program, which can prevent further complications in neonates, seems essential, particularly in countries such as Iran where G6PD deficiency is highly prevalent.

Keywords

References

Stoll BJ, Klliegman RM. Jaundice and hyperbilirubinemia in the newborn. In: Behrman, Kliegman, and Jenson. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: Saunders. 2004; pp.562-96.
Halamek LP, Stevenson DK. Neonatal Jaundice and Liver Disease. In: Fanaroff AA, Martin RG. Neonatal- Perinatal Medicine. 7th ed. Missouri: St Louis Mosby. 2002; pp.1309-50.
Nathan DG, Orkin SH. Glucose 6- phosphate dehydrogenase- deficiency and hemolytic anemia. In: Nathan and Oski’s Hematology of Infancy and Childhood. 5th ed. Philadelphia: WB Saunders. 2000; pp.704-25.
Segal GB. Glocose 6-Phosphate Dehyrogenase and relaxed deficient. In: Behrman R E. Nelson textbook of pediatric. 16th ed. Philadelphia: Saunders. 2000; 1489.
Beutlr E. G6PD deficiency. Blood-New York-84. 1994; pp.3613-36.
Beutler E. Population genetics and clinical manifestations. Blood Rev. 1996; 10(1):45-52.
Salvati AM, Maffi D, Caprari P, Pasquino MT, Caforio MP, Tarzia A. Glucose-6-phosphate dehydrogenase deficiency and hereditary hemolytic anemia. Ann IST Super Sanita. 1999; 35(2):193–203.
Hon A, balakrishnan S, Ahmad Z. Hyperbilirubinemia and erythrocyte glucose-6 phosphate dehydrogenase deficiency in Malaysian newborns. Med J Malaysia. 1989; 44(1):30-4
Kaplan M, Hammerman C. Glucose-6-phosphate dehydrogenase deficiency and severe neonatal hyperbilirubinemia: a complexity of interactions between genes and environment. Semin Fetal Neonatal Med. 2010; 15(3):148-56.

10. Mohammadzadeh A, Jafarzadeh M, Farhat AS, Keramati MR, Badiee Z, Esmaily H, et al. Prevalence of G6PD in neonates of Northeast of Iran. J Chin Clin Med. 2009; 4(8):448-50.

11. Genzalez Quiroga G, Ramirez del Rio JL, Ortiz-Jalomo, García-Contreras RF, Cerda-Flores RM, Mata-Cárdenas BD, et al. Relative frequency of glucose-6- phosphate dehydrogenase deficiency in jaundiced newborn infants in the metropolitan area of Menterrey, Nuevo Leon. Arch Invest Med (Mex). 1990; 21(3):223–7.

12. Badens C, Leclaire M, Collomb J, Auquier P, Soyer P, Michel G, et al. Glucose-6- phosphate dehydrogenase et neonatal jaundice. Presse Med. 2001; 30(11):524–6.

13. Joseph R, Ho LY, Gomez JM, Rajdurai VS, Sivasankaran S, Yip YY. Mass newborn screening for glucose-6-phosphate dehydrogenase deficiency in Singapore. Southeast Asian J Trop Med Public Health. 1999; 30 Suppl 2:70–1.

14. Mallouh AA, Imseeh G, Abu-Osba YK, Hamdan JA. Screening for glucose-6-phosphate dehydrogenase deficiency can prevent severe neonatal jaundice. Ann Trop Paediatr. 1992; 12(4):391–5.

15. Ahmed H, Yukubu AM, Hendrickse RG. Neonatal jaundice in Zaira, Nigeria- a second prospective study. West Afr J Med. 1995; 14(1):15–23.

16. Washington EC, Ector W, Abboud M, Ohning B, Holden M. Hemolytic jaundice due to G6PD deficiency causing kernicterus in a female newborn. South Med J. 1995; 88(7):776-9.

17. Boskabadi H, Khodashenas E. The Frequency and Characteristics of Hypothyroidism Jaundice in Neonates with Hyperbilirubinemia; A Ten-Year Survey. J Kerman Univ Med Sci. 2014; 21(3):240-6

18. Iranpour R, Akbar MR, Haghshenas I. Glucose-6-phosphate dehydrogenase deficiency in neonates. Indian J Pediatr. 2003; 70(11):855-7.

19. Flym M, Hesia D. Serum billirubin level and glucose 6-phosphate dehydrogenase deficiency in American Negroes. J Pediatr. 1963; 63(1):160-1.

20. Atay E, Bozaykut A, Ipek IO. Glucose-6-phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia. J Trop Pediatr. 2006; 52(1):56-8.

21. Boskabadi H, Omidian M, Mafinejad SH. Prevalence and Clinical Manifestation of Glucose-6-Phosphate Dehydrogenase Deficiency in Newborns with Hyperbilirubinemia in Mashhad, Iran. Macedonian J Med Sci. 2010; 3(4):383-7.

22. Verma M, Singla D, Crowell SB. G6PD deficiency in neonates: A prospective study. Indian J Pediatr. 1990; 57(3):385-8.