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Milburn S, Bhutani VK, Weintraub A, Guttman K. Implementation of Universal Screening for G6PD Deficiency in Newborns. Pediatrics 2024:e2024065900. [PMID: 38988309 DOI: 10.1542/peds.2024-065900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/12/2024] Open
Abstract
We describe the implementation of universal glucose-6-phosphate dehydrogenase (G6PD) screening during the first year of New York State mandated testing, as well as operational challenges and clinical knowledge gained. All infants born at or transferred to our center between June 21, 2022 and June 30, 2023, underwent testing for G6PD enzyme deficiency and were included in the study cohort. Infant blood samples were collected and sent to a reference laboratory for quantitative assay. After initiation of universal screening, a quality improvement initiative was launched to:monitor and improve the suitability of blood sample collection to ensure timely return of results;improve the reliability and validity of the reference laboratory enzyme assay; andestablish accurate reference ranges for G6PD deficiency in newborns.A total of 5601 newborns were included. Within the first year of implementation, the percentage of samples yielding any test result increased from 76% to 85%, and most patients had a G6PD result available within 1 day of discharge. We established a more accurate threshold for G6PD deficiency in newborns of <4.9 U/g Hb and G6PD intermediate of <10.0 U/g Hb. Using the updated reference ranges, 224 patients in our cohort were identified as G6PD deficient or intermediate (4.0%). Through a quality-sensitive process, we identified the importance of a standardized approach, improved sample collection processes, decreased sample turnaround time, and established more accurate reference ranges. We hope our experiences will help others seeking to improve processes and implement similar programs at other institutions.
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Affiliation(s)
- Sarah Milburn
- Division of Newborn Medicine, Departments of Pediatrics
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Medicine, and Lucile Packard Children's Hospital, Stanford, California
| | | | - Katherine Guttman
- Division of Newborn Medicine, Departments of Pediatrics
- Brookdale Department of Geriatrics and Palliative Medicine, the Icahn School of Medicine, New York, New York; and
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2
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Vidavalur R, Bhutani VK. Georacial Epidemiological Estimates of Glucose-6-Phosphate Dehydrogenase Deficiency among Newborns in the United States. Am J Perinatol 2024; 41:e1841-e1849. [PMID: 37105226 DOI: 10.1055/a-2082-4859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is the most common inherited enzyme deficiency disorder worldwide and a major risk factor for the development of severe hyperbilirubinemia. Racial diversity of phenotypes and genotypes in affected individuals is likely to exist in the United States because of changing population demographics. The aim of the present study was to predict an empirical estimate of annual prevalence of G6PDd in newborns adjusted for geography (state of birth), maternal racial identity, and sex of the infant. STUDY DESIGN Birth statistics (2019) from National Center for Vital Statistics and CDC-WONDER data and race-specific prevalence of G6PDd in the United States were evaluated from published sources. We developed Simpson's diversity index (DI) for each State and correlated these to rates of G6PDd in neonates. Descriptive statistics including modeled prevalence and its association with DI were assessed using the Spearman's rho correlation test. We modeled state-specific prevalence for six states (California, Washington DC, Illinois, Massachusetts, New York, and Pennsylvania) using population-level allele frequencies and race, based on Hardy-Weinberg equilibrium. RESULTS We estimated 78,010 (95% confidence interval: 76,768-79,252) newborns had G6PDd at birth in 2019 with cumulative median prevalence of 17.3 (interquartile range: 12.4-23.2) per 1,000 live births for United States. A strong association was noted for DI and prevalence of G6PDd (p < 0.0005). Five states (Washington DC, Mississippi, Louisiana, Georgia, and Maryland) have the highest projected G6PDd prevalence, with a range of 35 to 48 per 1,000 live births. The probability of G6PDd for female heterozygotes, based on male prevalence, ranged from 1.1 to 7.5% for each cohort in the select six states. CONCLUSION States with diverse populations are likely to have higher rates of G6PDd. These prevalence estimates exceeded by several-fold when compared with disorders screened by existing state mandated newborn screening panels. These discrepancies are further confounded by known risk of severe neonatal hyperbilirubinemia that results with G6PDd and the life-long risk of hemolysis. Combined universal newborn predischarge screening for G6PDd and bilirubin could alert and guide a clinician's practices for parental education and closer medical surveillance during the vulnerable neonatal time period. KEY POINTS · G6PDd is a common X-linked disorder that can present with varied phenotypes among newborns.. · Prevalence of G6PDd and genotype distribution varies with sex, race, and ethnicity.. · We present regional race- and sex-based estimates of G6PDd in the United States..
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Affiliation(s)
- Ramesh Vidavalur
- Department of Neonatology, Cayuga Medical Center/Weill Cornell Medicine, Ithaca, New York
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford Children's Health, Stanford University School of Medicine, Stanford, California
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3
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Kaplan M, Hammerman C, Shapiro SM. Grand Rounds Hyperbilirubinemia following Phototherapy in Glucose-6-Phosphate Dehydrogenase-Deficient Neonates: Not Out of the Woods. J Pediatr 2023; 261:113452. [PMID: 37169338 DOI: 10.1016/j.jpeds.2023.113452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/22/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Michael Kaplan
- Department of Neonatology, Shaare Zedek Medical Center (M.K. Emeritus), Jerusalem, Israel; Faculty of Medicine of the Hebrew University, Jerusalem, Israel.
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center (M.K. Emeritus), Jerusalem, Israel; Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Steven M Shapiro
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
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Walz L, Brooks JC, Newman T. Evidence Suggests a Decrease in the Incidence of Kernicterus in California. J Pediatr 2022; 255:220-223.e1. [PMID: 36563899 DOI: 10.1016/j.jpeds.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 12/25/2022]
Abstract
We identified children diagnosed with kernicterus in the California Department of Developmental Services and estimated an incidence of 0.42 per 100 000 births from 1988 to 2014, significantly decreasing to 0.04 per 100 000 births after 2009. We also examined national infant kernicterus mortality from 1979 to 2016 using CDC data. It did not decrease significantly.
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Affiliation(s)
- Lucas Walz
- Life Expectancy Project, San Francisco, CA
| | | | - Thomas Newman
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA; Department of Pediatrics, University of California-San Francisco, San Francisco, CA
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Bancone G, Gilder ME, Win E, Gornsawun G, Penpitchaporn P, Moo PK, Archasuksan L, Wai NS, Win S, Aung KK, Hashmi A, Hanboonkunupakarn B, Nosten F, Carrara VI, McGready R. Technical evaluation and usability of a quantitative G6PD POC test in cord blood: a mixed-methods study in a low-resource setting. BMJ Open 2022; 12:e066529. [PMID: 36523222 PMCID: PMC9748916 DOI: 10.1136/bmjopen-2022-066529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES New point-of-care (POC) quantitative G6PD testing devices developed to provide safe radical cure for Plasmodium vivax malaria may be used to diagnose G6PD deficiency in newborns at risk of severe neonatal hyperbilirubinaemia, improving clinical care, and preventing related morbidity and mortality. METHODS We conducted a mixed-methods study analysing technical performance and usability of the 'STANDARD G6PD' Biosensor when used by trained midwives on cord blood samples at two rural clinics on the Thailand-Myanmar border. RESULTS In 307 cord blood samples, the Biosensor had a sensitivity of 1.000 (95% CI: 0.859 to 1.000) and a specificity of 0.993 (95% CI: 0.971 to 0.999) as compared with gold-standard spectrophotometry to diagnose G6PD-deficient newborns using a receiver operating characteristic (ROC) analysis-derived threshold of ≤4.8 IU/gHb. The Biosensor had a sensitivity of 0.727 (95% CI: 0.498 to 0.893) and specificity of 0.933 (95% CI: 0.876 to 0.969) for 30%-70% activity range in girls using ROC analysis-derived range of 4.9-9.9 IU/gHb. These thresholds allowed identification of all G6PD-deficient neonates and 80% of female neonates with intermediate phenotypes.Need of phototherapy treatment for neonatal hyperbilirubinaemia was higher in neonates with deficient and intermediate phenotypes as diagnosed by either reference spectrophotometry or Biosensor.Focus group discussions found high levels of learnability, willingness, satisfaction and suitability for the Biosensor in this setting. The staff valued the capacity of the Biosensor to identify newborns with G6PD deficiency early ('We can know that early, we can counsel the parents about the chances of their children getting jaundice') and at the POC, including in more rural settings ('Because we can know the right result of the G6PD deficiency in a short time, especially for the clinic which does not have a lab'). CONCLUSIONS The Biosensor is a suitable tool in this resource-constrained setting to identify newborns with abnormal G6PD phenotypes at increased risk of neonatal hyperbilirubinaemia.
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Affiliation(s)
- Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mary Ellen Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Elsie Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Penporn Penpitchaporn
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Phaw Khu Moo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Laypaw Archasuksan
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Sylverine Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, Texas, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth), Houston, Texas, USA
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Verena Ilona Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Alcántara-Ortigoza MA, Hernández-Ochoa B, González-Del Angel A, Ibarra-González I, Belmont-Martínez L, Gómez-Manzo S, Vela-Amieva M. Functional characterization of the p.(Gln195His) or Tainan and novel p.(Ser184Cys) or Toluca glucose-6-phosphate dehydrogenase (G6PD) gene natural variants identified through Mexican newborn screening for glucose-6-phosphate dehydrogenase deficiency. Clin Biochem 2022; 109-110:64-73. [PMID: 36089067 DOI: 10.1016/j.clinbiochem.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Newborn screening for glucose-6-phosphate dehydrogenase deficiency (G6PDd) was implemented in Mexico beginning in 2017. In a Mexican population, genotyping analysis of G6PD as a second-tier method identified a previously unreported missense variant, p.(Ser184Cys), which we propose to call "Toluca", and the extremely rare p.(Gln195His) or "Tainan" variant, which was previously described in the Taiwanese population as a Class II allele through in silico evaluations. Here, we sought to perform in vitro biochemical characterizations of the Toluca and Tainan G6PD natural variants and describe their associated phenotypes. METHODS The "Toluca" and "Tainan" variants were identified in three unrelated G6PDd newborn males, two of whom lacked evidence of acute hemolytic anemia (AHA) or neonatal hyperbilirubinemia (NHB). We constructed wild-type (WT), Tainan, and Toluca G6PD recombinant enzymes and performed in vitro assessments. RESULTS Both variants had diminished G6PD expression, decreased affinities for glucose-6-phosphate and NADP+ substrates, significant decreases in catalytic efficiency (∼97 % with respect to WT-G6PD), and diminished thermostabilities that were partially rescued by NADP+. In silico protein modeling predicted that the variants would have destabilizing effects on the protein tertiary structure, potentially reducing the enzyme half-lives and/or catalytic efficiencies. CONCLUSION Our data suggest that G6PD "Tainan" and "Toluca" are potential Class II natural variants, which agrees with the absence of chronic nonspherocytic hemolytic anemia (CNSHA) in our patients. It remains to be determined whether these variants represent high-risk genetic factors for developing CNSHA, AHA, and/or NHB.
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Affiliation(s)
- Miguel A Alcántara-Ortigoza
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, CP 04530, Ciudad de México, Mexico.
| | - Beatriz Hernández-Ochoa
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, CP 06720, Ciudad de México, Mexico
| | - Ariadna González-Del Angel
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, CP 04530, Ciudad de México, Mexico
| | - Isabel Ibarra-González
- Unidad de Genética de la Nutrición, Instituto de Investigaciones Biomédicas, UNAM/Instituto Nacional de Pediatría, CP 04530, Ciudad de México, Mexico
| | - Leticia Belmont-Martínez
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, CP 04530, Ciudad de México, Mexico
| | - Saúl Gómez-Manzo
- Laboratorio de Bioquímica Genética, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, CP 04530, Ciudad de México, Mexico.
| | - Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, CP 04530, Ciudad de México, Mexico.
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7
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Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, Grout RW, Bundy DG, Stark AR, Bogen DL, Holmes AV, Feldman-Winter LB, Bhutani VK, Brown SR, Maradiaga Panayotti GM, Okechukwu K, Rappo PD, Russell TL. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:188726. [PMID: 35927462 DOI: 10.1542/peds.2022-058859] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas B Newman
- Departments of Epidemiology & Biostatistics and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jon F Watchko
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Randall W Grout
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, Pennsylvania
| | - Alison Volpe Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Lori B Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vinod K Bhutani
- Department of Pediatrics, Neonatal and Developmental Medicine Stanford University School of Medicine, Stanford, California
| | | | - Gabriela M Maradiaga Panayotti
- Division of Primary Care, Duke Children's Hospital and Health Center, Duke University Medical Center, Durham, North Carolina
| | - Kymika Okechukwu
- Department of Quality, American Academy of Pediatrics, Itasca, Illinois
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Bahr TM, Agarwal AM, Meznarich JA, Prince WL, Wait TWP, Prchal JT, Christensen RD. Thirty-five males with severe (Class 1) G6PD deficiency (c.637G>T) in a North American family of European ancestry. Blood Cells Mol Dis 2021; 92:102625. [PMID: 34773909 DOI: 10.1016/j.bcmd.2021.102625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022]
Abstract
In North America, jaundiced neonates are not usually tested for G6PD deficiency if the family is of European ancestry. However, we describe such a family where ≥35 males have had severe (Class I) G6PD deficiency. Many of the jaundiced neonates did not have this diagnosis considered, at least three of whom developed bilirubin neurotoxicity. Over seven generations 35 affected males were identified. Three developed signs of kernicterus spectrum disorder; three had exchange transfusions for hyperbilirubinemia; and nine received one or more blood transfusions during childhood.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Neonatology, Intermountain Healthcare, Murray, UT, USA.
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT, USA; ARUP Laboratories, Salt Lake City, UT, USA
| | - Jessica A Meznarich
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | | | - Tirzah W P Wait
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Josef T Prchal
- Division of Hematology, Department of Internal Medicine, University of Utah Health, the Huntsman Cancer Institute, and the George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA; Neonatology, Intermountain Healthcare, Murray, UT, USA
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9
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Cortesi V, Manzoni F, Raffaeli G, Cavallaro G, Fattizzo B, Amelio GS, Gulden S, Amodeo I, Giannotta JA, Mosca F, Ghirardello S. Severe Presentation of Congenital Hemolytic Anemias in the Neonatal Age: Diagnostic and Therapeutic Issues. Diagnostics (Basel) 2021; 11:diagnostics11091549. [PMID: 34573891 PMCID: PMC8467765 DOI: 10.3390/diagnostics11091549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023] Open
Abstract
Congenital hemolytic anemias (CHAs) are a group of diseases characterized by premature destruction of erythrocytes as a consequence of intrinsic red blood cells abnormalities. Suggestive features of CHAs are anemia and hemolysis, with high reticulocyte count, unconjugated hyperbilirubinemia, increased lactate dehydrogenase (LDH), and reduced haptoglobin. The peripheral blood smear can help the differential diagnosis. In this review, we discuss the clinical management of severe CHAs presenting early on in the neonatal period. Appropriate knowledge and a high index of suspicion are crucial for a timely differential diagnosis and management. Here, we provide an overview of the most common conditions, such as glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiency, and hereditary spherocytosis. Although rare, congenital dyserythropoietic anemias are included as they may be suspected in early life, while hemoglobinopathies will not be discussed, as they usually manifest at a later age, when fetal hemoglobin (HbF) is replaced by the adult form (HbA).
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Affiliation(s)
- Valeria Cortesi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Francesca Manzoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Genny Raffaeli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
- Correspondence: ; Tel.: +39-(25)-5032234; Fax: +39-(25)-503221
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Bruno Fattizzo
- UO Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.F.); (J.A.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giacomo Simeone Amelio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Silvia Gulden
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Juri Alessandro Giannotta
- UO Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.F.); (J.A.G.)
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
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DelFavero JJ, Jnah AJ, Newberry D. Glucose-6-Phosphate Dehydrogenase Deficiency and the Benefits of Early Screening. Neonatal Netw 2021; 39:270-282. [PMID: 32879043 DOI: 10.1891/0730-0832.39.5.270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy worldwide, is an insufficient amount of the G6PD enzyme, which is vital to the protection of the erythrocyte. Deficient enzyme levels lead to oxidative damage, hemolysis, and resultant severe hyperbilirubinemia. If not promptly recognized and treated, G6PD deficiency can potentially lead to bilirubin-induced neurologic dysfunction, acute bilirubin encephalopathy, and kernicterus. Glucose-6-phosphate dehydrogenase deficiency is one of the three most common causes for pathologic hyperbilirubinemia. A change in migration patterns and intercultural marriages have created an increased incidence of G6PD deficiency in the United States. Currently, there is no universally mandated metabolic screening or clinical risk assessment tool for G6PD deficiency in the United States. Mandatory universal screening for G6PD deficiency, which includes surveillance and hospital-based risk assessment tools, can identify the at-risk infant and foster early identification, diagnosis, and treatment to eliminate neurotoxicity.
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11
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Dong XY, Wei QF, Li ZK, Gu J, Meng DH, Guo JZ, He XL, Sun XF, Yu ZB, Han SP. Causes of severe neonatal hyperbilirubinemia: a multicenter study of three regions in China. World J Pediatr 2021; 17:290-297. [PMID: 34047994 DOI: 10.1007/s12519-021-00422-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Available evidence suggests that our country bear great burden of severe hyperbilirubinemia. However, the causes have not been explored recently in different regions of China to guide necessary clinical and public health interventions. METHODS This was a prospective, observational study conducted from March 1, 2018, to February 28, 2019. Four hospitals in three regions of China participated in the survey. Data from infants with a gestational age ≥ 35 weeks, birth weight ≥ 2000 g, and total serum bilirubin (TSB) level ≥ 17 mg/dL (342 µmol/L) were prospectively collected. RESULTS A total of 783 cases were reported. Causes were identified in 259 cases. The major causes were ABO incompatibility (n = 101), glucose-6-phosphate dehydrogenase deficiency (n = 76), and intracranial hemorrhage (n = 70). All infants with glucose-6-phosphate dehydrogenase deficiency were from the central south region. Those from the central south region had much higher peak total bilirubin levels [mean, 404 μmol/L; standard deviation (SD), 75 μmol/L] than those from the other regions (mean, 373 μmol/L; SD, 35 μmol/L) (P < 0.001). CONCLUSIONS ABO incompatibility was the leading cause in the east and northwest regions, but cases in the central south region were mainly caused by both ABO incompatibility and glucose-6-phosphate dehydrogenase deficiency, and infants in this region had a much higher peak total bilirubin level. Intracranial hemorrhage may be another common cause. More thorough assessments and rigorous bilirubin follow-up strategies are needed in the central south region.
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Affiliation(s)
- Xiao-Yue Dong
- Department of Neonatology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Qiu-Fen Wei
- Department of Neonatology, Guangxi Maternal and Child Health Care Hospital, Nanning, China
| | - Zhan-Kui Li
- Department of Neonatology, NorthWest Women's and Children's Hospital, Xi'an, China
| | - Jie Gu
- Department of Neonatology, Yinchuan Maternal and Child Health Care Hospital, Yinchuan, China
| | - Dan-Hua Meng
- Department of Neonatology, Guangxi Maternal and Child Health Care Hospital, Nanning, China
| | - Jin-Zhen Guo
- Department of Neonatology, NorthWest Women's and Children's Hospital, Xi'an, China
| | - Xiao-Li He
- Department of Neonatology, Yinchuan Maternal and Child Health Care Hospital, Yinchuan, China
| | - Xiao-Fan Sun
- Department of Neonatology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Zhang-Bin Yu
- Department of Neonatology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Shu-Ping Han
- Department of Neonatology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China.
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12
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Kachur ME, Rosen BJ. Educational Case: Anemia in a Neonate. Acad Pathol 2021; 8:23742895211002829. [PMID: 33889717 PMCID: PMC8040593 DOI: 10.1177/23742895211002829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Megan E Kachur
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Benjamin J Rosen
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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13
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Javadi M, Deravi S, Zarei S, Mahdavi N, Ranjbaran M. Prevalence of G6PD deficiency in Iranian neonates with jaundice: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:5813-5820. [PMID: 33722175 DOI: 10.1080/14767058.2021.1895738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis study aimed to estimate the overall prevalence of Glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonates with jaundice who were admitted to hospitals in Iran. MATERIALS AND METHODS In this systematic review and meta-analysis, we searched PubMed/Medline, Scopus, ISI Web of Sciences, and Iranian Local databases up to December 2019.We calculated Prevalence and 95% Confidence Interval (95% CI) of G6PD deficiency as summary measures. We conducted subgroup analysis based on the sex and quality of studies, while meta-regression were applied for investigating the effect of years of studies and years of publication on the pooled prevalence. We applied sensitivity analysis to investigate the effect of excluding each study on the pooled prevalence estimation. RESULTS The total sample size was 9799 people. The pooled prevalence of G6PD deficiency among neonates with jaundice in Iran was 7.0% (95% CI: 5.5-8.5%). The results of subgroup analysis showed that, pooled prevalence of G6PD deficiency among male neonate (12.1%, 95%CI: 7.6-16.7%) was more prevalent that female (3.00%, 95%CI: 1.1-4.9%). Based on the sensitivity analysis, lower and higher pooled prevalence of G6PD deficiency was observed 5.8% (95%CI: 4.7-6.9%) and 7.3% (95%CI: 5.7-8.8%) respectively by excluding each study. CONCLUSION The overall prevalence of G6PD deficiency was 7% in Iranian neonates with Jaundice. Prevalence was high in male and early hours of life. We recommend screening test for G6PD deficiency in neonates to prevent its complications.
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Affiliation(s)
- Maryam Javadi
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Somayeh Deravi
- Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Shabnam Zarei
- Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nader Mahdavi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Ranjbaran
- Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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14
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Wong RJ, Montiel C, Kunda M, Stevenson DK, Bhutani VK. A novel point-of-care device for measuring glucose-6-phosphate dehydrogenase enzyme deficiency. Semin Perinatol 2021; 45:151356. [PMID: 33293060 PMCID: PMC7856170 DOI: 10.1016/j.semperi.2020.151356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Extreme hyperbilirubinemia can cause bilirubin neurotoxicity. Infants with glucose-6-phosphate dehydrogenase (G6PD) deficiency can develop hemolysis and thus are at high risk. We evaluated a device that quantitatively measures G6PD activity kinetically using digital microfluidics (DMF). Intra- and inter-instrument and -day imprecision (CVs) were first assessed. G6PD activity in 86 samples was then measured and compared between DMF and 2 reference methods. Overall DMF reproducibility was 3.8% over 5 days by 2 operators on 2 instruments. Mean intra- and inter-instrument variabilities were 3.6% and 3.9%, respectively (n = 28), with a user variability of 4.3%. Mean G6PD activity was 6.40±4.62 and 6.37±4.62 U/g hemoglobin for DMF and Reference Methods 1 (n = 46) and 12.15±3.86 and 11.48±1.55 for DMF and 2 (n = 40), respectively, and strongly correlated (r = 0.95 and 0.95) with mean biases of +0.04±2.90 and +0.67±1.55 for methods 1 and 2, respectively. The novel device could be used for early newborn G6PD screening.
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Affiliation(s)
- Ronald J Wong
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Cynthia Montiel
- Department of Pediatrics, Division of Neonatal and
Developmental Medicine, Stanford University School of Medicine, Stanford, CA,
USA
| | - Megana Kunda
- Department of Pediatrics, Division of Neonatal and
Developmental Medicine, Stanford University School of Medicine, Stanford, CA,
USA
| | - David K Stevenson
- Department of Pediatrics, Division of Neonatal and
Developmental Medicine, Stanford University School of Medicine, Stanford, CA,
USA
| | - Vinod K Bhutani
- Department of Pediatrics, Division of Neonatal and
Developmental Medicine, Stanford University School of Medicine, Stanford, CA,
USA
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15
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Lau CS, Joseph R, Aw TC. Screening for Congenital Hypothyroidism. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Roy Joseph
- National University of Singapore, Singapore
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16
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Okolie F, South-Paul JE, Watchko JF. Combating the Hidden Health Disparity of Kernicterus in Black Infants: A Review. JAMA Pediatr 2020; 174:1199-1205. [PMID: 32628268 DOI: 10.1001/jamapediatrics.2020.1767] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Kernicterus is a devastating, permanently disabling neurologic condition resulting from bilirubin neurotoxicity. Black neonates account for more than 25% of kernicterus cases in the US, despite making up only approximately 14% of all births. This is a largely overlooked health disparity. OBSERVATIONS The black kernicterus health disparity exists despite a lower overall incidence of clinically significant hyperbilirubinemia among black neonates, a paradox recently explained by a previously unrecognized risk for hazardous hyperbilirubinemia. Aligned with national and global health initiatives to reduce or eliminate health disparities, this review highlights the multiple biologic and nonbiologic factors contributing to kernicterus risk in black infants and approaches to reduce this health disparity. This includes both parent-level and clinician-level kernicterus prevention strategies, with an emphasis on improving parental health literacy on neonatal jaundice and acute bilirubin encephalopathy and clinician awareness of the key factors that contribute to hazardous hyperbilirubinemia risk in this vulnerable group. Parent-level prevention strategies include efforts to improve their health literacy on neonatal jaundice and acute bilirubin encephalopathy and empower care seeking for jaundice. Clinician-level prevention strategies include efforts to eliminate community and institutional barriers that impede access to care, heighten clinician awareness of the factors that contribute to kernicterus risk in this vulnerable patient group, and strengthen newborn hyperbilirubinemia management and bilirubin surveillance. CONCLUSIONS AND RELEVANCE There are multiple opportunities for intervention to reduce black kernicterus risk. Although kernicterus is a rare disorder, the incidence among black infants is not a trivial matter nor are efforts to prevent kernicterus. While the multiple interacting biologic and nonbiologic contributors to increased kernicterus risk among black infants pose a considerable challenge to clinicians, there are opportunities for intervention to reduce this risk and health disparity. Continued study is imperative to understand the current scope of kernicterus and its occurrence in black neonates.
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Affiliation(s)
- Francesca Okolie
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, New York
| | - Jeannette E South-Paul
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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17
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Fasting glucose-to-HbA1c ratio is a good indicator of G6PD deficiency, but not thalassemia, in patients with type 2 diabetes mellitus. Clin Chim Acta 2020; 506:9-15. [PMID: 32156605 DOI: 10.1016/j.cca.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/22/2020] [Accepted: 03/06/2020] [Indexed: 12/23/2022]
Abstract
AIMS Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency or thalassemia have a shorter red blood cell lifespan; therefore, HbA1c is underestimated in these patients. To address these issues, we sought an early indicator for G6PD deficiency or thalassemia in DM patients. METHODS A total of 4908 patients with DM and 1848 subjects without DM were included in this study. Fasting glucose (FG) levels, HbA1c levels, hemogram profiles and G6PD activities were measured. Genotypic analyses of G6PD deficiency and thalassemia were performed. RESULTS DM patients with G6PD deficiency had significantly higher FG/HbA1c ratios than did those without G6PD deficiency (26.54 vs. 18.36; p < 0.0001). We divided the FG level into four categories: ≤150, 151-250, 251-350, and ≥351 mg/dL. Among all groups, only patients with DM and G6PD deficiency had higher FG/HbA1c ratios than those of patients with DM alone or DM with thalassemia. To evaluate the reliability of the FG/HbA1c ratio, receiver operating characteristic analyses were performed. The areas under the curve for detecting FG ≤ 150, 151-250, 251-350, and ≥351 mg/dL with G6PD deficiency based on the FG/HbA1c ratio were 0.839 (p < 0.001), 0.888 (p < 0.001), 0.891 (p < 0.001), and 0.640 (p = 0.3954), respectively. G6PD deficiency was confirmed by genetic analysis. We found common mutations that influenced G6PD activity and HbA1c levels. CONCLUSIONS The FG/HbA1c ratio is a good indicator of DM with G6PD deficiency. If this ratio is determined to be high in a clinical setting, then the clinician must consider whether the patient has a G6PD deficiency, and HbA1c reference values must be adjusted to avoid misdiagnosis and incorrect treatment decisions.
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18
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Aynalem YA, Mulu GB, Akalu TY, Shiferaw WS. Prevalence of neonatal hyperbilirubinaemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood-type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Paediatr Open 2020; 4:e000750. [PMID: 33024835 PMCID: PMC7517555 DOI: 10.1136/bmjpo-2020-000750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hyperbilirubinaemia is a silent cause of newborn disease and death worldwide. However, studies of the disease in sub-Saharan Africa are highly variable with respect to its prevalence. Hence, this study aimed to estimate the overall magnitude of neonatal hyperbilirubinaemia and its association with glucose-6-phosphate dehydrogenase (G6PD) deficiency and blood-type incompatibility in sub-Saharan Africa. METHODS PubMed, Scopus, Google Scholar and the Cochrane Review were systematically searched online to retrieve hyperbilirubinaemia-related articles. All observational studies reported the prevalence of hyperbilirubinaemia in sub-Saharan Africa were included for analysis and excluded if the study failed to determine the desired outcome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Heterogeneity across the included studies was evaluated using the inconsistency index (I2). Subgroup and meta- regression analysis were also done. Publication bias was examined by funnel plot and the Egger's regression test. The random-effect model was fitted to estimate the pooled prevalence of neonatal hyperbilirubinaemia. The meta-analysis was performed using the STATA V.14 software. RESULTS A total of 30 486 studies were collected from the different databases and 10 articles were included for the final analysis. The overall magnitude of neonatal hyperbilirubinaemia was 28.08% (95% CI20.23 to 35.94, I2=83.2) in sub-Saharan Africa. Neonates with G6PD deficiency (OR 2.42, 95% CI 1.64 to 3.56, I2=37%) and neonates that had a blood type that was incompatible with their mother's (OR 3.3, (95% CI 1.96 to 5.72, I2=84%) were more likely to develop hyperbilirubinaemia. CONCLUSION The failure to prevent and screen G6PD deficiency and blood-type incompatibility with their mother's results in high burden of neonatal hyperbilirubinaemia in sub-Saharan Africa. Therefore, early identification and care strategies should be developed to the affected neonates with G6PD deficiency and blood-type incompatibility with their mother's to address long-term medical and scholastic damages among those exposed to hyperbilirubinaemia.
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Affiliation(s)
| | - Getaneh Baye Mulu
- College of Health Science, Debre Birhan University, Debre Birhan, Ethiopia
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19
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Digital Microfluidic Platform to Maximize Diagnostic Tests with Low Sample Volumes from Newborns and Pediatric Patients. Diagnostics (Basel) 2020; 10:diagnostics10010021. [PMID: 31906315 PMCID: PMC7169462 DOI: 10.3390/diagnostics10010021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022] Open
Abstract
"Children are not tiny adults" is an adage commonly used in pediatrics to emphasize the fact that children often have different physiological responses to sickness and trauma compared to adults. However, despite widespread acceptance of this concept, diagnostic blood testing is an excellent example of clinical care that is not yet customized to the needs of children, especially newborns. Cumulative blood loss resulting from clinical testing does not typically impact critically ill adult patients, but can quickly escalate in children, leading to iatrogenic anemia and related comorbidities. Moreover, the tests prioritized for rapid, near-patient testing in adults are not always the most clinically relevant tests for children or newborns. This report describes the development of a digital microfluidic testing platform and associated clinical assays purposely curated to address current shortcomings in pediatric laboratory testing by using microliter volumes (<50 µL) of samples. The automated platform consists of a small instrument and single-use cartridges, which contain all reagents necessary to prepare the sample and perform the assay. Electrowetting technology is used to precisely manipulate nanoliter-sized droplets of samples and reagents inside the cartridge. To date, we have automated three disparate types of assays (biochemical assays, immunoassays, and molecular assays) on the platform and have developed over two dozen unique tests, each with important clinical application to newborns and pediatric patients. Cell lysis, plasma preparation, magnetic bead washing, thermocycling, incubation, and many other essential functions were all performed on the cartridge without any user intervention. The resulting assays demonstrate performance comparable to standard clinical laboratory assays and are economical due to the reduced hands-on effort required for each assay and lower overall reagent consumption. These capabilities allow a wide range of assays to be run simultaneously on the same cartridge using significantly reduced sample volumes with results in minutes.
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20
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Bahr TM, Lozano-Chinga M, Agarwal AM, Meznarich JA, Yost CC, Li P, Reading NS, Prchal JT, Christensen RD. A Novel Variant in G6PD (c.1375C>G) Identified from a Hispanic Neonate with Extreme Hyperbilirubinemia and Low G6PD Enzymatic Activity. Neonatology 2020; 117:532-535. [PMID: 32987391 DOI: 10.1159/000510300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
We report a novel glucose-6-phosphate dehydrogenase (G6PD) variant (c.1375C>G) discovered in a 3-day-old Hispanic male child from Salt Lake City, UT, USA. This newborn presented with severe hyperbilirubinemia (29.8 mg/dL or 510 μmol/L) and marked hemolysis evidenced by elevated end-tidal carbon monoxide concentration (5.9 ppm, normal <1.7 ppm). Despite a very low prevalence of G6PD deficiency in Hispanic populations, we pursued testing for this condition and found he had low erythrocyte G6PD enzyme activity (2.8 U/g Hb, normal 9.9-16.6 U/g Hb) and a novel G6PD variant. His mother was heterozygous for this same variant, and she had a moderate decrease in G6PD enzyme activity (7.1 U/g Hb). On the basis of these findings, we propose this variant as a novel pathogenic mutation.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA,
| | - Michell Lozano-Chinga
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, Utah, USA.,ARUP Laboratories, Salt Lake City, Utah, USA
| | - Jessica A Meznarich
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Christian C Yost
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA.,Molecular Medicine Program, University of Utah Health, Salt Lake City, Utah, USA
| | - Peng Li
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, Utah, USA.,ARUP Laboratories, Salt Lake City, Utah, USA
| | - N Scott Reading
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, Utah, USA.,Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, Utah, USA
| | - Josef T Prchal
- ARUP Laboratories, Salt Lake City, Utah, USA.,Molecular Medicine Program, University of Utah Health, Salt Lake City, Utah, USA.,Division of Hematology, Department of Internal Medicine, The Huntsman Cancer Institute, University of Utah Health, and The George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA.,Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
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21
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Liu Z, Yu C, Li Q, Cai R, Qu Y, Wang W, Wang J, Feng J, Zhu W, Ou M, Huang W, Tang D, Guo W, Liu F, Chen Y, Fu L, Zhou Y, Lv W, Zhang H, Zhang J, Wang M, Yang J, Wan K, Miao J, Yuan Z, Liu H, He X, Li W, Chen W, Ye L, Chen Y, Huang S, Liu H, Ding H, Gan X, Wang S, Qiang R, Gong M, Teng P, Wang H, Zhou M, Wei H, Liu X, Tang K, Ma Y, Wu H, Shu X, Chen Y, Zhuang D, Li H, Liu Z, Liu X, Chen Y, Zhu L, Zhu X, Mo C, Tang H, Yin F, Shao Z, Zhang P, Peng B, Lu Q, Wang Z, Zou L. Chinese newborn screening for the incidence of G6PD deficiency and variant of G6PD gene from 2013 to 2017. Hum Mutat 2019; 41:212-221. [PMID: 31489982 DOI: 10.1002/humu.23911] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 11/10/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common X-linked enzymopathies caused by G6PD gene variant. We aimed to provide the characteristics of G6PD deficiency and G6PD gene variant distribution in a large Chinese newborn screening population. We investigated the prevalence of G6PD in China from 2013 to 2017. Then, we examined G6PD activity and G6PD gene in representative Chinese birth cohort to explore the distribution of G6PD gene variant in 2016. We then performed multicolor melting curve analysis to classify G6PD gene variants in 10,357 neonates with activity-confirmed G6PD deficiency, and DNA Sanger sequencing for G6PD coding exons if hot site variants were not found. The screened population, organizations, and provinces of G6PD deficiency were increased from 2013 to 2017 in China. The top five frequency of G6PD gene variants were c.1376G>T, c.1388G>A, c.95A>G, c.1024C>T, and c.871G>A and varied in different provinces, with regional and ethnic features, and four pathogenic variant sites (c.152C>T, c.290A>T, c.697G>C, and c.1285A>G) were first reported. G6PD deficiency mainly occurs in South China, and the frequency of G6PD gene variant varies in different regions and ethnicities.
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Affiliation(s)
- Zhidai Liu
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Chaowen Yu
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Qingge Li
- School of Life Science, Xiamen University, Xiamen, Fujian, China
| | - Ren Cai
- Department of Medical Genetics, Liuzhou Maternal and Child Health Hospital, Liuzhou, Guangxi, China
| | - Yiping Qu
- Newborn Screening Center of Zhejiang, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weipeng Wang
- Center of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Jie Wang
- Center of Clinical Laboratory, Maternal and Child Health Care Hospital of Hainan Province, Haikou, Hainan, China
| | - Jinwen Feng
- Key Laboratory of Newborn Screening Center of Yunfu, Yunfu, Guangdong, China
| | - Wenbin Zhu
- Fujian Neonatal Screening Center, Fujian Maternal and Children Health Hospital, Fuzhou, Fujian, China
| | - Mingcai Ou
- Newborn Screening Center of Sichuan, Maternal and Child Health Hospital of Sichuan Province, Chengdu, Sichuan, China
| | - Weitong Huang
- Newborn Screening Center of Nanning, Maternal and Child Health Hospital of Nanning, Nanning, Guangxi, China
| | - Deguo Tang
- Maternal and Child Health Hospital of Yongzhou, Yongzhou, Hunan, China
| | - Wei Guo
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Fangjie Liu
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Yanhua Chen
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Lifang Fu
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Yanxia Zhou
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Wenqiong Lv
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Hang Zhang
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Juan Zhang
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Ming Wang
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Jing Yang
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Kexing Wan
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Jingkun Miao
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Zhaojian Yuan
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Hao Liu
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Xiaoyan He
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Wenjie Li
- Qingdao Women & Children Hospital Neonatal Screening Lab, Qingdao, Shandong, China
| | - Wengao Chen
- Bijie Municipal Medical Technology Section of Healthcare and Family Planning Service Center, Bijie, Guizhou, China
| | - Lixin Ye
- Dongguan Newborn Screening Center, Dongguan Maternal & Infant Health Hospital, Dongguan, Guangdong, China
| | - Yajun Chen
- Medical Genetic Center of Maternal and Child Health Hospital of Shaoguan City, Shaoguan, Guangdong, China
| | - Shuodan Huang
- Newborn Screening Center of Meizhou, Meizhou, Guangdong, China
| | - Haiping Liu
- Newborn Screening Center of Foshan, Foshan, Guangdong, China
| | - Hongxiang Ding
- Department of Clinical Laboratory, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinhui Gan
- Neo-Screening Section, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, Shandong, China
| | - Shuyuan Wang
- Department of Eugenics and Genetic, Maternal and Child Health Hospital of Xiangtan City, Xiangtan, Hunan, China
| | - Rong Qiang
- Neonatal Screening Department, Prenatal Diagnosis Department, Genetic Medical Center, Northwest Women and Children's Hospital, Xi'an, Shanxi, China
| | - Minhong Gong
- Clinical Laboratory, Maternal and Child Health Hospital of Shangluo, Shangluo, Shanxi, China
| | - Ping Teng
- Newborn Screening Center of Changde, Changde, Hunan, China
| | - Hua Wang
- Maternal and Child Health Hospital of Hunan Province, Changsha, Hunan, China
| | - Muping Zhou
- Maternal and Child Health Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Hongwei Wei
- Maternal and Child Health Hospital of Linyi, Linyi, Shandong, China
| | - Xiangju Liu
- Maternal and Child Health Hospital of Tai'an, Tai'an, Shandong, China
| | - Kai Tang
- Newborn Screening Center of Baoji, Baoji, Shanxi, China
| | - Yahong Ma
- Maternal and Child Health Hospital of Yan'an, Yan'an, Shanxi, China
| | - Hongliang Wu
- Newborn Screening Center of Yueyang, Yueyang, Hunan, China
| | - Xiaoli Shu
- Gastrointestinal Laboratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yizhen Chen
- Clinical Laboratory, Maternal and Child Health Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Danyan Zhuang
- Department of Medical Statistical, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hui Li
- Center of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Zhi Liu
- Center of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Xiulian Liu
- Center of Clinical Laboratory, Maternal and Child Health Care Hospital of Hainan Province, Haikou, Hainan, China
| | - Yao Chen
- Fujian Neonatal Screening Center, Fujian Maternal and Children Health Hospital, Fuzhou, Fujian, China
| | - Lidan Zhu
- Department of Clinical Laboratory, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoyan Zhu
- Department of Eugenics and Genetic, Maternal and Child Health Hospital of Xiangtan City, Xiangtan, Hunan, China
| | - Caihong Mo
- Key Laboratory of Newborn Screening Center of Yunfu, Yunfu, Guangdong, China
| | - Hua Tang
- Maternal and Child Health Hospital of Hunan Province, Changsha, Hunan, China
| | - Feng Yin
- Maternal and Child Health Hospital of Tai'an, Tai'an, Shandong, China
| | - Zhibing Shao
- Newborn Screening Center of Yueyang, Yueyang, Hunan, China
| | - Penghui Zhang
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Bin Peng
- Department of Medical Statistical, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qing Lu
- Division of Translational and Regenerative Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Zhiguo Wang
- National Center for Clinical Laboratories, Beijing, China
| | - Lin Zou
- Department of Clinical Molecular Medicine & Newborn Screening Center, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China
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22
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Abstract
Immigrant and refugee children are at increased risk for physical, developmental, and behavioral health challenges. This article provides an overview of physical, developmental, and behavioral health considerations for immigrant and refugee children within an ecological framework that highlights family, community, and sociocultural influences. Experiences and exposures relevant to immigrant and refugee children are discussed. Clinical pearls are provided for topics of chronic disease, nutrition, infectious disease, developmental screening, and mental health assessment. Interdisciplinary and community partnerships are emphasized as a means to decrease barriers to care and facilitate family navigation of complex social, educational, and health care systems.
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Affiliation(s)
- Abigail L H Kroening
- Division of Developmental and Behavioral Pediatrics, Golisano Children's Hospital, University of Rochester, 601 Elmwood Avenue Box #671, Rochester, NY 14623, USA.
| | - Elizabeth Dawson-Hahn
- Division of General Pediatrics, University of Washington, 6200 Northeast 74th Street Suite 110, Seattle, WA 98115-81860, USA
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23
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Zhao J, Zhang X, Guan T, Wang X, Zhang H, Zeng X, Dai Q, Wang Y, Zhou L, Ma X. The association between glucose-6-phosphate dehydrogenase deficiency and abnormal blood pressure among prepregnant reproductive-age Chinese females. Hypertens Res 2018; 42:75-84. [PMID: 30382176 DOI: 10.1038/s41440-018-0118-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/07/2018] [Indexed: 01/28/2023]
Abstract
The morbidity of hypertension is increasing among young adults worldwide, and glucose-6-phosphate dehydrogenase (G6PD) deficiency is a high-prevalence genetic disease. We investigated whether G6PD deficiency was associated with abnormal blood pressure (including elevated blood pressure and hypertension) among prepregnant reproductive-age females. We conducted a cross-sectional study in Shenzhen, which included 154 917 females aged 20-49 who participated in the National Free Pre-conception Check-up Projects supported by the Chinese government. After adjusting for confounding factors, the odds ratios (ORs) for the effects of G6PD deficiency on elevated blood pressure and hypertension were 1.18 (95% confidence interval (CI): 1.03-1.35) and 1.11 (95% CI: 1.00-1.23), respectively. Moreover, the association between G6PD deficiency and abnormal blood pressure was statistically significant for systolic blood pressure (SBP) but not significant for diastolic blood pressure (DBP). The multivariable-adjusted ORs for females with G6PD deficiency in the SBP 120-139 mm Hg and SBP ≥ 140 mm Hg groups were 1.10 (95% CI: 1.00-1.21) and 1.75 (95% CI: 1.25-2.42), respectively, while the multivariable-adjusted ORs for females with G6PD deficiency in the DBP 80-89 mm Hg and DBP ≥ 90 mm Hg groups were 1.09 (95% CI: 0.98-1.21) and 0.89 (95% CI: 0.66-1.19), respectively. Subgroup analyses showed similar results. The findings of this study underscored that reproductive-age females with a G6PD deficiency had a higher risk of elevated blood pressure and hypertension. Therefore, females with G6PD deficiency combined with elevated blood pressure or hypertension were high-risk populations during prepregnancy and pregnancy periods. Early intervention and collaborative management approaches should be explored to reduce the burden of these two diseases and improve maternal and child health.
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Affiliation(s)
- Jun Zhao
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Xu Zhang
- National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Ting Guan
- Shenzhen Family Planning and Service Center, Guangdong, China
| | - Xingyu Wang
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China.,Beijing Hypertension League Institute, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Xuchun Zeng
- Shenzhen Family Planning and Service Center, Guangdong, China
| | - Qiaoyun Dai
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China.,National Human Genetic Resources Center, Beijing, China
| | - Long Zhou
- Shenzhen Family Planning and Service Center, Guangdong, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China. .,National Human Genetic Resources Center, Beijing, China. .,Graduate School of Peking Union Medical College, Beijing, China.
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24
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La Vieille S, Lefebvre DE, Khalid AF, Decan MR, Godefroy S. Dietary restrictions for people with glucose-6-phosphate dehydrogenase deficiency. Nutr Rev 2018; 77:96-106. [DOI: 10.1093/nutrit/nuy053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sébastien La Vieille
- Bureau of Chemical Safety, Food Directorate, Health Canada, Ottawa, Ontario, Canada
- Department of Food Sciences, Faculty of Agriculture and Food Sciences, Université Laval, Québec City, Québec, Canada
| | - David E Lefebvre
- Bureau of Chemical Safety, Food Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Ahmad Firas Khalid
- Health Policy PhD Program, McMaster University, Hamilton, Ontario, Canada
| | - Matthew R Decan
- Bureau of Chemical Safety, Food Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Samuel Godefroy
- Department of Food Sciences, Faculty of Agriculture and Food Sciences, Université Laval, Québec City, Québec, Canada
- Institute of Nutrition and Functional Foods, Université Laval, Québec City, Québec, Canada
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25
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Christensen RD, Agarwal AM, George TI, Bhutani VK, Yaish HM. Acute neonatal bilirubin encephalopathy in the State of Utah 2009–2018. Blood Cells Mol Dis 2018; 72:10-13. [DOI: 10.1016/j.bcmd.2018.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 12/01/2022]
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26
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Thielemans L, Trip-Hoving M, Landier J, Turner C, Prins TJ, Wouda EMN, Hanboonkunupakarn B, Po C, Beau C, Mu M, Hannay T, Nosten F, Van Overmeire B, McGready R, Carrara VI. Indirect neonatal hyperbilirubinemia in hospitalized neonates on the Thai-Myanmar border: a review of neonatal medical records from 2009 to 2014. BMC Pediatr 2018; 18:190. [PMID: 29895274 PMCID: PMC5998587 DOI: 10.1186/s12887-018-1165-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 06/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Indirect neonatal hyperbilirubinemia (INH) is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The manuscript describes the characteristics of neonates with INH, the burden of severe INH and identifies factors associated with severity in a resource-constrained setting. METHODS We conducted a retrospective evaluation of anonymized records of neonates hospitalized on the Thai-Myanmar border. INH was defined according to the National Institute for Health and Care Excellence guidelines as 'moderate' if at least one serum bilirubin (SBR) value exceeded the phototherapy threshold and as 'severe' if above the exchange transfusion threshold. RESULTS Out of 2980 records reviewed, 1580 (53%) had INH within the first 14 days of life. INH was moderate in 87% (1368/1580) and severe in 13% (212/1580). From 2009 to 2011, the proportion of severe INH decreased from 37 to 15% and the mortality dropped from 10% (8/82) to 2% (7/449) coinciding with the implementation of standardized guidelines and light-emitting diode (LED) phototherapy. Severe INH was associated with: prematurity (< 32 weeks, Adjusted Odds Ratio (AOR) 3.3; 95% CI 1.6-6.6 and 32 to 37 weeks, AOR 2.2; 95% CI 1.6-3.1), Glucose-6-phosphate dehydrogenase deficiency (G6PD) (AOR 2.3; 95% CI 1.6-3.3), potential ABO incompatibility (AOR 1.5; 95% CI 1.0-2.2) and late presentation (AOR 1.8; 95% CI 1.3-2.6). The risk of developing severe INH and INH-related mortality significantly increased with each additional risk factor. CONCLUSION INH is an important cause of neonatal hospitalization on the Thai-Myanmar border. Risk factors for severity were similar to previous reports from Asia. Implementing standardized guidelines and appropriate treatment was successful in reducing mortality and severity. Accessing to basic neonatal care including SBR testing, LED phototherapy and G6PD screening can contribute to improve neonatal outcomes.
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MESH Headings
- ABO Blood-Group System
- Blood Group Incompatibility/complications
- Glucosephosphate Dehydrogenase Deficiency/complications
- Hospitalization
- Humans
- Hyperbilirubinemia, Neonatal/complications
- Hyperbilirubinemia, Neonatal/epidemiology
- Hyperbilirubinemia, Neonatal/mortality
- Hyperbilirubinemia, Neonatal/therapy
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/therapy
- Myanmar/epidemiology
- Phototherapy
- Retrospective Studies
- Risk Factors
- Thailand/epidemiology
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Affiliation(s)
- L. Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôspital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Trip-Hoving
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - J. Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - C. Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - T. J. Prins
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - E. M. N. Wouda
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- University of Groningen, Groningen, The Netherlands
| | - B. Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand
| | - C. Po
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - C. Beau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - M. Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - T. Hannay
- University of Glasgow, Glasgow, Scotland UK
| | - F. Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - B. Van Overmeire
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôspital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - R. McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - V. I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
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27
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28
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Spring R, Schlaack H, Rice M, Staat MA, Quinn CT. Glucose-6-phosphate dehydrogenase deficiency in internationally adopted children. Pediatr Blood Cancer 2018; 65:e26990. [PMID: 29369491 DOI: 10.1002/pbc.26990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 11/08/2022]
Abstract
There are conflicting guidelines about screening of internationally adopted children for glucose-6-phosphate dehydrogenase (G6PD) deficiency, a common genetic disorder. In a multi-ethnic population of 2,169 internationally adopted children, we found that the prevalence of G6PD deficiency was 1.6% overall and 2.2% in males. Prevalence differed by country or region of origin, ranging from 0 to 13% overall and 0 to 22% in males. The prevalence in females was 1%. A diagnosis of G6PD deficiency informs the treatment of malaria and enables education and counseling to prevent morbidity and mortality from G6PD deficiency. Screening for G6PD deficiency should be strongly considered for internationally adopted children.
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Affiliation(s)
- Rachel Spring
- International Adoption Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hanna Schlaack
- International Adoption Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marilyn Rice
- International Adoption Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mary A Staat
- International Adoption Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Charles T Quinn
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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29
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Abstract
Glycated hemoglobin (HbA1c) measures the amount of glucose in the blood in the previous 2-3 months and is used to test whether an individual has diabetes (HbA1c≥6.5%), or how well they are managing their diabetes. Genome-wide association studies have successfully identified multiple genomic loci influencing HbA1c, through both glycemic (factors that affect the amount blood glucose levels) and erythrocytic (factors that affect the red blood cell) pathways. Inaccuracies in HbA1c, due to non-glycemic variants, could lead to suboptimal care or adverse health consequences. A recently published example is the erythrocytic variant (rs1050828) in G6PD, which leads to the artificial lowering of HbA1c and missed diagnosis of diabetes using current thresholds. In this review we will discuss recent insights into the genetic etiology of HbA1c, and how these can translate to the clinic.
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Affiliation(s)
- Aaron Leong
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Eleanor Wheeler
- Department of Human Genetics, Wellcome Sanger Institute, Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
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30
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Thielemans L, Gornsawun G, Hanboonkunupakarn B, Paw MK, Porn P, Moo PK, Van Overmeire B, Proux S, Nosten F, McGready R, Carrara VI, Bancone G. Diagnostic performances of the fluorescent spot test for G6PD deficiency in newborns along the Thailand-Myanmar border: A cohort study. Wellcome Open Res 2018; 3:1. [PMID: 29552643 PMCID: PMC5829521 DOI: 10.12688/wellcomeopenres.13373.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 01/19/2023] Open
Abstract
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited enzymatic disorder associated with severe neonatal hyperbilirubinemia and acute haemolysis after exposure to certain drugs or infections. The disorder can be diagnosed phenotypically with a fluorescent spot test (FST), which is a simple test that requires training and basic laboratory equipment. This study aimed to assess the diagnostic performances of the FST used on umbilical cord blood by locally-trained staff and to compare test results of the neonates at birth with the results after one month of age. Methods: We conducted a cohort study on newborns at the Shoklo Malaria Research Unit, along the Thai-Myanmar border between January 2015 and May 2016. The FST was performed at birth on the umbilical cord blood by locally-trained staff and quality controlled by specialised technicians at the central laboratory. The FST was repeated after one month of age. Genotyping for common local G6PD mutations was carried out for all discrepant results. Results: FST was performed on 1521 umbilical cord blood samples. Quality control and genotyping revealed 10 misdiagnoses. After quality control, 10.7% of the males (84/786) and 1.2% of the females (9/735) were phenotypically G6PD deficient at birth. The FST repeated at one month of age or later diagnosed 8 additional G6PD deficient infants who were phenotypically normal at birth. Conclusions: This study shows the short-comings of the G6PD FST in neonatal routine screening and highlights the importance of training and quality control. A more conservative interpretation of the FST in male newborns could increase the diagnostic performances. Quantitative point-of-care tests might show higher sensitivity and specificity for diagnosis of G6PD deficiency on umbilical cord blood and should be investigated.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Pen Porn
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Paw Khu Moo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Bart Van Overmeire
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Point-of-Care Testing for G6PD Deficiency: Opportunities for Screening. Int J Neonatal Screen 2018; 4:34. [PMID: 31709308 PMCID: PMC6832607 DOI: 10.3390/ijns4040034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/14/2018] [Indexed: 12/15/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an X-linked genetic disorder, is associated with increased risk of jaundice and kernicterus at birth. G6PD deficiency can manifest later in life as severe hemolysis, when the individual is exposed to oxidative agents that range from foods such as fava beans, to diseases such as typhoid, to medications such as dapsone, to the curative drugs for Plasmodium (P.) vivax malaria, primaquine and tafenoquine. While routine testing at birth for G6PD deficiency is recommended by the World Health Organization for populations with greater than 5% prevalence of G6PD deficiency and to inform P. vivax case management using primaquine, testing coverage is extremely low. Test coverage is low due to the need to prioritize newborn interventions and the complexity of currently available G6PD tests, especially those used to inform malaria case management. More affordable, accurate, point-of-care (POC) tests for G6PD deficiency are emerging that create an opportunity to extend testing to populations that do not have access to high throughput screening services. Some of these tests are quantitative, which provides an opportunity to address the gender disparity created by the currently available POC qualitative tests that misclassify females with intermediate G6PD activity as normal. In populations where the epidemiology for G6PD deficiency and P. vivax overlap, screening for G6PD deficiency at birth to inform care of the newborn can also be used to inform malaria case management over their lifetime.
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Flores SR, Hall EM, De Jesús VR. Glucose-6-phosphate dehydrogenase enzyme stability in filter paper dried blood spots. Clin Biochem 2017; 50:878-881. [PMID: 28479150 PMCID: PMC10081145 DOI: 10.1016/j.clinbiochem.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Prior to initial distribution of Glucose-6-phosphate dehydrogenase (G6PD) proficiency testing (PT) materials, we evaluated G6PD enzyme stability in dried blood spots (DBS) under various temperature and humidity environments to develop storage and usage guidelines for our new materials. DESIGN & METHODS We prepared fresh G6PD-normal DBS materials and conducted stability evaluations of daily use and short and long-term storage under various temperature and humidity environments. RESULTS G6PD DBS PT materials retained 92% of initial activity after 30days of use at 4°C. Materials stored at -20°C and 4°C with desiccant for 30days retained 95% and 90% of initial activity, respectively. When stored for one year at -20°C or six months at 4°C specimens retained >90% of initial activity. Specimens stored at 37°C with desiccant lost 10% activity in three days. At the end of 30days, specimens stored under 'Extreme'-humidity >50% without desiccant- conditions at 37°C assayed below the NSQAP cut off for G6PD. Humidity exacerbated loss of enzyme activity with increasing temperature and time duration. CONCLUSION Data suggest that G6PD PT materials can be stored at 4°C and used for up to one month and can be stored at -20°C for one year and yield >90% enzyme activity. Exposure to warm temperatures, especially with elevated humidity, should be avoided. Desiccant should always be used to mitigate humidity effects.
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33
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Wheeler E, Leong A, Liu CT, Hivert MF, Strawbridge RJ, Podmore C, Li M, Yao J, Sim X, Hong J, Chu AY, Zhang W, Wang X, Chen P, Maruthur NM, Porneala BC, Sharp SJ, Jia Y, Kabagambe EK, Chang LC, Chen WM, Elks CE, Evans DS, Fan Q, Giulianini F, Go MJ, Hottenga JJ, Hu Y, Jackson AU, Kanoni S, Kim YJ, Kleber ME, Ladenvall C, Lecoeur C, Lim SH, Lu Y, Mahajan A, Marzi C, Nalls MA, Navarro P, Nolte IM, Rose LM, Rybin DV, Sanna S, Shi Y, Stram DO, Takeuchi F, Tan SP, van der Most PJ, Van Vliet-Ostaptchouk JV, Wong A, Yengo L, Zhao W, Goel A, Martinez Larrad MT, Radke D, Salo P, Tanaka T, van Iperen EPA, Abecasis G, Afaq S, Alizadeh BZ, Bertoni AG, Bonnefond A, Böttcher Y, Bottinger EP, Campbell H, Carlson OD, Chen CH, Cho YS, Garvey WT, Gieger C, Goodarzi MO, Grallert H, Hamsten A, Hartman CA, Herder C, Hsiung CA, Huang J, Igase M, Isono M, Katsuya T, Khor CC, Kiess W, Kohara K, Kovacs P, Lee J, Lee WJ, Lehne B, Li H, Liu J, Lobbens S, Luan J, Lyssenko V, Meitinger T, Miki T, Miljkovic I, Moon S, Mulas A, Müller G, Müller-Nurasyid M, Nagaraja R, Nauck M, Pankow JS, Polasek O, Prokopenko I, Ramos PS, Rasmussen-Torvik L, Rathmann W, Rich SS, Robertson NR, Roden M, Roussel R, Rudan I, Scott RA, Scott WR, Sennblad B, Siscovick DS, Strauch K, Sun L, Swertz M, Tajuddin SM, Taylor KD, Teo YY, Tham YC, Tönjes A, Wareham NJ, Willemsen G, Wilsgaard T, Hingorani AD, Egan J, Ferrucci L, Hovingh GK, Jula A, Kivimaki M, Kumari M, Njølstad I, Palmer CNA, Serrano Ríos M, Stumvoll M, Watkins H, Aung T, Blüher M, Boehnke M, Boomsma DI, Bornstein SR, Chambers JC, Chasman DI, Chen YDI, Chen YT, Cheng CY, Cucca F, de Geus EJC, Deloukas P, Evans MK, Fornage M, Friedlander Y, Froguel P, Groop L, Gross MD, Harris TB, Hayward C, Heng CK, Ingelsson E, Kato N, Kim BJ, Koh WP, Kooner JS, Körner A, Kuh D, Kuusisto J, Laakso M, Lin X, Liu Y, Loos RJF, Magnusson PKE, März W, McCarthy MI, Oldehinkel AJ, Ong KK, Pedersen NL, Pereira MA, Peters A, Ridker PM, Sabanayagam C, Sale M, Saleheen D, Saltevo J, Schwarz PEH, Sheu WHH, Snieder H, Spector TD, Tabara Y, Tuomilehto J, van Dam RM, Wilson JG, Wilson JF, Wolffenbuttel BHR, Wong TY, Wu JY, Yuan JM, Zonderman AB, Soranzo N, Guo X, Roberts DJ, Florez JC, Sladek R, Dupuis J, Morris AP, Tai ES, Selvin E, Rotter JI, Langenberg C, Barroso I, Meigs JB. Impact of common genetic determinants of Hemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations: A transethnic genome-wide meta-analysis. PLoS Med 2017; 14:e1002383. [PMID: 28898252 PMCID: PMC5595282 DOI: 10.1371/journal.pmed.1002383] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/03/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) is used to diagnose type 2 diabetes (T2D) and assess glycemic control in patients with diabetes. Previous genome-wide association studies (GWAS) have identified 18 HbA1c-associated genetic variants. These variants proved to be classifiable by their likely biological action as erythrocytic (also associated with erythrocyte traits) or glycemic (associated with other glucose-related traits). In this study, we tested the hypotheses that, in a very large scale GWAS, we would identify more genetic variants associated with HbA1c and that HbA1c variants implicated in erythrocytic biology would affect the diagnostic accuracy of HbA1c. We therefore expanded the number of HbA1c-associated loci and tested the effect of genetic risk-scores comprised of erythrocytic or glycemic variants on incident diabetes prediction and on prevalent diabetes screening performance. Throughout this multiancestry study, we kept a focus on interancestry differences in HbA1c genetics performance that might influence race-ancestry differences in health outcomes. METHODS & FINDINGS Using genome-wide association meta-analyses in up to 159,940 individuals from 82 cohorts of European, African, East Asian, and South Asian ancestry, we identified 60 common genetic variants associated with HbA1c. We classified variants as implicated in glycemic, erythrocytic, or unclassified biology and tested whether additive genetic scores of erythrocytic variants (GS-E) or glycemic variants (GS-G) were associated with higher T2D incidence in multiethnic longitudinal cohorts (N = 33,241). Nineteen glycemic and 22 erythrocytic variants were associated with HbA1c at genome-wide significance. GS-G was associated with higher T2D risk (incidence OR = 1.05, 95% CI 1.04-1.06, per HbA1c-raising allele, p = 3 × 10-29); whereas GS-E was not (OR = 1.00, 95% CI 0.99-1.01, p = 0.60). In Europeans and Asians, erythrocytic variants in aggregate had only modest effects on the diagnostic accuracy of HbA1c. Yet, in African Americans, the X-linked G6PD G202A variant (T-allele frequency 11%) was associated with an absolute decrease in HbA1c of 0.81%-units (95% CI 0.66-0.96) per allele in hemizygous men, and 0.68%-units (95% CI 0.38-0.97) in homozygous women. The G6PD variant may cause approximately 2% (N = 0.65 million, 95% CI 0.55-0.74) of African American adults with T2D to remain undiagnosed when screened with HbA1c. Limitations include the smaller sample sizes for non-European ancestries and the inability to classify approximately one-third of the variants. Further studies in large multiethnic cohorts with HbA1c, glycemic, and erythrocytic traits are required to better determine the biological action of the unclassified variants. CONCLUSIONS As G6PD deficiency can be clinically silent until illness strikes, we recommend investigation of the possible benefits of screening for the G6PD genotype along with using HbA1c to diagnose T2D in populations of African ancestry or groups where G6PD deficiency is common. Screening with direct glucose measurements, or genetically-informed HbA1c diagnostic thresholds in people with G6PD deficiency, may be required to avoid missed or delayed diagnoses.
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Affiliation(s)
- Eleanor Wheeler
- Department of Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Aaron Leong
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Rona J. Strawbridge
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Universitetsjukhuset, Solna, Sweden
| | - Clara Podmore
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Man Li
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Division of Nephrology, University of Utah, Salt Lake City, UT, United States of America
- Department of Human Genetics, University of Utah, Salt Lake City, UT, United States of America
| | - Jie Yao
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jaeyoung Hong
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Audrey Y. Chu
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States of America
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Weihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Cardiology, Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Xu Wang
- Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Peng Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States of America
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, Jilin, China
- College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Nisa M. Maruthur
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Bianca C. Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Stephen J. Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Yucheng Jia
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Edmond K. Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Li-Ching Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Wei-Min Chen
- University of Virginia Center for Public Health Genomics, Charlottesville, VA, United States of America
| | - Cathy E. Elks
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Personalised Healthcare & Biomarkers, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, United States of America
| | - Qiao Fan
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Min Jin Go
- Division of Structural and Functional Genomics, Center for Genome Science, Korean National Institute of Health, Osong, Chungchungbuk-do, South Korea
| | - Jouke-Jan Hottenga
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yao Hu
- The Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Anne U. Jackson
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, United States of America
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Young Jin Kim
- Division of Structural and Functional Genomics, Center for Genome Science, Korean National Institute of Health, Osong, Chungchungbuk-do, South Korea
| | - Marcus E. Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Claes Ladenvall
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Lund University Diabetes Centre, Lund University, Lund, Sweden
| | - Cecile Lecoeur
- University of Lille, CNRS, Institut Pasteur of Lille, UMR 8199—EGID, Lille, France
| | - Sing-Hui Lim
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Carola Marzi
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Munich, Munich, Germany
| | - Mike A. Nalls
- Data Tecnica International, Glen Echo, MD, United States of America
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, United States of America
| | - Pau Navarro
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, Scotland
| | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Lynda M. Rose
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Denis V. Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, United States of America
| | - Serena Sanna
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Monserrato, Italy
| | - Yuan Shi
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
| | - Daniel O. Stram
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Fumihiko Takeuchi
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shu Pei Tan
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
| | - Peter J. van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jana V. Van Vliet-Ostaptchouk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Andrew Wong
- MRC Unit for Lifelong Health & Ageing, London, United Kingdom
| | - Loic Yengo
- University of Lille, CNRS, Institut Pasteur of Lille, UMR 8199—EGID, Lille, France
| | - Wanting Zhao
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
| | - Anuj Goel
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Maria Teresa Martinez Larrad
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Dörte Radke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Perttu Salo
- National Institute for Health and Welfare (THL), Helsinki, Finland
- University of Helsinki, Institute for Molecular Medicine, Finland (FIMM) and Diabetes and Obesity Research Program, Helsinki, Finland
| | - Toshiko Tanaka
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, United States of America
| | - Erik P. A. van Iperen
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, Netherlands
| | - Goncalo Abecasis
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, United States of America
| | - Saima Afaq
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Behrooz Z. Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Amelie Bonnefond
- University of Lille, CNRS, Institut Pasteur of Lille, UMR 8199—EGID, Lille, France
| | - Yvonne Böttcher
- Integrated Research and Treatment (IFB) Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Erwin P. Bottinger
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland
| | - Olga D. Carlson
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States of America
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- School of Chinese Medicine, China Medical University, Taichung City, Taiwan
| | - Yoon Shin Cho
- Division of Structural and Functional Genomics, Center for Genome Science, Korean National Institute of Health, Osong, Chungchungbuk-do, South Korea
- Department of Biomedical Science, Hallym University, Chuncheon, Gangwon-do, South Korea
| | - W. Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, AL, United States of America
| | - Christian Gieger
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Harald Grallert
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Munich, Munich, Germany
| | - Anders Hamsten
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Universitetsjukhuset, Solna, Sweden
| | - Catharina A. Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Chao Agnes Hsiung
- Division of Endocrinology, Diabetes, Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States of America
| | - Jie Huang
- Boston VA Research Institute, Inc., Boston, MA, United States of America
| | - Michiya Igase
- Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masato Isono
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomohiro Katsuya
- Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chiea-Chuen Khor
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Wieland Kiess
- Center of Pediatric Research, University Hospital for Children & Adolescents, Dept. of Women's & Child Health, University of Leipzig, Leipzig, Germany
- LIFE Child, LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Katsuhiko Kohara
- Faculty of Collaborative Regional Innovation, Ehime University, Ehime, Japan
| | - Peter Kovacs
- Integrated Research and Treatment (IFB) Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Juyoung Lee
- Division of Structural and Functional Genomics, Center for Genome Science, Korean National Institute of Health, Osong, Chungchungbuk-do, South Korea
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Benjamin Lehne
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Huaixing Li
- The Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Jianjun Liu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Stephane Lobbens
- University of Lille, CNRS, Institut Pasteur of Lille, UMR 8199—EGID, Lille, France
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Tetsuro Miki
- Department of Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sanghoon Moon
- Division of Structural and Functional Genomics, Center for Genome Science, Korean National Institute of Health, Osong, Chungchungbuk-do, South Korea
| | - Antonella Mulas
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Monserrato, Italy
| | - Gabriele Müller
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Ramaiah Nagaraja
- Laboratory of Genetics, National Institute on Aging, Baltimore, MD, United States of America
| | - Matthias Nauck
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Ozren Polasek
- University of Split, Split, Croatia
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Inga Prokopenko
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, United Kingdom
| | - Paula S. Ramos
- Department of Medicine, Medical University of South Carolina, Charleston, SC, United States of America
| | - Laura Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Neil R. Robertson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ronan Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordelier, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Igor Rudan
- University of Edinburgh, Edinburgh, United Kingdom
| | - Robert A. Scott
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - William R. Scott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Cardiology, Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Bengt Sennblad
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Centre for Molecular Medicine, Karolinska Universitetsjukhuset, Solna, Sweden
- Science for life laboratory, Karolinska Institutet, Solna, Sweden
| | - David S. Siscovick
- The New York Academy of Medicine, New York, NY, United States of America
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Liang Sun
- The Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Morris Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Salman M. Tajuddin
- Health Disparities Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Yik-Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Life Sciences Institute, National University of Singapore, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
| | - Anke Tönjes
- Department of Medicine; University of Leipzig, Leipzig, Germany
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Gonneke Willemsen
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tom Wilsgaard
- Dept of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Aroon D. Hingorani
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | | | | | | | - Josephine Egan
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States of America
| | - Luigi Ferrucci
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States of America
| | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Antti Jula
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
| | - Inger Njølstad
- Dept of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Colin N. A. Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Manuel Serrano Ríos
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Hugh Watkins
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tin Aung
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Matthias Blüher
- Department of Medicine; University of Leipzig, Leipzig, Germany
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, United States of America
| | - Dorret I. Boomsma
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stefan R. Bornstein
- Dept of Medicine III, University of Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - John C. Chambers
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Cardiology, Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Yduan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Monserrato, Italy
- Dipartimento di Scienze Biomediche, Università di Sassari, Italy
| | - Eco J. C. de Geus
- Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Michele K. Evans
- Health Disparities Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, Division of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Philippe Froguel
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, United Kingdom
- CNRS 8199-Lille University, France
| | - Leif Groop
- Lund University Diabetes Centre, Lund University, Lund, Sweden
- Finnish Institute for Molecular Medicine (FIMM), Helsinki, Finland
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States of America
| | - Tamara B. Harris
- National Institute on Aging, Bethesda, MD, United States of America
| | - Caroline Hayward
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Chew-Kiat Heng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Norihiro Kato
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Bong-Jo Kim
- Division of Structural and Functional Genomics, Center for Genome Science, Korean National Institute of Health, Osong, Chungchungbuk-do, South Korea
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School Singapore, Singapore
| | - Jaspal S. Kooner
- Department of Cardiology, Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Antje Körner
- Center of Pediatric Research, University Hospital for Children & Adolescents, Dept. of Women's & Child Health, University of Leipzig, Leipzig, Germany
- LIFE Child, LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Diana Kuh
- MRC Unit for Lifelong Health & Ageing, London, United Kingdom
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Xu Lin
- The Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC, United States of America
| | - Ruth J. F. Loos
- The Charles Bronfman Institute for Personalized Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- The Mindich Child Health Development Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Patrik K. E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Synlab Academy, Synlab Services GmbH, Mannheim, Germany
| | - Mark I. McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Albertine J. Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ken K. Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
| | - Mark A. Pereira
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Annette Peters
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Michele Sale
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Danish Saleheen
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
- Center for Non-Communicable Diseases, Karachi, Pakistan
| | - Juha Saltevo
- Department of Medicine, Central Hospital, Central Finland, Jyväskylä, Finland
| | - Peter EH. Schwarz
- Dept of Medicine III, University of Dresden, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Wayne H. H. Sheu
- Division of Endocrine and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Timothy D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Saudi Diabetes Research Group, King Abdulaziz University, Fahd Medical Research Center, Jeddah, Saudi Arabia
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - James F. Wilson
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, Scotland
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tien Yin Wong
- Singapore Eye Research Institute, The Academia Level 6, Discovery Tower, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- School of Chinese Medicine, China Medical University, Taichung City, Taiwan
| | - Jian-Min Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Division of Cancer Control and Population Sciences,University of Pittsburgh Cancer Institute, Pittsburgh, PA, United States of America
| | - Alan B. Zonderman
- Laboratory of Epidemiology & Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America
| | - Nicole Soranzo
- Department of Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
- The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, United Kingdom
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - David J. Roberts
- Biomedical Research Centre Oxford Haematology Theme and Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
- NHS Blood and Transplant, Headington, Oxford, United Kingdom
| | - Jose C. Florez
- Harvard Medical School, Boston, MA, United States of America
- Diabetes Unit and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, United States of America
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, United States of America
| | - Robert Sladek
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, United States of America
| | - Andrew P. Morris
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - E-Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elizabeth Selvin
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Inês Barroso
- Department of Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, Cambridge, United Kingdom
- Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - James B. Meigs
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, United States of America
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Golden WC. The African-American neonate at risk for extreme hyperbilirubinemia: a better management strategy is needed. J Perinatol 2017; 37:321-322. [PMID: 28400613 DOI: 10.1038/jp.2017.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- W C Golden
- Division of Neonatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Cunningham AD, Hwang S, Mochly-Rosen D. Glucose-6-Phosphate Dehydrogenase Deficiency and the Need for a Novel Treatment to Prevent Kernicterus. Clin Perinatol 2016; 43:341-54. [PMID: 27235212 PMCID: PMC8265784 DOI: 10.1016/j.clp.2016.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hyperbilirubinemia occurs frequently in newborns, and in severe cases can progress to kernicterus and permanent developmental disorders. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, one of the most common human enzymopathies, is a major risk factor for hyperbilirubinemia and greatly increases the risk of kernicterus even in the developed world. Therefore, a novel treatment for kernicterus is needed, especially for G6PD-deficient newborns. Oxidative stress is a hallmark of bilirubin toxicity in the brain. We propose that the activation of G6PD via a small molecule chaperone is a potential strategy to increase endogenous defense against bilirubin-induced oxidative stress and prevent kernicterus.
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Affiliation(s)
- Anna D Cunningham
- Department of Chemical and Systems Biology, Stanford University, 269 Campus Drive, Stanford, CA 94305, USA
| | - Sunhee Hwang
- Department of Chemical and Systems Biology, Stanford University, 269 Campus Drive, Stanford, CA 94305, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University, 269 Campus Drive, Stanford, CA 94305, USA.
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Kaplan M, Hammerman C, Bhutani VK. The Preterm Infant: A High-Risk Situation for Neonatal Hyperbilirubinemia Due to Glucose-6-Phosphate Dehydrogenase Deficiency. Clin Perinatol 2016; 43:325-40. [PMID: 27235211 DOI: 10.1016/j.clp.2016.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prematurity and glucose-6-phosphate dehydrogenase (G6PD) deficiency are risk factors for neonatal hyperbilirubinemia. The 2 conditions may interact additively or synergistically, contributing to extreme hyperbilirubinemia, with the potential for bilirubin neurotoxicity. This hyperbilirubinemia is the result of sudden, unpredictable, and acute episodes of hemolysis in combination with immaturity of bilirubin elimination, primarily of conjugation. Avoidance of contact with known triggers of hemolysis in G6PD-deficient individuals will prevent some, but not all, episodes of hemolysis. All preterm infants with G6PD deficiency should be vigilantly observed for the development of jaundice both in hospital and after discharge home.
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Affiliation(s)
- Michael Kaplan
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, 9112102 Israel; Department of Neonatology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
| | - Cathy Hammerman
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, P.O. Box 12271, Jerusalem, 9112102 Israel; Department of Neonatology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel
| | - Vinod K Bhutani
- Department of Pediatrics, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94305, USA
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Sirdah MM, Al-Kahlout MS, Reading NS. National G6PD neonatal screening program in Gaza Strip of Palestine: rationale, challenges and recommendations. Clin Genet 2016; 90:191-8. [PMID: 27064064 DOI: 10.1111/cge.12786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Abstract
Congenital genetic disorders affecting neonates or young children can have serious clinical consequences if undiagnosed and left untreated. Early detection and an accurate diagnosis are, therefore, of major importance for preventing negative patient outcomes. Even though the occurrence of each specific metabolic disorder may be rare, their collective impact of preventable complications may be of considerable importance to the public health. Our previous studies showed that glucose-6-phosphate dehydrogenase (G6PD) deficiency is a problem of public health importance that has been shown to be a predominant cause of acute hemolytic anemia requiring hospitalization in Palestinian young children in Gaza Strip. Intriguingly, the majority of these children had one of the three variants, Mediterranean(c.) (563T) , African G6PD A-(c.) (202A) (/c.) (376G) and heretofore unrecognized as a common G6PD-deficient variant G6PD Cairo(c.) (404C) . The high prevalence of G6PD deficiency, as well as dietary factors in the region that precipitate anemia, argues for a need to protect the Palestinian children from a treatable and manageable genetic and metabolic disorder. This work reviews and discusses rationales and challenges of G6PD screening program in Gaza Strip. We advocate adopting a national neonatal G6PD screening program in Gaza Strip to identify children at risk and promote wellness and health for Palestine.
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Affiliation(s)
- M M Sirdah
- Biology Department, Al Azhar University-Gaza, Gaza, Palestine.,Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - M S Al-Kahlout
- Al Nasser Pediatric Hospital, Palestinian Ministry of Health, Gaza, Palestine
| | - N S Reading
- Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Bhutani VK, Srinivas S, Castillo Cuadrado ME, Aby JL, Wong RJ, Stevenson DK. Identification of neonatal haemolysis: an approach to predischarge management of neonatal hyperbilirubinemia. Acta Paediatr 2016; 105:e189-94. [PMID: 26802319 DOI: 10.1111/apa.13341] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 12/21/2015] [Accepted: 01/19/2016] [Indexed: 11/28/2022]
Abstract
AIM Relative contributions of increased production [by end-tidal carbon monoxide concentrations (ETCOc)] and decreased elimination of bilirubin to predischarge hour-specific total bilirubin (TB) levels were assessed in healthy late-preterm and term newborns. Secondly, we report predischarge ETCOc ranges to guide clinical management of hyperbilirubinemia. METHODS TB and ETCOc (≤3 timepoints) determinations of newborns aged between six hours and <6 days (n = 79) were stratified by postnatal age epochs. Hyperbilirubinemia risk was assessed by plotting TB values as a function of ETCOc. RESULTS Stratifications of ETCOc (in ppm, mean, median and interquartile ranges) by postnatal age epochs (0-24, 24-48 and 48-72) were as follows: 2.0, 1.9, 1.8-2.2 (n = 11); 1.6, 1.5, 1.1-2.0 (n = 58); and 2.0, 1.8, 1.6-2.3 (n = 9), respectively. Infants with ETCOc ≥ 2.5 were at high risk, between 1.5 and 2.5 at moderate risk and ≤1.5 were at low risk. Risk due to haemolysis alone was not independent (p < 0.01). For infants with TB >75th percentile (n = 31), 23% had ETCO ≤1.5, and 77% had ETCOc > 1.5 (p < 0.00003). CONCLUSION Near-simultaneous ETCOc and TB measurements in infants with TB >75th percentile accurately identify haemolytic hyperbilirubinemia.
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Affiliation(s)
- Vinod K. Bhutani
- Division of Neonatal and Developmental Medicine; Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
| | - Shanmukha Srinivas
- Division of Neonatal and Developmental Medicine; Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
| | - Martin E. Castillo Cuadrado
- Division of Neonatal and Developmental Medicine; Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
| | - Janelle L. Aby
- Division of General Pediatrics; Stanford University School of Medicine; Stanford CA USA
| | - Ronald J. Wong
- Division of Neonatal and Developmental Medicine; Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
| | - David K. Stevenson
- Division of Neonatal and Developmental Medicine; Department of Pediatrics; Stanford University School of Medicine; Stanford CA USA
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39
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Watchko JF. Extreme Neonatal Hyperbilirubinemia: A View from Down Under. J Pediatr 2016; 168:7-9. [PMID: 26515613 DOI: 10.1016/j.jpeds.2015.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Lam R, Li H, Nock ML. Assessment of G6PD screening program in premature infants in a NICU. J Perinatol 2015; 35:1027-9. [PMID: 26491849 DOI: 10.1038/jp.2015.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Targeted screening for glucose-6-phosphate dehydrogenase deficiency (G6PDdef) using fluorescent spot test (FST) is done in our newborn nursery (NN) and now in our NICU. Premature infants have higher G6PD levels than term infants. FST may result in under diagnosis of G6PDdef in preterms. We sought to determine if FST is appropriate for diagnosis of G6PDdef at<35 weeks and assess screening in NICU. STUDY DESIGN Retrospective chart review of male, inborn infants<35 weeks in NICU from 2008 to 2011. Difference in G6PDdef incidence<5% between NN and NICU was acceptable for equivalence. RESULTS Out of 679 subjects, 442 were screened for G6PDdef and 11.3% had abnormal results. Binomial testing comparing 11.3% (95% confidence interval (CI) 8.5 to 14.6) incidence of G6PDdef in NICU and reported incidence in NN (11%) demonstrated no difference. 12.2% of Black/African American males were not screened. CONCLUSION FST is appropriate for screening all at-risk newborns. A number of at-risk premature males were not screened.
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Affiliation(s)
- R Lam
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR, USA
| | - H Li
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH, USA
| | - M L Nock
- Division of Neonatology, Department of Pediatrics, University Hospitals Case Medical Center Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Bhutani VK, Kaplan M, Glader B, Cotten M, Kleinert J, Pamula V. Point-of-Care Quantitative Measure of Glucose-6-Phosphate Dehydrogenase Enzyme Deficiency. Pediatrics 2015; 136:e1268-75. [PMID: 26459646 PMCID: PMC4621802 DOI: 10.1542/peds.2015-2122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Widespread newborn screening on a point-of-care basis could prevent bilirubin neurotoxicity in newborns with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We evaluated a quantitative G6PD assay on a digital microfluidic platform by comparing its performance with standard clinical methods. METHODS G6PD activity was measured quantitatively by using digital microfluidic fluorescence and the gold standard fluorescence biochemical test on a convenience sample of 98 discarded blood samples. Twenty-four samples were designated as G6PD deficient. RESULTS Mean ± SD G6PD activity for normal samples using the digital microfluidic method and the standard method, respectively, was 9.7 ± 2.8 and 11.1 ± 3.0 U/g hemoglobin (Hb), respectively; for G6PD-deficient samples, it was 0.8 ± 0.7 and 1.4 ± 0.9 U/g Hb. Bland-Altman analysis determined a mean difference of -0.96 ± 1.8 U/g Hb between the digital microfluidic fluorescence results and the standard biochemical test results. The lower and upper limits for the digital microfluidic platform were 4.5 to 19.5 U/g Hb for normal samples and 0.2 to 3.7 U/g Hb for G6PD-deficient samples. The lower and upper limits for the Stanford method were 5.5 to 20.7 U/g Hb for normal samples and 0.1 to 2.8 U/g Hb for G6PD-deficient samples. The measured activity discriminated between G6PD-deficient samples and normal samples with no overlap. CONCLUSIONS Pending further validation, a digital microfluidics platform could be an accurate point-of-care screening tool for rapid newborn G6PD screening.
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Affiliation(s)
- Vinod K. Bhutani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michael Kaplan
- Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Bertil Glader
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Parental education and the WHO neonatal G-6-PD screening program: a quarter century later. J Perinatol 2015; 35:779-84. [PMID: 26181718 DOI: 10.1038/jp.2015.77] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/21/2015] [Accepted: 06/01/2015] [Indexed: 11/09/2022]
Abstract
Neonatal screening for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in any population with a male frequency >3-5%, combined with parental education regarding the dietary, environmental and sepsis-related triggers for hemolysis was recommended by the WHO (World Health Organization) Working Group in 1989. As the aim of identifying G-6-PD deficiency in the newborn period is to avert or detect extreme hyperbilirubinemia developing at home, before the development of kernicterus, the parental role in identifying evolving icterus was considered integral to any screening program. Now, a quarter century after publication of this report, severe bilirubin neurotoxicity associated with G-6-PD deficiency continues to be encountered worldwide. Screening programs have not been universally introduced but several national or regional maternal child health programs have implemented neonatal G-6-PD screening. Some reports detail the role of parental education, based on the above mentioned principles, through a variety of audio-visual materials. The paucity of randomized controlled trials or validated evidence to demonstrate the effectiveness of the contribution of parental education fails to meet the ideal testable evidence-based approach. However, our review of the cumulative experience and evidence currently available does supply certain information reflecting a positive impact of screening programs combined with parental input. We propose that the current information is sufficient to continue to support and apply the Working Group's recommendations. In order not to waste unnecessary time available, data may be used in lieu of randomized trials to continue to recommend screening programs, as suggested, in high-risk regions. If the incidence of kernicterus associated with G-6-PD deficiency is to be diminished, G-6-PD screening in combination with parental explanation may be one instance in which the consensus approach suggested by the WHO Working Group, rather than reliance on (nonexistent) evidence-based studies, should continue to be practiced.
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Bernardo J, Nock M. Pediatric Provider Insight Into Newborn Screening for Glucose-6-Phosphate Dehydrogenase Deficiency. Clin Pediatr (Phila) 2015; 54:575-8. [PMID: 25385930 PMCID: PMC4946335 DOI: 10.1177/0009922814557786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a major contributor to neonatal hyperbilirubinemia, yet newborn screening for this disorder in the United States is not standard practice. We surveyed pediatric providers regarding a novel newborn G6PD screening program successfully implemented in 2007 at a US urban women's hospital newborn nursery. STUDY DESIGN An electronic survey was distributed to 472 pediatric providers addressing extent to which they were influenced by the screening program. RESULTS Ninety-two (20%) providers responded, of whom 74 (80%) had taken care of G6PD-deficient patients diagnosed by the screening program. A majority found the diagnosis helpful for patient management and influential in their management. Most common changes in management included more counseling on jaundice and follow-up and avoidance of hemolytic crisis triggers. CONCLUSIONS General pediatric providers support newborn G6PD screening and appreciate the current program. Knowing the G6PD deficiency status of newborns informed and influenced pediatric providers' care.
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Affiliation(s)
- Janine Bernardo
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Mary Nock
- Division of Neonatology, University Hospitals, Rainbow Babies and Children’s Hospitals, Cleveland, OH
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Abstract
"Common red blood cell disorders encountered in the normal newborn nursery include hemolytic disease of the newborn and resultant hyperbilirubinemia, anemia, and polycythemia. A less frequent clinically relevant hematologic issue in newborns to be covered herein is thrombocytopenia."
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Affiliation(s)
- Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, Magee-Womens Hospital, 300 Halket Street and Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15213, USA.
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Abstract
After a review of the current health scene in India, the authors suggest that the Government of India should consider seriously, the introduction of new born screening. As a first step, a central advisory committee should be constituted to recommend what is required to be done to strengthen the infrastructure and the manpower to carry out new born screening, and the disorders to be screened. In the urban hospitals newborn screening (NBS) for three disorders can be easily introduced (congenital hypothyroidism, congenital adrenal hyperplasia and G-6-PD deficiency), while in the rural areas this should begin with congenital hypothyroidism, especially in the sub Himalayan areas. Concurrently, logistic issues regarding diets and special therapies for inborn errors of metabolism should be sorted out, laboratories to confirm the diagnosis should be set up, and a cadre of metabolic physicians should be build up to treat those identified to have inborn errors of metabolism. Once these are established on a firm footing, tandem mass spectrometry should be introduced as it allows the identification of a number of disorders in an affordable manner. The recent improvements and current trends in health care in India have created the necessary infrastructure for adopting NBS for the benefit of infants in India.
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46
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Affiliation(s)
- M Jeffrey Maisels
- Division of Newborn Medicine, Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, Mich.
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Abstract
Increased hemolysis in the presence of severe neonatal hyperbilirubinemia appears to augment the risk of bilirubin neurotoxicity. The mechanism of this intensifying effect is uncertain. In direct antiglobulin titer (DAT) positive, isoimmune hemolytic disease, the bilirubin threshold at which neurotoxicity occurs appears to be lower than in DAT-negative hyperbilirubinemia. In other hemolytic conditions, the hemolysis may simply facilitate the development of extremely high serum bilirubin levels. Whether the hemolytic process per se exerts an independent effect or whether a very rapid rise in serum bilirubin might lead to greater penetration of the blood-brain barrier is unclear. In this review, we survey the synergistic role of hemolysis associated with severe hyperbilirubinemia in the potentiation of bilirubin-induced neurotoxicity and suggest methods of identifying at-risk babies with increased hemolysis to allow for their increased surveillance.
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Affiliation(s)
- Michael Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Ruben Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Kuzniewicz MW, Wickremasinghe AC, Wu YW, McCulloch CE, Walsh EM, Wi S, Newman TB. Incidence, etiology, and outcomes of hazardous hyperbilirubinemia in newborns. Pediatrics 2014; 134:504-9. [PMID: 25092943 DOI: 10.1542/peds.2014-0987] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Total serum bilirubin (TSB) levels ≥ 30 mg/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts. METHODS We identified infants born ≥ 35 weeks' gestational age from 1995-2011 in Kaiser Permanente Northern California (n = 525409) and examined the medical records of infants with a TSB ≥ 30 mg/dL to determine etiology and the occurrence of acute bilirubin encephalopathy. We reviewed inpatient and outpatient encounters through 2013 for evidence of sensorineural hearing loss (SNHL) or cerebral palsy (CP). RESULTS We identified 47 infants with TSB ≥ 30 mg/dL (8.6 per 100000 births). In 44 infants (94%), the hyperbilirubinemia occurred after the initial birth hospitalization. The etiology was not identified in 33 (70%). Glucose-6-phosphate dehydrogenase (G6PD) activity was measured in only 25 (53%) of whom 10 (40%) were deficient. Four children had acute bilirubin encephalopathy of whom 2 developed both CP and SNHL, and 1 developed isolated SNHL. These 3 infants all had G6PD deficiency and TSB >40 mg/dL. One additional 35-week infant with TSB 38.2 mg/dL had SNHL. CONCLUSIONS Hazardous (≥ 30 mg/dL) hyperbilirubinemia is a rare event. No etiology could be identified from the clinical record in most cases. G6PD deficiency was the leading cause of hazardous hyperbilirubinemia when an etiology was identified, but many were not tested. Chronic, bilirubin-induced neurotoxicity was uncommon and occurred only in the setting of additional risk factors and TSB values well over (>15 mg/dL) the American Academy of Pediatrics exchange transfusion thresholds.
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Affiliation(s)
- Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Pediatrics,
| | - Andrea C Wickremasinghe
- Department of Pediatrics, Kaiser Permanente Santa Clara, Santa Clara, California Epidemiology and Biostatistics, and
| | - Yvonne W Wu
- Departments of Pediatrics, Neurology, University of California, San Francisco, San Francisco, California; and
| | | | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Soora Wi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Thomas B Newman
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Pediatrics, Epidemiology and Biostatistics, and
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Causes of hemolysis in neonates with extreme hyperbilirubinemia. J Perinatol 2014; 34:616-9. [PMID: 24762414 DOI: 10.1038/jp.2014.68] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/04/2014] [Accepted: 03/06/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We instituted a quality improvement process to enhance our capacity to diagnose genetic hemolytic conditions in neonates with extreme hyperbilirubinemia. STUDY DESIGN During a 1-year period, whenever the total serum bilirubin (TSB) was >25 mg dl(-1) a special evaluation was performed. If we deemed an erythrocyte membrane defect likely, based on red blood cell morphology, EMA-flow cytometry was performed. Otherwise 'next-generation' sequencing was performed using a panel of genes involved in neonatal hyperbilirubinemia. RESULT Ten neonates had a TSB ⩾ 25 mg dl(-1). Two others were evaluated as part of this process at the request of their attending neonatologists, because each had a TSB >14 mg dl(-1) in the first hours after birth and required phototherapy for ⩾ 1 week. Explanations for the jaundice were found in all 12 neonates. Five had hereditary spherocytosis, three of which also had ABO hemolytic disease. Two had pyruvate kinase deficiency. One had severe G6PD deficiency. The other four had ABO hemolytic disease. CONCLUSION On the basis of the present small case series, we suggest that among neonates with extreme hyperbilirubinemia, it can be productive to pursue a genetic basis for hemolytic disease.
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Prevention of Kernicterus in South Asia: role of neonatal G6PD deficiency and its identification. Indian J Pediatr 2014; 81:599-607. [PMID: 24763814 DOI: 10.1007/s12098-014-1410-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
Extreme hyperbilirubinemia (EHB) caused by neonatal glucose-6-phosphate dehydrogenase (G6PD) deficiency is strongly associated with mortality and long-term neurodevelopmental impairment, yet there are limited national strategies to reduce this burden in South Asia. Current known and predicted prevalence of G6PD deficiency in Afghanistan, Bangladesh, Bhutan, India, Nepal, and Pakistan ranges from 3.8 to 15 %, with regional "hot spots" exceeding 22 %. Annually, 3.14 million infants are born at risk for this condition. In 2010, South Asian countries reported 37 million (27 %) of world-wide livebirths ≥ 32 wk gestational-age and G6PD deficiency accounted for > 33 % of the global EHB burden, in contrast to 2.2 % for those born in high-income nations. Traditional national approach includes universal newborn screening in malaria-endemic countries or those with prevalence >3.5 %. However, screening implementation should be best optimized using timely quantitative enzyme assay and identification of at-risk female newborns. Furthermore, economic and social constraints, in context of sub-regional variances, call for flexible problem-solving methods in anticipation of changing community demographics. Thus, incremental and need-based newborn screening programs could be the most optimal approach. A human-centered design (HCD) approach, as an alternate pathway, could build the evidence to translate the complex biology of G6PD deficiency and the biodesign of affordable technologies, allowing facilitation of access to knowledge and services, in order to deliver on a long-term public health mandate. Key steps would encompass the initiation of local inquiry of both quantitative and qualitative data to identify at-risk communities and to prospectively design for local innovative solutions.
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