Results of Glucose-6-phosphate Dehydrogenase Deficiency Screening Related to Medical Expenses in Neonatal Hyperbilirubinemia: A Randomized Controlled Trial
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Abstract
BACKGROUND: Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) is one of the risk factors of hyperbilirubinemia neurotoxicity. Nevertheless, G6PD screening is inaccessible at general hospitals throughout Thailand. The threshold for initiation of phototherapy in infants with risks of hyperbilirubinemia neurotoxicity is lower than for infants without risk. Practically, newborn infants with unknown G6PD status would be assumed to have G6PD deficiency until proven otherwise. Therefore, unnecessary phototherapy and hospital costs occurs when infants are later found to be G6PD normal.
OBJECTIVES: To compare whether G6PD screening at birth from cord blood could decrease the early use of phototherapy and medical expenses.
METHODS: A single-blind randomized controlled trial was conducted in neonates born at 35 weeks of gestation or later at Burapha University Hospital between October 2021 and March 2022. Neonates were randomly assigned to either a cord blood G6PD screening group or control group. Infants’ medical expenses during 14 days of life were evaluated.
RESULTS: Two hundred forty-one neonates were randomized to either a cord blood G6PD screening group or control group. Two hundred thirty-nine neonates, including 121 in the cord blood G6PD screening group and 118 in the control group, completed the intervention. Total medical expenses during 14 days of life in the cord blood G6PD screening group was insignificantly higher than in the control group (425 vs 350 Baht, p=0.03). The number of neonates in the cord blood G6PD screening group who received phototherapy was lower than the control group (15.7% vs 22.9%, p=0.16). Among the neonates who received phototherapy, the subthreshold phototherapy rate in the cord blood G6PD screening group was significantly lower than in the control group (26.3% vs 66.7%, p=0.007).
CONCLUSIONS: G6PD deficiency screening at birth can decrease the subthreshold phototherapy rate but increase medical expenses.
Thaiclinicaltrials.org number, TCTR20220705006
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