The role of hemolysis in inducing jaundice in the newborns with G6PD deficiency

Background: Jaundice is a common disorder in neonates and G6PD deficiency is one of its known etiologic factors that could result in kernicterus. This study was done to determine (1) incidence of this enzyme deficiency in icteric newborns and (2) the role of hemolysis in inducing jaundice in G6PD deficient neonates.
Methods: This is a 3-year cross-sectional study performed on 505 icteric newborn infants admitted to 22e Bahman hospital in Mashad. G6PD activity was measured qualitatively in the patients. The case group consisted of 34 newborns with G6PD deficiency and the control group included also 34 neonates without this enzyme-defect. In addition to routine laboratory tests, hemolysis indicators were also evaluated in both groups and data were analyzed statistically with SPSS.
Findings: The incidence of G6PD deficiency was 6.7% (85% male and 15% female). Mean level of total bilirubin was significantly higher in case group (22.73mg/dl vs 19.25mg/dl in control group with pv<0.05). In each group hemolysis was proved to exist in only 2 neonates and Coombs test was negative in all of the patients. There were no significant differences in the mean level of hematocrit and reticulocyte counts between the two groups (pv<0.05).
Conclusions: With respect to the high incidence of G6PD deficiency in this study (6.7%) and significant incidence in females, measurement of G6PD activity should be recommended in all newborns with jaundice regardless of sex. Hemolysis plays a minor role in inducing jaundice in these newborns and most of them have nonhemolytic jaundice, so that exchange transfusion should be done according to the same indications of other nonhemolytic icterus cases. Because of higher level of serum bilirubin in G6PD deficient neonates, phototherapy must be started early and with lower levels of serum bilirubin.

Keywords
Jaundice , Newborns , G6PD deficiency , Hemolysis , Exchange transfusion