Hyperbilirubinemia among African American, glucose-6-phosphate dehydrogenase-deficient neonates.
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), > or =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 > or =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.
Kaplan
Michael
M
Department of Neonatology, Shaare Zedek Medical Center, PO Box 3525, Jerusalem 91031, Israel. kaplan@cc.huji.ac.il
Herschel
Marguerite
M
Hammerman
Cathy
C
Hoyer
James D
JD
Stevenson
David K
DK
D001663:Bilirubin / Q000097:blood; D044383:Black People; D002248:Carbon Monoxide / Q000032:analysis; D005954:Glucosephosphate Dehydrogenase / Q000378:metabolism; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D006461:Hemolysis; D006801:Humans; D006932:Hyperbilirubinemia / Q000208:ethnology* / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D010789:Phototherapy; D012044:Regression Analysis; D012306:Risk; D001741:Black or African American
D002248:Carbon Monoxide; D005954:Glucosephosphate Dehydrogenase; D001663:Bilirubin