115 - Association between ETCOc and Hemolytic Diseases from G6PD Deficiency and ABO Incompatibility in Asian Neonates

Glucose-6- phosphate dehydrogenase(G6PD) deficiency and ABO hemolytic disease of newborn (HDN) are well-established risk factors for neonatal hyperbilirubinemia, and the Guangdong province has a disproportionally high prevalence of G6PD deficiency in China. Previous studies suggest the level of end-tidal carbon monoxide-corrected (ETCOc) may be a good indicator for hemolysis.


Objective:

To examine the association of HDN from G6PD deficiency and ABO incompatibility with the level of ETCOc in 72 hours after birth.


Design/Methods:

We performed a case-control study as the secondary analysis of the Hyperbilirubinemia Risk Evaluation and Management by ETCOc randomized control trial (HEME trial) of 2,500 neonates who were born at ≥35 weeks’ gestational age with a birth weight ≥2000 grams and a transcutaneous bilirubin(TCB) level >40^th percentile of Bhutani nomogram within 72 hours after birth. Cases were infants who had either a confirmed diagnosis of G6PD deficiency or ABO HDN. Controls were infants who had no diagnosis of G6PD deficiency or ABO HDN. Logistic regression was used for the multivariable analyses of the diagnosis of G6PD deficiency/ABO HDN and ETCOc adjusting for gestational age, birth weight, sex and maternal blood group.


Results:

Infants who had a diagnosis of G6PD deficiency/ABO HDN had significantly higher proportion of maternal type O and were recruited at an earlier age with a higher TCB and ETCOc levels (Table 1). ETCOc at recruitment was significantly associated with the diagnosis of G6PD deficiency/ABO HDN (odds ratio [OR]= 3.88, 95% confidence interval [CI]= 2.87, 5.26, P < 0.01). A level of ETCOc between 1.5 and 2.5 ppm or a level ≥2.5 ppm was associated with 2.36-folds (95% CI = 1.58, 3.55, P < 0.01) or 7.64-folds (95%CI = 4.57, 12.77, P < 0.01) increase in the risk of G6PD deficiency or ABO HDN in all participants, with a stronger estimated effect in female participants (Table 2). Higher ETCOc levels were found within the first 72 hours of life in infants with G6PD deficiency or ABO HDN (Figure 1).  


Conclusion(s):

Our results suggest that ETCOc level within 72 hours after birth is associated to the hemolytic diseases from G6PD deficiency/ABO HDN among near-term and term Chinese newborns. Further studies are warranted to examine the effect of ETCOc after birth on the screening and prediction of hemolytic diseases from G6PD deficiency/ABO HDN.