ELECTRONIC ARTICLE |
Hyperbilirubinemia Among African American, Glucose-6-Phosphate Dehydrogenase-Deficient Neonates
* Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
Faculty of Medicine, Hebrew University, Jerusalem, Israel
Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
|| Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
¶ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
# Department of Pediatrics, Stanford University School of Medicine, Stanford, California
Background. Although glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is prevalent in African Americans, their risk of associated neonatal hyperbilirubinemia has not been prospectively studied.
Objective. To compare hemolysis and the risk of hyperbilirubinemia among African American, G-6-PD-deficient neonates (study group) and G-6-PD-normal control subjects.
Methods. Consecutive, healthy, term and near-term, male neonates born to African American mothers comprised the patient cohort. G-6-PD testing was performed with umbilical cord blood samples. Routine management included measurement of the end tidal carbon monoxide level corrected for ambient carbon monoxide level (ETCOc) within 4 hours after delivery (assessment of hemolysis), 
1 predischarge bilirubin determination, and additional bilirubin testing as clinically indicated. Indications for phototherapy were identical for study patients and control subjects. Neonates were monitored for the first 1 week of life. ETCOc results, the incidence of hyperbilirubinemia (defined as a transcutaneous or plasma total bilirubin concentration of 95th percentile for the hour of life), and the need for phototherapy were compared between the G-6-PD-deficient and G-6-PD-normal groups.
Results. Five hundred male patients were enrolled, of whom 64 (12.8%) were G-6-PD-deficient. ETCOc values (median and interquartile range) were higher among G-6-PD-deficient neonates than among control neonates (2.4 ppm [2.0–2.9 ppm] vs 2.1 ppm [1.7–2.5 ppm]). More G-6-PD-deficient neonates developed hyperbilirubinemia than did control subjects (14 of 64, 21.9%, vs 29 of 436, 6.7%; relative risk: 3.27; 95% confidence interval: 1.83-5.86), whereas 13 (20.3%) met the criteria for phototherapy, compared with 25 control subjects (5.7%) (relative risk: 3.53; 95% confidence interval: 1.91-6.56). No cases of kernicterus were observed.
Conclusions. Within the African American neonatal population, there is a subgroup of G-6-PD-deficient infants with elevated rates of hemolysis, a higher incidence of hyperbilirubinemia, and a greater requirement for phototherapy, compared with G-6-PD-normal control subjects. These newborns should be monitored vigilantly for the development of hyperbilirubinemia.
Key Words: glucose-6-phosphate dehydrogenase deficiency • African American • hemolysis • neonatal hyperbilirubinemia • kernicterus • phototherapy • bilirubin • end tidal carbon monoxide
Abbreviations: ETCOc, end tidal carbon monoxide level corrected for ambient carbon monoxide level • G-6-PD, glucose-6-phosphate dehydrogenase • PTB, plasma total bilirubin • TcB, transcutaneous bilirubin • Hb, hemoglobin
Received for publication Jan 26, 2004; Accepted Mar 9, 2004.
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