Association Between G6PD Deficiency and Hyperbilirubinemia in Neonates: A Meta-Analysis

Hyperbilirubinemia is prevalent in newborns and multiple factors are responsible for the occurrence of neonatal hyperbilirubinemia. G6PD (Glucose-6-Phosphate Dehydrogenase) deficiency is recognized as one of the risk factors. However, many pediatricians did not take into account the probable effect of G6PD-deficiency when severe neonatal hyperbilirubinemia occurred. The aim of the present study was to perform a meta-analysis to investigate whether G6PD-deficiency increases the risk of hyperbilirubinemia and phototherapy in newborn. We searched PubMed and Embase databases for eligible articles according to explicit study inclusion and exclusion criteria. Risk ratios (RRs) and 95% confidence interval (CI) were selected as the evaluation indexes. Cochrane Q and I² test were utilized to assess the heterogeneity among studies. A total of five cohort studies were included in this meta-analysis. There were 21,585 participants enrolled in these studies including 877 newborns with hyperbilirubinemia and 261 newborns receiving phototherapy. Comparison of the incidence of hyperbilirubinemia in newborns with G6PD-deficiency to the ones with normal G6PD in each study yielded a pooled RR of 3.92 (95% CI, 2.13–7.20; P <.0001). The pooled RR of receiving phototherapy in G6PD-deficiency neonates is 3.01 (95% CI, 2.20–4.12; P <.0001) when compared to G6PD normal neonates. This study revealed a significant correlation between G6PD-deficiency and neonatal hyperbilirubinemia, as well as G6PD-deficiency and phototherapy. G6PD-deficient newborns have higher risk of hyperbilirubinemia and phototherapy than the ones with normal G6PD. Monitoring the level of G6PD in newborns is important for predicting the occurrence of hyperbilirubinemia.     

Methaemoglobinaemia with G6PD deficiency: rare cause of persistently low saturations in neonates

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. CONCLUSION: 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.     

A novel G6PD mutation leading to chronic hemolytic anemia

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important cause of hemolytic anemia worldwide. Severely affected patients have chronic hemolysis with exacerbations following oxidative stress. Mutations causing severe chronic non-spherocytic hemolytic anemia (CNSHA) commonly cluster in Exon 10, a region important for protein dimerization. An African-American male presented at age 2 weeks with pallor and jaundice, and was found to have hemolytic anemia with G6PD deficiency. His severe clinical course was inconsistent with the expected G6PD A(-) variant. DNA sequencing revealed two common mutations (A(-)) and a third novel Exon 10 mutation. This inherited haplotype represents a novel triple G6PD coding mutation causing chronic hemolysis.     

G6PD deficiency in newborn infants

Five hundred consecutive newborns were screened for erythrocytic G6PD deficiency in cord blood. The overall incidence of G6PD deficiency was found to be 2.80 percent. The incidence of G6PD deficiency was higher among males (3.77%) compared to females (1.44%). The incidence of erythrocytic G6PD deficiency was higher in Muslims (16.67%) compared to Hindus (2.63%). No definite relationship of erythrocytic G6PD deficiency was observed with consanguinity. Fifty per cent mothers of G6PD deficient newborns were also found to be G6PD deficient. Among brothers and sisters of G6PD deficient children the incidence of G6PD deficiency was 50.00 and 9.10 per cent respectively. There was no significant difference in the incidence of hyperbilirubinemia between erythrocytic G6PD deficient and non deficient newborns.     

Effect of G-6 PD deficiency on sickle cell disease in Saudi Arabia

High incidence of G6PD deficiency has been reported in areas of the eastern province of Saudi Arabia where sickle cell gene is also prevalent. This study was conducted to assess the co-incidence of this enzymopathy with Hb S and its influence upon the clinical and hematological expression of sickle cell disease. Eighty three children with SS disease, 145 patients with sickle cell trait and 100 random cord blood as samples with normal Hb AF, and an FS electrophoretic pattern respectively were examined. The frequency of interaction of G6PD deficiency with Hb S was found significantly increased but no effect of this enzyme defect was discerned on the clinical and hematological status of homozygous sickle cell disease.     

ERYTHROCYTE GLUCOSE 6-PHOSPHATE DEHYDROGENASE DEFICIENCY (G6PD TYPE A-) AND NEONATAL JAUNDICE

ABSTRACT. The association of erythrocyte G6PD deficiency (type A-) and hyperbilirubinaemia in two groups of Nigerian male newborns has been examined. The results provide evidence that the enzyme deficiency is the single most important factor in the pathogenesis of severe neonatal jaundice in this West African population.     

重庆市新生儿高胆红素血症患儿G6PD基因突变类型及临床特点

目的研究重庆市新生儿黄疸儿G6PD三种常见基因突变与其临床表现特点之间的关系。初步估计其基因突变频率并探讨其临床意义和遗传学特征。方法应用突变特异性扩增系统(ARMS)法,检测54例重庆市新生儿黄疸儿的G6PD基因突变类型。结果检出G1388A突变39例(72%),G1376T突变8例(15%),未定型者7例(13%)。未检出G95A。结论本研究首次对重庆市新生儿黄疸儿进行G1388A、G1376T和A95G突变检测。提示G1388A和G1376T为重庆市新生儿黄疸儿G6PD缺乏症基因突变的主要类型。ARMS法是一种简便、快速、经济的检测G6PD已知基因突变的方法。本研究发现这两种突变类型仅见于中国人和华裔人群,具有遗传学及临床意义。     

Glucose-6-phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia

The aim of this article is to investigate the prevalence of Glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonatal hyperbilirubinemia and to compare the clinical presentation and course of G6PD-deficient and normal patients. This study included a total of 624 term neonates with indirect hyperbilirubinemia from March 2001 to September 2004. Birth weight, sex, weight at admission, serum bilirubin at admission, maximum bilirubin, phototherapy duration, duration of hospitalization and the need for exchange transfusion were recorded. Laboratory evaluations included blood group typing of mother and newborn, complete blood count, peripheral blood smear, serum total and direct bilirubin, direct coombs test, reticulocyte count, serum-free T4 and TSH, urine analysis, urinary reducing substance and erythrocyte G6PD level. The analysis of the results indicated that 24 neonates with indirect hyperbilirubinemia were G6PD-deficient. No statistically significant difference was detected between G6PD-deficient and normal groups in relation to the time of onset of jaundice, reticulocyte count, hematocrit level, phototherapy duration and duration of hospitalization. Serum bilirubin at admission, maximum serum bilirubin level and the need for exchange transfusion were higher in G6PD-deficient group. From this study our conclusion is that the G6PD deficiency is a common enzyme defect causing severe indirect hyperbilirubinemia which may result in kernicterus. Early neonatal screening programmes should be instituted in countries where the deficiency is prevalent.     

Cooperating G6PD mutations associated with severe neonatal hyperbilirubinemia and cholestasis

We report a novel glucose-6-phosphate dehydrogenase (G6PD) mutation, which we propose to name G6PD Cincinnati (c.1037A > T, p.N346I), found in combination with G6PD Gastonia (c.637G > T, p.V213L) in an infant who presented with neonatal cholestasis. The G6PD Cincinnati mutation results in a non-conservative amino acid substitution at the tetramer interface disturbing its formation, as seen by native gel electrophoresis and immunoblotting. G6PD Gastonia disrupts dimerization of the enzyme and by itself causes chronic non-spherocytic hemolytic anemia. The G6PD Cincinnati mutation may have aggravated the clinical picture of G6PD Gastonia with the result of severe perinatal hemolysis causing cholestasis and associated liver injury.     

ERYTHROCYTE GLUCOSE 6-PHOSPHATE DEHYDROGENASE DEFICIENCY (G6PD TYPE A-) AND NEONATAL JAUNDICE

Abstract. The association of erythrocyte G6PD deficiency (type A^-) and hyperbilirubinaemia in two groups of Nigerian male newborns has been examined. The results provide evidence that the enzyme deficiency is the single most important factor in the pathogenesis of severe neonatal jaundice in this West African population.     

������6��������øȱ���������ߵ�����Ѫ֢�����ʼ����ص�

目的研究葡萄糖6磷酸脱氢酶(G6PD)缺乏的新生儿高胆红素血症发生率及发病特点。方法对近5年来中山市陈星海医院产科分娩的足月健康新生儿脐带血进行G6PD定量测定,对G6PD活性缺乏的患儿,按性别和酶活性缺乏的程度分组调查其高胆红素血症的发生率及发病时间。结果(1)418例G6PD活性缺乏的患儿共发生高胆红素血症82例,占19.62%。(2)在G6PD活性缺乏的患儿中,男性酶的活性极显著低于女性(P<0.01);高胆红素血症的发生率男性极显著高于女性(P<0.01);酶活性缺乏程度不同的3组患儿高胆红素血症发生率有显著差别(P<0.05);G6PD活性缺乏的患儿发生高胆红素血症的时间主要在出生后的1周内。结论在新生儿期,G6PD活性缺乏的患儿高胆红素血症的发生率较高,发病具有男性多于女性、酶活性缺乏程度越重高胆红素血症的发生率越高的特点,患儿发生高胆红素血症的高峰时间在出生后的2～4d。     

Screening for glucose-6-phosphate dehydrogenase deficiency using a modified formazan method: A pilot study on Filipino male newborns

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency has increased prevalence rates in tropical Africa, tropical and subtropical Asia and some parts of the Mediterranean. Earlier studies on G6PD deficiency in the Philippines have shown prevalence rates of 4.5% to 25.7%. METHODS: In the present study, 3278 male newborns were screened for G6PD deficiency using the modified formazan method, a simple screening procedure affordable in the setting of a developing country. Subjects with positive screening results were recalled for confirmatory testing using a commercial assay kit for quantitative enzyme determination. RESULTS: Of the 3278 boys studied, 186 revealed positive screening results. Of the 186, 65 boys had confirmatory testing. Of these 65 boys, 45 were confirmed to have G6PD deficiency and 20 had normal results. This study reveals an incidence of G6PD deficiency of 3.9% among male Filipinos. CONCLUSIONS: This study recommends the inclusion of G6PD deficiency in the panel of disorders for newborn screening among Filipino newborns.     

PCR-Based Allelic Discrimination for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in Ugandan Umbilical Cord Blood

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked disorder in the world. G6PD deficiency puts children at risk for hyperbilirubinemia and kernicterus during the newborn period and an increased risk of severe hemolysis after exposure to many antimalarial medications. A laboratory diagnosis of G6PD deficiency is rare in the developing world due to limited resources. We developed a TaqMan-based allele-specific assay to rapidly determine rates of G6PD deficiency contributing alleles (G202A and A376G) in East Africa. We tested umbilical cord blood from 100 Ugandan newborns and found that the overall allele frequency of G202A was .13 and A376G was .32. The overall incidence of G6PD A? (G202A/A376G) was 6%; all A? variants were males. There was no correlation between G6PD deficiency and umbilical cord blood hemoglobin, white blood count, platelet count, or other hematologic parameters. Allele-specific PCR can serve as a rapid method to determine specific G6PD deficiency allele frequencies in a given population and as a diagnostic tool in a hospital setting in which laboratory resources are present.     

A prolonged neonatal jaundice associated with a rare G6PD mutation

Glucose‐6‐phosphate dehydrogenase (G6PD), a X‐linked hereditary deficiency, is one of most common clinically significant enzyme defects. Despite its largely known role in acute and life‐threatening haemolytic crises, G6PD deficiency may be also associated with neonatal jaundice that, when severe and untreated, may lead to the potential of bilirubin encephalopathy. A prolonged neonatal jaundice was found to be associated with a rare G6PD mutation (c.383T>G; p.L128R), the latter simply annotated in literature database. In this article, we clinically and phenotipically describe a case of an Italian neonate carrying the c.383T>G G6PD mutation. Finally, we named this variant “G6PD Salerno.” Pediatr Blood Cancer 2009;53:475–478. © 2009 Wiley‐Liss, Inc.     

男性新生儿红细胞葡萄糖-6-磷酸脱氢酶活性中度缺乏的探讨

目的探讨男性新生儿红细胞葡萄糖6磷酸脱氢酶(G6PD)活性中度缺乏的原因。方法根据遗传规律,把G6PD活性分为正常、中度缺乏和显著缺乏,并对我院2000年至2005年10月出生的10733名新生儿的资料与各地检测G6PD活性报道的资料进行比较、分析和研究。结果男性新生儿G6PD活性中度缺乏发生率约为1.5%～2.5%(约占男性新生儿G6PD活性总缺乏率的15%～25%)。结论本研究发现男性新生儿G6PD活性中度缺乏是客观存在的并和孟德尔遗传定律矛盾,它与G6PD变异型的酶活性表现、统计学方法、糖尿病和溶血等多种因素等有关。     

男性新生儿红细胞葡萄糖-6-磷酸脱氢酶活性中度缺乏的探讨

目的探讨男性新生儿红细胞葡萄糖-6-磷酸脱氢酶（G6PD）活性中度缺乏的原因。方法根据遗传规律，把G6PD活性分为正常、中度缺乏和显著缺乏，并对我院2000年至2005年10月出生的10733名新生儿的资料与各地检测G6PD活性报道的资料进行比较、分析和研究。结果男性新生儿G6PD活性中度缺乏发生率约为1．5％～2．5％（约占男性新生儿G6PD活性总缺乏率的15％～25％）。结论本研究发现男性新生儿G6PD活性中度缺乏是客观存在的并和孟德尔遗传定律矛盾，它与G6PD变异型的酶活性表现、统计学方法、糖尿病和溶血等多种因素等有关。     

儿童G6PD缺乏症355例临床分析

目的探讨儿童G6PD缺乏症的发病因素、临床特点、诊断及治疗措施,为指导临床治疗提供依据。方法回顾性总结355例儿童G6PD缺乏症的临床资料,对其诱因、发病机制、临床表现、实验室检查、治疗及预后进行分析。结果 G6PD缺乏症发病高峰年龄为1~3岁,男:女=17.7:1,春季多发;蚕豆、药物、感染等因素均为发病诱因,其中蚕豆所致的发病率最高,占78.3%;贫血、黄疸、尿色改变、肝肿大为主要临床表现;多伴有血常规、尿常规、胆红素、CK-MB、G6PD酶活性、高铁血红蛋白还原试验、血清结合珠蛋白等结果的异常;本病有3种最常见致病性基因突变,基因型及携带者比例分别为G1388A 38.6%、G1376T 31.2%、A95G 10.8%;全部患儿经去除诱因、输血、碱化尿液等对症支持治疗后可治愈出院,该病预后可,具一定的自限性。结论蚕豆病是G6PD缺乏症最常见的临床表现形式;G1388A、C1376T、A95G是我国G6PD缺乏症最常见的三种致病性基因突变类型,各致病性基因突变之间没有明显的临床表现及实验室检查差异。     

广西地区地中海贫血合并G6PD缺乏症患儿G6PD基因突变型的初步研究

目的 了解广西地区地中海贫血合并葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症患儿G6PD基因突变的类型。方法 采用自然或错配引物介导的聚合酶链反应（PCR）／限制性内切酶分析,检测11例地中海贫血合并G6PD缺乏症患儿G1388A、G1376T和A95G三种G6PD基因突变类型。结果 11例地中海贫血合并G6PD缺乏症患儿中,检出G1388A突变4例,G1376T突变3例,A95G突变1例,未定型3例。结论 广西地区地中海贫血合并G6PD缺乏症与单纯的G6PD缺乏症的基因突变型比较差异不明显,推测地中海贫血患儿的G6PD缺陷可能是原发性改变。婚前检查及产前诊断对减少地中海贫血合并G6PD缺乏症患儿的出生具有十分重要的意义。     

G-6-PD缺乏症和新生儿高胆红素血症

葡萄糖-6-磷酸脱氢酶缺乏症是一种常见的单基因遗传性疾病,在全球范围内分布非常广泛,而且人群中携带者频率很高。患者突然出现的急性溶血会导致血清总胆红素升高,引起高胆红素血症,甚至胆红素脑病。新生儿高胆红素血症是儿科医生经常遇到的问题,需要及时发现和处理。     

Glucose-6-phosphate dehydrogenase deficiency in neonates

Objective: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal hyperbilirubinemia, as has been found in several countries and among widely different ethnic groups, especially in Mediterranean region. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice.Methods : From March 1998 to April 2001 we studied 705 clinically icteric neonates who were admitted to Al-Zahra and Beheshti hospitals, two teaching hospitals in Isfahan, Iran. Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct coomb’s test, hemoglobin, blood smear, reticulocyte count and G6PD level.Results: In only 53(7.5%) of cases G6PD deficiency was diagnosed. In all G6PD deficient neonates no evidence of other factors known to cause hyperbilirubinemia were detected. The sex distribution was 13(24.5%)females and 40(75.5%)males in the G6PD deficient group. The mean bilirubin level in G6PD deficient and G6PD normal groups were 22.26 +/-8.36 and 18.14 +/-3.85 mg/dl, respectively (p=0.001). Phototherapy was required in G6PD deficient and other icteric neonates with duration of 3.76 +/-1.93 and 3.13 +/-2.14 days, respectively (p=0.045). Twenty-seven of the 53(50.9%) G6PD deficient infants required exchange transfusion. None of them developed kernicterus.Conclusions: Since the prevalence of severe hyperbilirubinemia among our neonates was relatively high and about half of them required exchange transfusion, early detection of this enzymopathy regardless of sex and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia and exchange transfusion.