Treatment Outcome of Hyperbilirubinaemia Among Icteric Neonates in Jos: The Impact of Glucose-6-Phosphate Dehydrogenase Status

Abstract

Background: Hyperbilirubinaemia is a common clinical manifestation of several neonatal disorders, one of which is Glucose-6-Phospate Dehydrogenase(G6PD) deficiency.

Objective: To determine the treatment outcome of hyperbilirubinaemia in relation to the G6PD status of icteric neonates in our environment.

Methodology: This was a cross sectional study of 150 icteric neonates enrolled consecutively as they were admitted into the Special Care Baby Units (SCBUs) of the Jos University Teaching Hospital, Bingham University Teaching Hospital, and the Plateau State Specialist Hospital. The neonates were reviewed clinically for fever, jaundice, cyanosis among other features. Blood sample was collected for Full Blood Count (FBC), Reticulocyte Count, Serum Bilirubin (SB) and G6PD assay using the Pointe Quantitative Diagnostic Kit (USA). G6PD deficiency was defined by enzyme activity < 6.0 IU/gHb.

Results: Subjects comprise of 92 (61.3%) males and 58 (38.7%) females (M: F= 1.6:1) with median age at presentation of 3 (Interquartile range-IQR: 1-4) days. One hundred and five (70%) were delivered at full-term gestation (≥37weeks) while 45 (30%) were delivered preterm(37weeks). Twenty-nine (19.3%) had history of jaundice in siblings. Fifty (35.7%) had birth weight < 2500g while 90 (64.3%) have normal birth weight. Their mean haemoglobin concentration was 15.90 ± 2.23 g/dl while median reticulocyte count was 2.5 (IQR: 2-3) %. Sixty-one (40.7 %) of the studied neonates were G6PD deficient with mean G6PD activity of 3.99(IQR: 2.72-4.94) IU/gHb and median concentration of total serum bilirubin of 205(IQR: 170.0-281.6) μmol/L. Mode of treatment of hyperbilirubinaemia in 88 (58.7%) of the studied subjects was by phototherapy, with 36 (59.0%) of them G6PD deficient. Sixty-two (41.3%) were treated with phototherapy and exchange blood transfusion. One hundred and twenty-two (81.3%) of all the subjects were discharged home fully recovered, 2 (1.3%) had acute bilirubin encephalopathy while mortality was recorded in 14 (9.3%).

Conclusion: Significant populations of icteric neonates in our environment are G6PD deficient and they turn out with a relatively good treatment outcome irrespective of their G6PD status.

Key words: Exchange blood transfusion, DAMA, Jaundice, Phototherapy