Effect of hemolysis and hyperbilirubinemia in glucose-6-phosphate dehydrogenase-deficient neonates

Objective: Recently, the role of hemolysis in the pathophysiology of hyperbilirubinemia in glucose-6phosphate dehydrogenase  (G6PD)  deficient  neonates  has  been  questioned  and  decreased  bilirubin conjugation has been suggested. We conducted a study to evaluate the effect of hemolysis on these neonates at the 17-Shahrivar Children Hospital in Rasht.  Methods: In  this  cross-sectional  study, from March  2007  to  September  2008,  483  healthy  term neonates with  icter who were admitted to our hospital were assessed. Sex, gestational age, mode of delivery, kind of milk (breast milk or formula), blood group and RH of mother and newborn, Coombs test (both direct and indirect), hemoglobin level at admission, reticulocyte count, total and direct bilirubin at admission, peripheral blood smear, G6PD activity and duration of admission, were evaluated. They were divided into two groups :G6PD deficient group and G6PD with normal activity group. The afore-mentioned variants were compared between the two groups. The results were analyzed by chi-square, t-test and Pearson’s correlation test, via  SPSS version 15 software.  Results: G6PD  deficiency  was  significantly  more  common  in  male  neonates  than  females(p< 0.001). Hemoglobin level at admission was significantly lower in G6PD deficient group (p< 0.001). Mean serum bilirubin at admission in G6PD deficient neonates was higher than normal neonats ( 18.48  3.65 versus 17.93  2.58 mg/dl) but this difference is not significant  (p= 0.289) Also  there  was  strong  positive  correlation  between  direct  and  total  bilirubin  in  both  groups. Severe anemia was not reported in either group. Conclusion: Hemolysis is the main mechanism of hyperbilirubinemia in G6PD deficient neonates and there were no findings of diminished bilirubin conjugation in our study.