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

Tina M. Slusher, Hendrik J. Vreman, Donald W. McLaren, Laura J. Lewison, Audrey K. Brown, David K. Stevenson

Research output: Contribution to journalArticle

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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).

Original languageEnglish (US)
Pages (from-to)102-108
Number of pages7
JournalThe Journal of Pediatrics
Volume126
Issue number1
DOIs
StatePublished - Jan 1 1995

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Carboxyhemoglobin
Glucosephosphate Dehydrogenase Deficiency
Bilirubin
Morbidity
Jaundice
Kernicterus
Rural Hospitals
Mortality
Glucosephosphate Dehydrogenase
Carbon Monoxide
Nigeria
Serum
Incidence

Cite this

Glucose-6-phosphate dehydrogenase deficiency and carboxyhemoglobin concentrations associated with bilirubin-related morbidity and death in Nigerian infants. / Slusher, Tina M.; Vreman, Hendrik J.; McLaren, Donald W.; Lewison, Laura J.; Brown, Audrey K.; Stevenson, David K.

In: The Journal of Pediatrics, Vol. 126, No. 1, 01.01.1995, p. 102-108.

Research output: Contribution to journalArticle

Slusher, Tina M. ; Vreman, Hendrik J. ; McLaren, Donald W. ; Lewison, Laura J. ; Brown, Audrey K. ; Stevenson, David K. / Glucose-6-phosphate dehydrogenase deficiency and carboxyhemoglobin concentrations associated with bilirubin-related morbidity and death in Nigerian infants. In: The Journal of Pediatrics. 1995 ; Vol. 126, No. 1. pp. 102-108.
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AB - 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).

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