Nigerian Journal of Paediatrics

G6PD deficiency and ABO incompatibility are far greater causes of severe jaundice than rhesus disease in Nigerian neonates

Niger J Paediatr 2018; 45 (3):174 – 175

LETTER TO THE EDITOR

Mabogunje CA

CC – BY G6PD deficiency and ABO incom-

Aina O

Emokpae AA

patibility are far greater causes of

Olusanya BO

severe jaundice than rhesus

disease in Nigerian neonates

DOI:http://dx.doi.org/10.4314/njp.v45i3.7

Accepted: 17th September 2018

dence in this journal or elsewhere to suggest any epide-

miological shift in the leading clinical risk factors for

Olusanya BO (

)

neonatal hyperbilirubinaemia in Nigeria.

Centre for Healthy Start Initiative,

More crucial is the contribution of, are non-clinical risk

286A Corporation Drive, Dolphin

factors linked to the three levels of delay commonly

Estate, Ikoyi, Lagos, Nigeria.

associated with bilirubin-induced mortality and neurode-

Email:

velopmental disorders, including kernicterus namely: i)

bolajoko.olusanya@uclmail.net

the timeliness of the decision to seek appropriate care by

mothers at the onset of jaundice, ii) reaching an appro-

Mabogunje CA, Aina O

priate health facility promptly, and iii) receiving ade-

Massey Street Children’s Hospital,

quate/appropriate care at the health facility.³ This is cor-

Lagos, Nigeria.

roborated by our experience in prospectively investigat-

ing the pattern and burden of acute bilirubin encephalo-

Emokpae AA

pathy in a foremost referral children’s hospital in inner -

Gbagada General Hospital,

city Lagos since 2008 which has been reported in sev-

Gbagada, Lagos, Nigeria.

eral reputable journals.^4-6

While we do not dispute the

importance of rhesus incompatibility for severe neonatal

Dear Editor,

jaundice in general,⁷ we feel constrained to draw atten-

tion to the exaggeration in Dr. Bhutani’s presentation as

We read with interest the Conference summary report of

to the scale of the problem among newborns in Nigeria,

the 10th Annual General and Scientific Meeting of the

compared to G6PD deficiency with an estimated na-

Nigerian Society of Neonatal Medicine (NISONM) held

tional prevalence of at least 15.0%. In fact, routine

in July 2017 at Ibadan, published in a prior issue of this

screening for G6PD deficiency is considered a priority

journal. We congratulate the leadership of NISONM for

for all malaria-endemic populations, and Nigeria should

disseminating the key messages from this important

not be an exception.⁸ Besides, neonatologists have a far

conference for the benefit of the readers of the journal

more limited role to play in the effective elimination of

and other stakeholders who could not attend the meet-

rhesus disease as championed by CURhE compared to

ing. We also commend the concerted efforts on many

obstetricians and public health practitioners. While the

fronts to advance the care of newborns in Nigeria

potential severity of haemolytic jaundice should be rec-

through global initiatives and collaborations.

ognised in all clinical settings, it is important for paedia-

tricians and child health specialists to disseminate and

However, we were deeply disturbed to read the sugges-

commit to evidence-based practices in advancing the

tion by one of the invited speakers at the conference, Dr.

interest of every newborn child in Nigeria building on

Vinod Bhutani from Stanford University, USA and co-

our local expertise generated over many decades of

founder of CURhE (Consortium for Universal Rhesus

dedicated research work.

Elimination), attributing the high rates of exchange

transfusions in Nigeria to the high prevalence of rhesus

incompatibility among newborns. This claim is mislead-

Conflict of interests: None

ing and unfounded based on the extensive body of litera-

Funding: None

ture on the burden of neonatal jaundice published in

Nigeria since 1960. Rather, available evidence clearly

shows that glucose-6-phosphate dehydrogenase (G6PD)

deficiency, (frequently exacerbated by exposure to ic-

terogenic agents or oxidant stressors such as insecti-

cides, menthol‑ based, naphthalene‑ camphor products,

sulfonamides or sulfa‑ containing drugs and herbal con-

coctions), ABO incompatibility and sepsis are the far

leading causes of haemolytic hyperbilirubinaemia re-

quiring exchange transfusion. Besides, there is no evi-

175

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