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Diala UM, Usman F, Appiah D, Hassan L, Ogundele T, Abdullahi F, Satrom KM, Bakker CJ, Lee BW, Slusher TM. Global Prevalence of Severe Neonatal Jaundice among Hospital Admissions: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:3738. [PMID: 37297932 PMCID: PMC10253859 DOI: 10.3390/jcm12113738] [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: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023] Open
Abstract
Evidence regarding the adverse burden of severe neonatal jaundice (SNJ) in hospitalized neonates in resource-constrained settings is sparse. We attempted to determine the prevalence of SNJ, described using clinical outcome markers, in all World Health Organization (WHO) regions in the world. Data were sourced from Ovid Medline, Ovid Embase, Cochrane Library, African Journals Online, and Global Index Medicus. Hospital-based studies, including the total number of neonatal admissions with at least one clinical outcome marker of SNJ, defined as acute bilirubin encephalopathy (ABE), exchange blood transfusions (EBT), jaundice-related death, or abnormal brainstem audio-evoked response (aBAER), were independently reviewed for inclusion in this meta-analysis. Of 84 articles, 64 (76.19%) were from low- and lower-middle-income countries (LMICs), and 14.26% of the represented neonates with jaundice in these studies had SNJ. The prevelance of SNJ among all admitted neonates varied across WHO regions, ranging from 0.73 to 3.34%. Among all neonatal admissions, SNJ clinical outcome markers for EBT ranged from 0.74 to 3.81%, with the highest percentage observed in the African and South-East Asian regions; ABE ranged from 0.16 to 2.75%, with the highest percentages observed in the African and Eastern Mediterranean regions; and jaundice-related deaths ranged from 0 to 1.49%, with the highest percentage observed in the African and Eastern Mediterranean regions. Among the cohort of neonates with jaundice, the prevalence of SNJ ranged from 8.31 to 31.49%, with the highest percentage observed in the African region; EBT ranged from 9.76 to 28.97%, with the highest percentages reported for the African region; ABE was highest in the Eastern Mediterranean (22.73%) and African regions (14.51%). Jaundice-related deaths were 13.02%, 7.52%, 2.01% and 0.07%, respectively, in the Eastern Mediterranean, African, South-East Asian and European regions, with none reported in the Americas. aBAER numbers were too small, and the Western Pacific region was represented by only one study, limiting the ability to make regional comparisons. The global burden of SNJ in hospitalized neonates remains high, causing substantial, preventable morbidity and mortality especially in LMICs.
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Affiliation(s)
- Udochukwu M. Diala
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, University of Jos Lamingo Campus, Jos 930232, Nigeria
| | - Fatima Usman
- Department of Paediatrics, Faculty of Clinical Services, College of Health Sciences, Bayero University, Aminu Kano Teaching Hospital Campus, Kano 700006, Nigeria
| | - Duke Appiah
- Department of Public Health, School of Population and Public Health, Faculty of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Laila Hassan
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Main Campus, Zaria 810211, Nigeria
| | - Tolulope Ogundele
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220005, Nigeria
| | - Fatima Abdullahi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Main Campus, Zaria 810211, Nigeria
| | - Katherine M. Satrom
- Department of Pediatrics, Faculty of Medical School, School of Medicine, University of Minnesota, University of Minnesota Twin Cities Campus, Minneapolis, MN 55455, USA
| | - Caitlin J. Bakker
- Dr. John Archer Library and Archives, University of Regina, Regina, SK S4S 0A2, Canada
| | - Burton W. Lee
- National Institute of Health, Bethesda, MD 20892, USA
| | - Tina M. Slusher
- Department of Pediatrics, Faculty of Medical School, School of Medicine, University of Minnesota, University of Minnesota Twin Cities Campus, Minneapolis, MN 55455, USA
- Hennepin Healthcare, Minneapolis, MN 55415, USA
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Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G, Narter F, Tunc G, Atasay B, Gultekin ND, Arsan S, Koc E. The Turkish Neonatal Jaundice Online Registry: A national root cause analysis. PLoS One 2018; 13:e0193108. [PMID: 29474382 PMCID: PMC5825038 DOI: 10.1371/journal.pone.0193108] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background Neonatal jaundice (NNJ) is common, but few root cause analyses based on national quality registries have been performed. An online registry was established to estimate the incidence of NNJ in Turkey and to facilitate a root cause analysis of NNJ and its complications. Methods A multicenter prospective study was conducted on otherwise healthy newborns born at ≥35 weeks of gestation and hospitalized for only NNJ in 50 collaborator neonatal intensive care units across Turkey over a 1-year period. Patients were analyzed for their demographic and clinical characteristics, treatment options, and complications. Results Of the 5,620 patients enrolled, 361 (6.4%) had a bilirubin level ≥25 mg/dL on admission and 13 (0.23%) developed acute bilirubin encephalopathy. The leading cause of hospital admission was hemolytic jaundice, followed by dehydration related to a lack of proper feeding. Although all infants received phototherapy, 302 infants (5.4%) received intravenous immunoglobulin in addition to phototherapy and 132 (2.3%) required exchange transfusion. The infants who received exchange transfusion were more likely to experience hemolytic causes (60.6% vs. 28.1%) and a longer duration of phototherapy (58.5 ± 31.7 vs. 29.4 ± 18.8 h) compared to infants who were not transfused (p < 0.001). The incidence of short-term complications among discharged patients during follow-up was 8.5%; rehospitalization was the most frequent (58%), followed by jaundice for more than 2 weeks (39%), neurological abnormality (0.35%), and hearing loss (0.2%). Conclusions Severe NNJ and bilirubin encephalopathy are still problems in Turkey. Means of identifying at-risk newborns before discharge during routine postnatal care, such as bilirubin monitoring, blood group analysis, and lactation consultations, would reduce the frequency of short- and long-term complications of severe NNJ.
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Affiliation(s)
- Omer Erdeve
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Okulu
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
- * E-mail:
| | - Ozgur Olukman
- Department of Pediatrics, Division of Neonatology, Behcet Uz Children’s Hospital, Izmir, Turkey
| | - Dilek Ulubas
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Gokhan Buyukkale
- Department of Pediatrics, Division of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Fatma Narter
- Department of Neonatology, Kartal Lutfi Kirdar Education and Training Hospital, Istanbul, Turkey
| | - Gaffari Tunc
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Begum Atasay
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Nazli Dilay Gultekin
- Department of Pediatrics, Division of Neonatology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Saadet Arsan
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Esin Koc
- Department of Pediatrics, Division of Neonatology, Gazi University School of Medicine, Ankara, Turkey
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Cherepnalkovski AP, Zemunik T, Glamocanin S, Piperkova K, Gunjaca I, Kocheva S, Jovanova BC, Krzelj V. Molecular Characterization of Glucose-6-phosphate Dehydrogenase Deficiency in Families from the Republic of Macedonia and Genotype-phenotype Correlation. Med Arch 2015; 69:284-8. [PMID: 26622077 PMCID: PMC4639331 DOI: 10.5455/medarh.2015.69.284-288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/25/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction: Glucose-6-phospahte dehydrogenase deficiency (G6PD) is one of the most common inherited disorders affecting around 400 million people worldwide. Molecular analysis of the G6PD gene identified more than 140 distinct mutations, the majority being single base missense mutations. G6PD Mediterranean is the most common variant found in populations of the Mediterranean area. Aim: The aim of our study was to perform molecular characterization of G6PD deficiency in families from the Republic of Macedonia and correlate the findings to disease phenotype. Patients and methods: Six patients and seven other family members were selected for genetic characterization, the selection procedure involved clinical evaluation and G6PD quantitative testing. All patients were first screened for the Mediterranean mutation, and subsequently for the Seattle mutation. Mutations were detected using PCR amplification and appropriate restriction endonuclease cleavage. Results: Four hemizygote and 3 heterozygous carriers for G6PD Mediterranean were detected. All G6PD deficient patients from this group showed clinical picture of hemolysis, and in 66.6% neonatal jaundice was confirmed based on history data. To our knowledge, this is the first study concerned with molecular aspects of the G6PD deficiency in R. Macedonia. Conclusion: This study represents a step towards a more comprehensive genetic evaluation in our population and better understanding of the health issues involved.
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Affiliation(s)
| | - Tatijana Zemunik
- Department of Medical Biology, School of Medicine, University of Split, Croatia
| | - Sofijanka Glamocanin
- University Pediatric Clinic, Medical Faculty, University "St. Cyril and Methodius", Skopje, Republic of Macedonia
| | - Katica Piperkova
- University Pediatric Clinic, Medical Faculty, University "St. Cyril and Methodius", Skopje, Republic of Macedonia
| | - Ivana Gunjaca
- Department of Medical Biology, School of Medicine, University of Split, Croatia
| | - Svetlana Kocheva
- University Pediatric Clinic, Medical Faculty, University "St. Cyril and Methodius", Skopje, Republic of Macedonia
| | - Biljana Coneska Jovanova
- University Pediatric Clinic, Medical Faculty, University "St. Cyril and Methodius", Skopje, Republic of Macedonia
| | - Vjekoslav Krzelj
- University Hospital Split and School of Medicine, University of Split, Croatia
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Albayrak C, Albayrak D. Red cell glucose 6-phosphate dehydrogenase deficiency in the northern region of Turkey: is G6PD deficiency exclusively a male disease? Pediatr Hematol Oncol 2015; 32:85-91. [PMID: 25116429 DOI: 10.3109/08880018.2014.940074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic defect that can cause hemolytic crisis. However, this disease affects both males and females. In Turkey, the frequency of this enzyme deficiency was reported to vary, from 0.25 to 18%, by the geographical area. Its prevalence in the northern Black Sea region of Turkey is unknown. The aims of this study were to assess the prevalence of G6PD deficiency in the northern region Turkey in children and adults with hyperbilirubinemia and hemolytic anemia. This report included a total of 976 G6PD enzyme results that were analyzed between May 2005 and January 2014. G6PD deficiency was detected in 5.0% of all patients. G6PD deficiency was significantly less frequent in females (1.9%, 6/323) than in males (6.6%, 43/653). G6PD deficiency was detected in 3.7% of infants with hyperbilirubinemia, 9.2% of children, and 4.5% of adults with hemolytic anemia. In both the newborn group and the group of children, G6PD deficiency was significantly more frequent in males. In the combined group of children (groups I and II), the proportion of males was 74% and 67% in all groups (P = .0008). In conclusion, in northern region of Turkey, G6PD deficiency is an important cause of neonatal hyperbilirubinemia and hemolytic crisis in children and adults. This study suggests that most pediatricians thought that G6PD deficiency is exclusively a male disease. For this reason, some female patients may have been undiagnosed.
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Affiliation(s)
- Canan Albayrak
- Department of Pediatric Hematology and Oncology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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