Chinese Medicine, 2010, 1, 55-57
doi:10.4236/cm.2010.12011 Published Online September 2010 (http://www.SciRP.org/journal/cm)
Prevalence of Glucose-6-Phosphate Dhydrogenase
Deficient Neonates and Cost Effective of Enzyme Screening
in Tehran, Iran
Hossein Dahifar1, Aboulfazl Ghorbani2, Manijeh Ghods3
1Associate Professor of Shaheed Beheshti University Medical Sciences and Health Services
Shohada Hospital, Pediatric-Department, Tajrish Sq, Tehran, Iran
2Booali Hospital, Pathology Department, Marivan, Iran
3Medical microbiology, Sandwell and West Birmingham Hospital, Birmingham, England
Received May 28, 2010; revised July 14, 2010; accepted July 26, 2010
Abstract
Background: Newborn screening is an area with potential for immense impact in lifelong morbidity and
mortality. Objective: To determine cost effective for glucose-6-phosphate dehydrogenase (G-6-PD) enzyme
screening and prevalence of deficiency in newborns and children in Tehran, Iran. Materials and Methods:
All full term newborns, neonates with icterus and children with acute hemolysis were evaluated to determine
prevalence of G-6-PD enzyme deficiency and cost effectiveness of a screening test for G-6-PD enzyme defi-
ciency. The qualitative color reduction test performed on healthy newborns and quantitative test on newborns
with icterus and children with acute hemolysis. Results: Three (2%) of 146 screened newborns were G-6-PD
deficient at a cost of $ 18 for three positive screening tests and $ 856 for 143 unaffected newborns Thirty-one
(11.4%) of 272 newborns readmitted with icterus were G-6-PD deficient with a cost of 31 tests were $186
and $1446 for unaffected newborns. The only significant difference between G-6-PD deficient and normal
newborns was bilirubin level (p < 0.001). Eleven (0.2%) of 5054 hospitalized children were found to be
G-6-PD deficient at a screening cost of $ 66 and $ 3.258 for remainder children. The prevalence of G-6-PD
is estimated to be approximately 2.4% and 2.2% in males and females respectively. Conclusion: Glucose-6-
phosphate dehydrogenase screening in newborns is not cost effective and for prevention of hemolysis during
the next years all newborns admitted with icterus should be evaluated for G-6-PD enzyme deficiency.
Keywords: Screening, Newborns, G-6-PD
1. Introduction
Mass newborn screening is the second type of prospec-
tive care. It is a very important issue for all physicians
caring for neonates because it combines a number of
significant medical and legal issues. One of the medical
requirements of an acceptable mass screening program
for a specific disease is that the test should be simple and
inexpensive [1]. One of the accepted but less widely
practiced screening test is for G-6-PD enzyme deficiency
recommended by WHO expert group [2]. In addition,
recommendation of WHO is all newborns should be car-
ried out screening in area with a prevalence of G 6 PD
deficiency of 3-5% or more in males.[3] In the United
States, there are significant state-to-state differences in
the disorders that are included in initial newborn screen-
ing, the methods of screening, and follow up [4].
Distribution of the G-6-PD deficiency varies among
different population reflecting geographic and ethnic
variations. Each society is unique and must make its own
choices in neonatal screening based on its economy,
epidemiology and ethnics. We have decided to determine
prevalence of G-6-PD enzyme deficiency and whether or
not G-6-PD screening in newborns is economically ef-
fective.
2. Materials and Methods
This prospective study was conducted in Tehran, Iran, at
Aria Hospital and Tehran Children Hospital, including
neonates born in Aria Hospital from April 2006 through
March 2007. After obtaining the informed consent from

H. DAHIFAR ET AL. 56
one parent enrolled neonates were screened for G-6-PD
enzyme level. Similarly enrolled newborns with icterus
and hospitalized children with acute hemolisis were
screened.
The qualitative color reduction G-6-PD screening test
(Kit Saba Laboratory (Tehran, Iran)) was performed on
all healthy newborns before hospital discharge. Results
were reported as normal or deficient. The quantitative
test (kit chem. Enzyme) was performed on children with
acute hemolysis and newborns with icterus with results
reported in IU/gHb (normal range 7.5-14.5 IU/gHb). We
economically compared morbidity (rate of readmission
of newborns with jaundice) and children with symptoms
of pallor, dark urine, icterus, abdominal pain (acute
hemolysis) with G-6-PD screening test results of new-
borns.
3. Results
During the entire study period, a total of 146 (33.8%) of
431 uncomplicated full term or near term newborns (82
males) with a mean birth weight of 3278.4 g born at Aria
hospital were screened for G-6-PD enzyme. Of these,
3(2%) that all were male newborn were G-6-PD deficient
at a rate of 20 per 1000 live newborns. The cost of
G-6-PD for every one newborn is about $6 or $6000 per
1000 newborns. A total of 5054 children with different
chief complaints and ages were hospitalized at Tehran
Children Hospital over the period, of these, 11(0.2%) or
2 per 1000 hospitalized children with icterus, pallor, dark
urine and abdominal pain (acute hemolysis) had con-
sumed fava beans within two days. Of these, 7(63.6%) of
11 children were males. The mean first blood hemoglo-
bin level was 7.8g% and G-6-PD test revealed deficiency.
Eight (72.7%) of 11 children were transfused and re-
mainder received supportive therapy and all were dis-
charged after two nights. The cost of two nights hospi-
talization for one patient with parent is about $140 or
$1540 for 11 patients. Screening of 5054 patients cost
$30324. The cost of hospitalization of 2 per 1000 chil-
dren with G-6-PD deficiency is $280 and the cost of
screening 1000 children is $6000. The comparison of
cost of 1000 G-6-PD screening with two deficient per
1000 children is very expensive and is not economical.
On the other hand, 31(11.4%) of 272 icteric newborns
(13 males) who were admitted over the same period were
G-6-PD deficient and 6 (19.3%) of 31 newborns (3 fe-
males) recieved exchange transfusion. The prevalence of
G-6-PD deficiency is approximately 2.4% and 2.2% in
male and female newbornbs respectively and characteris-
tics of newborns are shown in Table 1. The only signifi-
cant difference between normal and deficient G-6-PD
newborns is bilirubin level (p < 0.001). There is no sta-
tistically significant difference between exchange trans-
Table 1. Characteristics and laboratory examination of
newborns with jaundice.
Normal
G-6-PD G-6-PD
deficient
Normal
G-6-PD
Exchange
transfused
G-6-PD
deficient
Exchange
transfused
Total No 236 13 31 6
Males 121 6 18 3
Females 115 7 13 3
Age / day 8.6 5.7 6.4 4.9
Hemoglobin
g% 14 15.9 15.4 17.4
Reticulo-
cytes% 0.9 1.7 1.2 1.2
Bilirubin
mg% 15.9 27 21.6 28.4
The numbers are defined as mean
fused newborns with normal G-6-PD and deficient new-
borns.
4. Discussion
In the current study we showed cost of G-6-PD screening
in uncomplicated healthy full term newborns. In icteric
neonates associated with G-6-PD deficiency their jaun-
dice can not be related only to G-6-PD deficiency but
confounding factors such as breast milk, or poor nursing
technique and perinatal factors such as maternal diabetes,
induced or augumented labor, superimposed on G-6-PD
deficiency may exacerbate hyperbilirubinemia, treatment
costs, duration of hospitalization and need for exchange
transfusion.
Clearly, the fact that a G-6-PD deficient infant also
develops hyperbilirubinemia or kernicterus does not
mean that G-6-PD deficiency was the primary cause of
the severe hyperbilirubinemia [5]. In our study such con-
founders can-not be defined and we can not attribute all
hyperbilirubinemia to G-6-PD deficiency. In our study,
G-6-PD deficiency in newborns or children does not in-
duce morbidity or mortality such as mental retardation or
other irreversible clinical manifestation. The most com-
mon clinical manifestations of G-6-PD deficiency is
neonatal jaundice and acute hemolytic anemia in children
related to medications such as Chinese remedies, naph-
thalene, henna, fava and oxidant drugs particularly in
Iran, henna, feva bean, naphthalene, aspirin and infection.
The only clinical manifestation in our newborns with
G-6-PD deficiency was bilirubin level higher than nor-
mal G-6-PD newborns Table 1. Routine screening of all
newborns will not identify every affected G-6-PD defi-
cient newborns. The male G-6-PD deficient infants will
be detected, but many heterozygot females will be
missed [6]. In our study, all newborns screened for

H. DAHIFAR ET AL. 57
G-6-PD deficiency were males. There were not differ-
ences between hemoglobin level and number of reticu-
locytes on automated differential in G-6-PD deficient
and normal G-6-PD newborns. We do not have evidence
of hemolysis in newborns. Although it has previously
been shown that G-6-PD deficiency can induce kernic-
terus as a complication of G-6-PD deficiency associated
neonatal jaundice in many population groups [7] our
study did not demonstrate any kernicterus in newborns
with jaundice. Our study demonstrated prevalence of
G-6-PD deficiency approximately 2.4% in males and it is
versus of recommendation of WHO [3]. Given that in
this study only 0.2% of young children were admitted
with acute hemolysis from fava bean ingestion. If we
compare them with children due to gastroenteritis with
prevalence of approximately 41% is extremely low [8].
In comparison the cost of newborn screening is also low.
Currently, to our knowledge, newborn G-6-PD screening
is not performed in the other provinces of Iran and the
prevalence of G-6-PD deficiency in north, south, east
and west provinces should be different and I hope to be
determined by other investigators.
5. Conclusions
This study demonstrated that global G-6-PD enzyme
screening in newborns in Tehran, Iran for prevention of
hemolysis following ingestion some drugs, fava beans or
simultaneous with infection during the next years is not
economically feasible. We suggest all newborns with
jaundice should be evaluated for G-6-PD enzyme defi-
ciency and that prevalence of deficiency in all provinces
of Iran should be determined before establishing a uni-
versal Iranian G-6-PD deficiency screening program.
6. Acknowledgements
We thank Mrs Manijeh Hejazi and Miss Mojgan Moosavi
for their assistances.
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