Glucose-6-phosphate dehydrogenase deficiency and carboxyhemoglobin concentrations associated with bilirubin-related morbidity and death in Nigerian infants,☆☆,,★★

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Abstract

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 μmol/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 μL/L). The COHb levels > 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. (J PEDIATR 1995;126:102-8)

Section snippets

Patients

The study protocol was approved by the institutional review board at the University of Texas Southwestern Medical Center at Dallas, as well as by the hospital administrator at Eku Baptist Hospital, Eku, Nigeria, and included informed consent from the parents or guardians of the infants who served as subjects of this investigation. Fifty-five clinically jaundiced infants, ≤10 days of age, admitted to Eku Baptist Hospital were enrolled from June to October 1991 and during June and July of 1992,

RESULTS

Infants ranged in age from 1 to 10 days, with a mean of 3.9 ± 1.6 days, (n = 55). Average weight was 2.7 ± 0.8 kg, with a range of 1.1 to 4.2 (n = 54; one not recorded). Twenty-one infants (39%) were > 2.5 kg. There were 39 boys and 15 girls (one not recorded); all infants were black. Twenty-two infants were born in the hospital at Eku and admitted directly from the obstetrics department. Twenty were born in outlying hospitals or clinics and subsequently came to Eku without a documented stay at

DISCUSSION

The COHb level is an accepted index of total bilirubin production in neonatal subjects under various clinical conditions.16, 17 Although COHb concentrations in this study correlated with bilirubin levels, half of the variability cannot be explained by this relationship, most likely because of individual differences in bilirubin elimination from the body during the first several days of life. Except when bilirubin production is extremely high and associated consequently with extremely high

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    From the Departments of Pediatrics, University of Texas Southwestern Medial Center at Dallas, Stanford University School of Medicine, Stanford, California, State University of New York Health Science Center at Brooklyn, Eku Baptist Hospital, Eku, Nigeria, and Children's Medical Center of Dallas, Dallas, Texas.

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    Supported in part by National Institute of Child Health and Development grants HD14426 and RR00070, by the Mary L. Johnson Research Fund, and by designated gifts from individuals of Pike County Methodist and Baptist churches.

    Reprint requests: David K. Stevenson, MD, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305-5119.

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    0022-3476/95/$3.00 + 0 9/23/59586

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