Kilicdag Hasan, Gökmen Zeynel, Ozkiraz Servet, Gulcan Hande, Tarcan Aylin
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Baskent University, Ankara, Turkey.
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Baskent University, Ankara, Turkey.
Pediatr Neonatol. 2014 Jun;55(3):202-7. doi: 10.1016/j.pedneo.2013.10.006. Epub 2013 Dec 8.
The aim of this study was to investigate glucose 6-phosphate dehydrogenase (G6PD) activity in term and late preterm babies with severe neonatal hyperbilirubinemia and its relationship to the severity and treatment of this disorder, regardless of level of G6PD activity (deficient/normal).
A total of 529 term and late preterm (≥35 weeks) infants (228 female, 301 male) who were diagnosed with severe hyperbilirubinemia were included in this study. In each case, serum was collected to evaluate blood group, direct Coombs' test, complete blood cell count, total and direct bilirubin, thyroid-stimulating hormone, and G6PD activity. A partial correlation analysis was carried out to assess the relationship between G6PD activity and total bilirubin levels.
A significant correlation was found between the severity of hyperbilirubinemia and G6PD activity in both males and females. Male neonates who had G6PD levels <12 U/g Hb required more phototherapy time than neonates who had G6PD levels ≥12 U/g Hb; and female neonates who had G6PD levels <16 U/g Hb required more phototherapy time than neonates who had G6PD levels ≥16 U/g Hb (p < 0.0001). When we analyzed only breastfed infants, a significant difference also emerged in both sexes. Decreased G6PD activity was associated with increased phototherapy time and the need for exchange transfusion.
Routine checks of G6PD level in hyperbilirubinemic neonates are very important in providing proper medical management to prevent bilirubin-induced neurological dysfunction. Appropriate identification of G6PD (<12 U/g Hb for male infants and <16 U/g Hb for female infants) raises awareness of the severity of the condition and the necessity for immediate care of severe hyperbilirubinemic infants.
本研究旨在调查足月和晚期早产儿患严重新生儿高胆红素血症时的葡萄糖-6-磷酸脱氢酶（G6PD）活性，以及其与该病症严重程度和治疗的关系，而不考虑G6PD活性水平（缺乏/正常）。
本研究纳入了529例足月和晚期早产儿（≥35周）（228例女性，301例男性），这些婴儿被诊断为严重高胆红素血症。对每个病例采集血清，以评估血型、直接抗人球蛋白试验、全血细胞计数、总胆红素和直接胆红素、促甲状腺激素以及G6PD活性。进行偏相关分析以评估G6PD活性与总胆红素水平之间的关系。
在男性和女性中，均发现高胆红素血症的严重程度与G6PD活性之间存在显著相关性。G6PD水平<12 U/g Hb的男性新生儿比G6PD水平≥12 U/g Hb的新生儿需要更多的光疗时间；G6PD水平<16 U/g Hb的女性新生儿比G6PD水平≥16 U/g Hb的新生儿需要更多的光疗时间（p<0.0001）。当仅分析母乳喂养的婴儿时，两性中也出现了显著差异。G6PD活性降低与光疗时间增加和换血需求相关。
对高胆红素血症新生儿进行G6PD水平的常规检查对于提供适当的医疗管理以预防胆红素诱导的神经功能障碍非常重要。正确识别G6PD（男性婴儿<12 U/g Hb，女性婴儿<16 U/g Hb）可提高对病情严重程度的认识以及对严重高胆红素血症婴儿立即进行护理的必要性。
