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Risk Factors Predicting the Need for Phototherapy in Glucose 6 Phosphate Dehydrogenase-Deficient Infants in a Large
Krishna Revanna Gopagondanahalli1,2,3, Rashmi Arun Mittal1, Abdul Alim Abdul Haium2,3,4,5
1Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
Insights
Glucose 6-phosphate dehydrogenase (G6PD) deficiency in newborns increases jaundice risk. High day-four bilirubin levels and ABO incompatibility predict the need for phototherapy, guiding closer infant monitoring.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Genetics
Background:
- Glucose 6-phosphate dehydrogenase (G6PD) deficiency is a common genetic disorder.
- It significantly elevates the risk of severe neonatal hyperbilirubinemia (jaundice).
- Early identification of at-risk infants is crucial for timely intervention.
Purpose of the Study:
- To identify risk factors for phototherapy need in G6PD-deficient neonates.
- To assess predictors of severe jaundice beyond 72 hours of life.
- To evaluate the safety of early discharge protocols for these infants.
Main Methods:
- Retrospective cohort study of 681 full-term G6PD-deficient infants.
- Comparison of infants requiring phototherapy versus those not requiring it.
- Analysis of baseline characteristics, day 4 bilirubin levels, G6PD levels, and ABO incompatibility.
Main Results:
- 58% of G6PD-deficient infants required phototherapy.
- Lower gestational age, lower G6PD levels, and higher day 4 total serum bilirubin (TSB) were associated with phototherapy need.
- Day 4 TSB >180 µmol/L and ABO incompatibility were significant predictors of phototherapy.
Conclusions:
- G6PD-deficient infants with day 4 TSB >180 µmol/L and ABO incompatibility require close monitoring.
- These factors indicate a higher risk for needing phototherapy.
- Findings support targeted monitoring strategies for G6PD-deficient newborns.
Introduction:
Glucose 6-phosphate dehydrogenase (G6PD) deficiency increases the risk of severe neonatal hyperbilirubinemia. This study evaluates the risk factors predicting the need for phototherapy in G6PD-deficient neonates after 72 h of age and assesses the safety of early discharge.
Methods:
A retrospective cohort study of 681 full-term G6PD-deficient infants with a birth weight ≥2,500 g over 4 years was conducted. We compared the baseline characteristics, bilirubin level on day 4 (after 72 h of life), day of peak bilirubin, G6PD levels, and concomitant ABO incompatibility between the group that required phototherapy (Group A) and those who did not (Group B).
Results:
396 infants (58%), predominantly males, required phototherapy in the first week of life. The infants who required phototherapy had a lower median gestational age (38.3 vs. 38.7 weeks, p < 0.01) and had lower G6PD levels (2.3 ± 2.5 vs. 3 ± 3.4 IU, p < 0.05) compared to the controls. The mean day-four total serum bilirubin (TSB) levels were higher (213 ± 32 vs. 151 ± 37 µmol/L, p < 0.01), with bilirubin level peaking earlier (3 vs. 4 days of life, p < 0.01) in group A. Regression analysis identified TSB levels on day 4, Chinese race, lower gestation, and concomitant ABO incompatibility as the significant predictors for the need for phototherapy in the study population. In particular, coexisting ABO blood group incompatibility increased the risk of jaundice requiring phototherapy (OR 4.27, 95% CI: 1.98-121, p < 0.01). Day four TSB values above 180 µmol/L predicted the need for phototherapy with 86% sensitivity and 80% specificity. The findings were similar across both male and female infants with G6PD deficiency.
Conclusion:
G6PD-deficient infants with day four TSB levels of >180 µmol/L (10.5 mg/dL) and associated ABO blood group incompatibility have a higher risk of requiring phototherapy in the first week of life and should be closely monitored.
