title: Methaemoglobinaemia with G6PD deficiency: rare cause of persistently low saturations in neonates.
abstract: We report a very rare case of methaemoglobinaemia associated with glucose 6 phosphate dehydrogenase (G6PD) deficiency, complicating a respiratory illness in a preterm neonate. This neonate had consistently low saturation readings despite being ventilated at moderately high pressures in 100% oxygen. An arterial blood gas confirmed a high methaemoglobin level and a high pO2, inconsistent with the saturations. In addition, the bilirubin increased to exchange levels and was difficult to control with quadruple phototherapy. A double volume exchange transfusion was performed, which reduced both bilirubin and methaemoglobin. The pulse oximetry then started to correlate well with pO2. G6PD deficiency was confirmed.
  
  
  CONCLUSIONS
  Paediatricians should remember that methaemoglobinaemia is a rare but important cause of persistently low saturations, and exchange transfusion is a reliable treatment for this condition.
authors.affiliation: Department of Paediatrics, Sandwell & West Birmingham NHS Hospitals Trust, Birmingham, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Titheradge
authors.forename: Katie
authors.initials: K
authors.lastname: Nolan
authors.forename: Shanmugasundaram
authors.initials: S
authors.lastname: Sivakumar
authors.forename: Srinivas
authors.initials: S
authors.lastname: Bandi
mesh_terms: D003937:Diagnosis, Differential; D005078:Exchange Transfusion, Whole Blood; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications*; D006801:Humans; D006932:Hyperbilirubinemia / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008708:Methemoglobinemia / Q000150:complications*; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood*; D010789:Phototherapy; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology*
chemical_list: D010100:Oxygen