The case for routine neonatal glucose-6-phosphate dehydrogenase (G6PD) screening in Indonesia

Glucose-6-phosphate dehydrogenase (G6PD) is the key housekeeping enzyme necessary to generate reduced NADPH for its downstream antioxidant activity; its deficiency is the world's most common enzymopathy. Clinical symptoms of G6PD deficiency are acute hemolytic anemia and neonatal hyperbilirubinemia. Untreated hyperbilirubinemia can progress to bilirubin neurotoxicity. Data on the prevalence of G6PD deficiency and neonatal hyperbilirubinemia is scarce in Indonesia and there is a need for a nationwide association study of neonatal hyperbilirubinemia and G6PD deficiency. Indonesia started its national newborn screening implementation program in 2025. Only 46.8% of specimens received by the referral laboratories were tested, resulting in a G6PD prevalence of 0.25% in newborns. The data highlighted substantial challenges related to specimen quality, referral pathways and geographic coverage. This may underestimate the true national burden because Indonesia has a remarkably diverse ethnic group, and G6PD prevalence is very heterogeneous, where the prevalent regions coincide with malaria endemicity. These remote regions face challenges in accessing referral laboratories due to vast geographic distances. Further studies are needed to ensure that integration of G6PD screening to the NBS program is necessary, especially in G6PD prevalent regions in Indonesia.