{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T23:24:33Z","timestamp":1780788273942,"version":"3.54.1"},"reference-count":51,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,8,1]]},"abstract":"<jats:p>Background. Although glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is prevalent in African Americans, their risk of associated neonatal hyperbilirubinemia has not been prospectively studied.<\/jats:p><jats:p>Objective. To compare hemolysis and the risk of hyperbilirubinemia among African American, G-6-PD-deficient neonates (study group) and G-6-PD-normal control subjects.<\/jats:p><jats:p>Methods. Consecutive, healthy, term and near-term, male neonates born to African American mothers comprised the patient cohort. G-6-PD testing was performed with umbilical cord blood samples. Routine management included measurement of the end tidal carbon monoxide level corrected for ambient carbon monoxide level (ETCOc) within 4 hours after delivery (assessment of hemolysis), \u22651 predischarge bilirubin determination, and additional bilirubin testing as clinically indicated. Indications for phototherapy were identical for study patients and control subjects. Neonates were monitored for the first 1 week of life. ETCOc results, the incidence of hyperbilirubinemia (defined as a transcutaneous or plasma total bilirubin concentration of \u226595th percentile for the hour of life), and the need for phototherapy were compared between the G-6-PD-deficient and G-6-PD-normal groups.<\/jats:p><jats:p>Results. Five hundred male patients were enrolled, of whom 64 (12.8%) were G-6-PD-deficient. ETCOc values (median and interquartile range) were higher among G-6-PD-deficient neonates than among control neonates (2.4 ppm [2.0\u20132.9 ppm] vs 2.1 ppm [1.7\u20132.5 ppm]). More G-6-PD-deficient neonates developed hyperbilirubinemia than did control subjects (14 of 64, 21.9%, vs 29 of 436, 6.7%; relative risk: 3.27; 95% confidence interval: 1.83-5.86), whereas 13 (20.3%) met the criteria for phototherapy, compared with 25 control subjects (5.7%) (relative risk: 3.53; 95% confidence interval: 1.91-6.56). No cases of kernicterus were observed.<\/jats:p><jats:p>Conclusions. Within the African American neonatal population, there is a subgroup of G-6-PD-deficient infants with elevated rates of hemolysis, a higher incidence of hyperbilirubinemia, and a greater requirement for phototherapy, compared with G-6-PD-normal control subjects. These newborns should be monitored vigilantly for the development of hyperbilirubinemia.<\/jats:p>","DOI":"10.1542\/peds.114.2.e213","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e213-e219","source":"Crossref","is-referenced-by-count":82,"title":["Hyperbilirubinemia Among African American, Glucose-6-Phosphate Dehydrogenase-Deficient Neonates"],"prefix":"10.1542","volume":"114","author":[{"given":"Michael","family":"Kaplan","sequence":"first","affiliation":[{"name":"Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel"},{"name":"Faculty of Medicine, Hebrew University, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marguerite","family":"Herschel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy","family":"Hammerman","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel"},{"name":"Faculty of Health Sciences, Ben Gurion University of the Negev, Be\u2019er Sheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Hoyer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,8,1]]},"reference":[{"key":"2021121006443913800_R1","unstructured":"Johnson LH, Brown AK. A pilot registry for acute and chronic kernicterus in term and near term infants. Pediatrics.1999;104(suppl):736A"},{"key":"2021121006443913800_R2","doi-asserted-by":"crossref","unstructured":"Johnson LH, Bhutani VK, Brown AK. System-based approach to management of neonatal jaundice and prevention of kernicterus. J Pediatr.2002;140:396\u2013403","DOI":"10.1067\/mpd.2002.123098"},{"key":"2021121006443913800_R3","doi-asserted-by":"crossref","unstructured":"Penn AA, Enzmann DR Hahn JS, Stevenson DK. Kernicterus in a full term infant. Pediatrics.1994;93:1003\u20131006","DOI":"10.1542\/peds.93.6.1003"},{"key":"2021121006443913800_R4","doi-asserted-by":"crossref","unstructured":"Washington EC, Ector W, Abboud M, Ohning B, Holden K. Hemolytic jaundice due to G6PD deficiency causing kernicterus in a female newborn. South Med J.1995;88:776\u2013779","DOI":"10.1097\/00007611-199507000-00019"},{"key":"2021121006443913800_R5","doi-asserted-by":"crossref","unstructured":"Carpentieri U, Moore RL, Nichols MM. Kernicterus in a newborn female with G-6-PD deficiency. J Pediatr.1974;89:854\u2013855","DOI":"10.1016\/S0022-3476(76)80828-1"},{"key":"2021121006443913800_R6","doi-asserted-by":"crossref","unstructured":"Moore AM, Perlman M. Symptomatic hypoglycemia in otherwise healthy, breastfed, term newborns. Pediatrics.1999;103:837\u2013839","DOI":"10.1542\/peds.103.4.837"},{"key":"2021121006443913800_R7","doi-asserted-by":"crossref","unstructured":"MacDonald MG. Hidden risks: early discharge and bilirubin toxicity due to glucose-6-phosphate dehydrogenase deficiency. Pediatrics.1995;96:734\u2013738","DOI":"10.1542\/peds.96.4.734"},{"key":"2021121006443913800_R8","doi-asserted-by":"crossref","unstructured":"Ahlfors CE, Herbsman O. Unbound bilirubin in a term newborn with kernicterus. Pediatrics.2003;111:1110\u20131112","DOI":"10.1542\/peds.111.5.1110"},{"key":"2021121006443913800_R9","doi-asserted-by":"crossref","unstructured":"Tarlow AR, Brewer GJ, Carson PE, Alving AS. Primaquine sensitivity. Arch Int Med.1962;109:209\u2013234","DOI":"10.1001\/archinte.1962.03620140081013"},{"key":"2021121006443913800_R10","doi-asserted-by":"crossref","unstructured":"Heller P, Best WR, Nelson RB, Becktel J. Clinical implications of sickle-cell trait and glucose-6-phosphate dehydrogenase deficiency in hospitalized black male patients. N Engl J Med.1979;300:1001\u20131005","DOI":"10.1056\/NEJM197905033001801"},{"key":"2021121006443913800_R11","doi-asserted-by":"crossref","unstructured":"O\u2019Flynn MED, Hsia DY-H. Serum bilirubin levels and glucose-6-phosphate dehydrogenase deficiency in newborn American Negroes. J Pediatr.1963;63:160\u2013161","DOI":"10.1016\/S0022-3476(63)80314-5"},{"key":"2021121006443913800_R12","unstructured":"Maisels MJ. Jaundice. In: Avery GB, Fletcher MA, MacDonald MG, eds. Neonatology: Pathophysiology and Management of the Newborn. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:765\u2013819"},{"key":"2021121006443913800_R13","doi-asserted-by":"crossref","unstructured":"Maisels MJ, Newman TB. Jaundice in full-term and near-term babies who leave the hospital within 36 hours. Clin Perinatol.1998;25:295\u2013302","DOI":"10.1016\/S0095-5108(18)30116-7"},{"key":"2021121006443913800_R14","doi-asserted-by":"crossref","unstructured":"Brown AK, Damus K, Kim MH, et al. Factors relating to readmission of term and near term neonates in the first two weeks of life. J Perinat Med.1999;27:263\u2013275","DOI":"10.1515\/JPM.1999.037"},{"key":"2021121006443913800_R15","doi-asserted-by":"crossref","unstructured":"Stevenson DK, Fanaroff AA, Maisels MJ, et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics.2001;108:31\u201339","DOI":"10.1542\/peds.108.1.31"},{"key":"2021121006443913800_R16","doi-asserted-by":"crossref","unstructured":"Beutler E. G6PD deficiency. Blood.1994;84:3613\u20133636","DOI":"10.1182\/blood.V84.11.3613.bloodjournal84113613"},{"key":"2021121006443913800_R17","doi-asserted-by":"crossref","unstructured":"Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics.1999;103:6\u201314","DOI":"10.1542\/peds.103.1.6"},{"key":"2021121006443913800_R18","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics.1994;94:558\u2013565","DOI":"10.1542\/peds.94.4.558"},{"key":"2021121006443913800_R19","unstructured":"Beutler E. Red Cell Metabolism: A Manual of Biochemical Methods. 3rd ed. New York, NY: Grune & Stratton; 1984:68\u201371"},{"key":"2021121006443913800_R20","doi-asserted-by":"crossref","unstructured":"Kaplan M, Leiter C, Hammerman C, Rudensky B. Enzymatic activity in glucose-6-phosphate dehydrogenase-normal and -deficient neonates measured with a commercial kit. Clin Chem.1995;41:1665\u20131667","DOI":"10.1093\/clinchem\/41.11.1665"},{"key":"2021121006443913800_R21","doi-asserted-by":"crossref","unstructured":"Vreman HJ, Mahoney JJ, Stevenson DK. Carbon monoxide and carboxyhemoglobin. Adv Pediatr.1995;42:303\u2013334","DOI":"10.1016\/S0065-3101(24)00118-X"},{"key":"2021121006443913800_R22","doi-asserted-by":"crossref","unstructured":"Stevenson DK, Vreman HJ. Carboxyhemoglobin and bilirubin production in neonates. Pediatrics.1997;100:252\u2013254","DOI":"10.1542\/peds.100.2.252"},{"key":"2021121006443913800_R23","doi-asserted-by":"crossref","unstructured":"Stevenson DK, Vraman HJ, Oh W, et al. Bilirubin production in healthy term infants as measured by carbon monoxide in breath. Clin Chem.1994;40:1934\u20131939","DOI":"10.1093\/clinchem\/40.10.1934"},{"key":"2021121006443913800_R24","doi-asserted-by":"crossref","unstructured":"Vreman HJ, Stevenson DK, Oh W, et al. Semiportable electrochemical instrument for determining carbon monoxide in breath. Clin Chem.1994;40:1927\u20131933","DOI":"10.1093\/clinchem\/40.10.1927"},{"key":"2021121006443913800_R25","doi-asserted-by":"crossref","unstructured":"Alden ER, Lynch SR, Wennberg RP. Carboxyhemoglobin determination in evaluating neonatal jaundice. Am J Dis Child.1978;127:214\u2013217","DOI":"10.1001\/archpedi.1974.02110210064008"},{"key":"2021121006443913800_R26","doi-asserted-by":"crossref","unstructured":"Valaes T. Severe neonatal jaundice associated with glucose-6-phosphate dehydrogenase deficiency: pathogenesis and global epidemiology. Acta Paediatr Suppl.1994;394:58\u201376","DOI":"10.1111\/j.1651-2227.1994.tb13216.x"},{"key":"2021121006443913800_R27","doi-asserted-by":"crossref","unstructured":"Kaplan M, Hammerman C. Severe neonatal hyperbilirubinemia: a potential complication of glucose-6-phosphate dehydrogenase deficiency. Clin Perinatol.1998;25:575\u2013590","DOI":"10.1016\/S0095-5108(18)30098-8"},{"key":"2021121006443913800_R28","doi-asserted-by":"crossref","unstructured":"Slusher TM, Vreman HJ, McLaren DW, Lewison LJ, Brown AK, Stevenson DK. Glucose-6-phosphate dehydrogenase deficiency and carboxyhemoglobin concentrations associated with bilirubin-related morbidity and death in Nigerian infants. J Pediatr.1995;126:102\u2013108","DOI":"10.1016\/S0022-3476(95)70510-4"},{"key":"2021121006443913800_R29","doi-asserted-by":"crossref","unstructured":"Kaplan M, Hammerman C. Glucose-6-phosphate dehydrogenase-deficient neonates: a potential cause for concern in North America. Pediatrics.2000;106:1478\u20131480","DOI":"10.1542\/peds.106.6.1478"},{"key":"2021121006443913800_R30","unstructured":"Stoll BJ, Kliegman RM. Jaundice and hyperbilirubinemia in the newborn. In: Behrman RE, Kliegman RM, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: WB Saunders; 2004:592\u2013596"},{"key":"2021121006443913800_R31","doi-asserted-by":"crossref","unstructured":"Brown AK. Hyperbilirubinemia in black infants: role of glucose-6-phosphate dehydrogenase deficiency. Clin Pediatr.1992;31:712\u2013715","DOI":"10.1177\/000992289203101203"},{"key":"2021121006443913800_R32","unstructured":"Centers for Disease Control and Prevention. Kernicterus in full-term infants: United States, 1994\u20131998. MMWR Morb Mortal Wkly Rep.2001;50:491\u2013494"},{"key":"2021121006443913800_R33","doi-asserted-by":"crossref","unstructured":"Zinkham WH. Peripheral blood and bilirubin values in normal full-term primaquine-sensitive Negro infants: effect of vitamin K. Pediatrics.1963;31:983\u2013995","DOI":"10.1542\/peds.31.6.983"},{"key":"2021121006443913800_R34","doi-asserted-by":"crossref","unstructured":"Wolff JA, Grossman BH, Paya K. Neonatal serum bilirubin and glucose-6-phospahte dehydrogenase deficiency. Am J Dis Child.1967;113:251\u2013254","DOI":"10.1001\/archpedi.1967.02090170115013"},{"key":"2021121006443913800_R35","unstructured":"Segel GB. Glucose-6-phosphate dehydrogenase (G-6-PD) and related deficiencies. In: Behrman RE, Kliegman RM, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: WB Saunders; 2004:1636\u20131638"},{"key":"2021121006443913800_R36","doi-asserted-by":"crossref","unstructured":"Linn S, Schoenbaum SC, Monson RR, Rosner B, Stubblefield PG, Ryan KJ. Epidemiology of neonatal hyperbilirubinemia. Pediatrics.1985;75:770\u2013774","DOI":"10.1542\/peds.75.4.770"},{"key":"2021121006443913800_R37","doi-asserted-by":"crossref","unstructured":"Eshaghpour E, Oski FA, Williams M. The relationship of erythrocyte glucose-6-phosphate dehydrogenase deficiency to hyperbilirubinemia in Negro premature infants. J Pediatr.1967;70:595\u2013601","DOI":"10.1016\/S0022-3476(67)80044-1"},{"key":"2021121006443913800_R38","doi-asserted-by":"crossref","unstructured":"Lopez R, Cooperman JM. Glucose-6-phosphate dehydrogenase deficiency and hyperbilirubinemia in the newborn. Am J Dis Child.1971;122:66\u201370","DOI":"10.1001\/archpedi.1971.02110010102020"},{"key":"2021121006443913800_R39","unstructured":"Karayalcin G, Acs H, Lanzkowsky P. G6PD deficiency and hyperbilirubinemia in black American full-term infants. NY State J Med.1979;79:22\u201325"},{"key":"2021121006443913800_R40","doi-asserted-by":"crossref","unstructured":"Gibbs WN, Gray R, Lowry M. Glucose-6-phosphate dehydrogenase deficiency and neonatal jaundice in Jamaica. Br J Haematol.1979;43:263\u2013274","DOI":"10.1111\/j.1365-2141.1979.tb03750.x"},{"key":"2021121006443913800_R41","doi-asserted-by":"crossref","unstructured":"Kaplan M, Rubaltelli FF, Hammerman C, et al. Conjugated bilirubin in neonates with glucose-6-phosphate dehydrogenase deficiency. J Pediatr.1996;128:695\u2013697","DOI":"10.1016\/S0022-3476(96)80138-7"},{"key":"2021121006443913800_R42","doi-asserted-by":"crossref","unstructured":"Kaplan M, Muraca M, Hammerman C, et al. Bilirubin conjugation, reflected by serum conjugated bilirubin fractions, in glucose-6-phosphate dehydrogenase-deficient neonates: a determining factor in the pathogenesis of hyperbilirubinemia. Pediatrics.1998;102(3). Available at: www.pediatrics.org\/cgi\/content\/full\/102\/3\/e37","DOI":"10.1542\/peds.102.3.e37"},{"key":"2021121006443913800_R43","doi-asserted-by":"crossref","unstructured":"Kaplan M, Renbaum P, Levy-Lahad E, Hammerman C, Lahad A, Beutler E. Gilbert syndrome and glucose-6-phosphate dehydrogenase deficiency: a dose-dependent genetic interaction crucial to neonatal hyperbilirubinemia. Proc Natl Acad Sci USA.1997;94:12128\u201312132","DOI":"10.1073\/pnas.94.22.12128"},{"key":"2021121006443913800_R44","unstructured":"Doyle JJ, Schmidt B, Blanchette V, Zipursky A. Hematology. In: Avery GB, Fletcher MA, MacDonald MG, eds. Neonatology: Pathophysiology and Management of the Newborn. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:1045\u20131099"},{"key":"2021121006443913800_R45","doi-asserted-by":"crossref","unstructured":"Matsunaga AT, Lubin AT. Hemolytic anemia in the newborn. Clin Perinatol.1995;22:803\u2013828","DOI":"10.1016\/S0095-5108(18)30281-1"},{"key":"2021121006443913800_R46","doi-asserted-by":"crossref","unstructured":"Javier MC, Krauss A, Nesin M. Corrected end-tidal carbon monoxide closely correlates with the corrected reticulocyte count in Coombs\u2019 test-positive term neonates. Pediatrics.2003;112:1333\u20131337","DOI":"10.1542\/peds.112.6.1333"},{"key":"2021121006443913800_R47","doi-asserted-by":"crossref","unstructured":"Kaplan M, Vreman HJ, Hammerman C, Leiter C, Abramov A, Stevenson DK. Contribution of haemolysis to jaundice in Sephardic Jewish glucose-6-phosphate dehydrogenase-deficient neonates. Br J Haematol.1996;93:822\u2013827","DOI":"10.1046\/j.1365-2141.1996.d01-1745.x"},{"key":"2021121006443913800_R48","doi-asserted-by":"crossref","unstructured":"Lo YS, Lu CC, Chiou SS, et al. Molecular characterization of glucose-6-phosphate dehydrogenase deficiency in Chinese infants with or without severe neonatal hyperbilirubinemia. Br J Haematol.1994;86:858\u2013862","DOI":"10.1111\/j.1365-2141.1994.tb04842.x"},{"key":"2021121006443913800_R49","doi-asserted-by":"crossref","unstructured":"Meloni T, Cutillo S, Testa U, et al. Neonatal jaundice and severity of glucose-6-phosphate dehydrogenase deficiency in Sardinian babies. Early Hum Dev.1987;15:317\u2013322","DOI":"10.1016\/0378-3782(87)90026-0"},{"key":"2021121006443913800_R50","unstructured":"Beutler E. Glucose-6-phosphate dehydrogenase deficiency and other red cell enzyme abnormalities. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, Seligsohn U, eds. Williams Hematology. New York, NY: McGraw-Hill; 2001:527\u2013545"},{"key":"2021121006443913800_R51","unstructured":"WHO Working Group. Glucose-6-phosphate dehydrogenase deficiency. Bull World Health Org.1989;67:601\u2013611"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/2\/e213\/1017460\/zpe0080400e213.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/2\/e213\/1017460\/zpe0080400e213.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T05:12:56Z","timestamp":1705209176000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/114\/2\/e213\/64639\/Hyperbilirubinemia-Among-African-American-Glucose"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,8,1]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2004,8,1]]},"published-print":{"date-parts":[[2004,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.114.2.e213","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,8,1]]}}}