Glucose-6-phosphate dehydrogenase deficiency and carboxyhemoglobin concentrations associated with bilirubin-related morbidity and death in Nigerian infants.
Our objective was to determine whether glucose-6-phosphate dehydrogenase (G6PD) deficiency and elevated carboxyhemoglobin (COHb) levels correlated with bilirubin-related morbidity and mortality rates. For this purpose, we studied 55 clinically jaundiced infants admitted to a rural mission hospital in southern Nigeria. Total serum bilirubin levels (range, 80 to 1016 mumol/L (4.7 to 59.4 mg/dl)) correlated with the percentage COHb concentrations (COHb = 0.45 + 0.08 Total serum bilirubin; r = 0.72). Infants were divided into two groups of equal size around the median COHb concentration (COHb range, 0.43% to 5.93% (median = 1.40%), with ambient carbon monoxide of 0.65 +/- 0.03 microL/L). The COHb levels > or = 1.40% were associated with the need for exchange transfusion (15/28, or 54%, vs 5/27, or 19%; p < 0.01) and with an increased incidence of clinical findings compatible with kernicterus (9/28, or 32%, vs 0/27, or 0%; p < 0.01). Mortality rate was 29% (8/29) among infants with higher COHb levels, and 7% (2/28) in those with lower levels (p = 0.08). Thirty-one percent (14/45) of the clinically jaundiced infants tested had G6PD deficiency. Thirty-six percent of the infants with G6PD deficiency died with presumed kernicterus, compared with only 3% (1/31) of the infants with a normal G6PD screening test result (p < 0.01). These data suggest that G6PD deficiency and increased bilirubin production, as indexed by COHb, are associated with jaundice-related morbidity and death in Nigerian infants.
Slusher
T M
TM
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas.
Vreman
H J
HJ
McLaren
D W
DW
Lewison
L J
LJ
Brown
A K
AK
Stevenson
D K
DK
D001663:Bilirubin / Q000097:blood*; D001803:Blood Transfusion; D002263:Carboxyhemoglobin / Q000032:analysis*; D005260:Female; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000097:blood* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007565:Jaundice / Q000097:blood* / Q000150:complications / Q000628:therapy; D007647:Kernicterus / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D008297:Male; D009549:Nigeria / Q000453:epidemiology
D002263:Carboxyhemoglobin; D001663:Bilirubin