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Hemolysis and dat positivity

Journal of Perinatology (2025)Cite this article

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We read with great interest the report of Wells et al., in which end tidal CO values, corrected for ambient CO (ETCOc) were compared with DAT positivity in the assessment of hemolysis for the management of neonatal hyperbilirubinemia [1]. It is remarkable that 8.4% (84/999) of infants in this study who were either DAT negative or who did not have their DAT evaluated, did have ETCOc levels ≥2.5 ppm (95th percentile), indicative of significant hemolysis.

It is unfortunate that causes of hemolysis, other than DAT positivity, were not taken into account in the management of these newborns. This is of especial clinical concern, considering that close to 50% of the study population were African American. African Americans have a male frequency of G6PD-deficiency of 11-13%. Affected newborns have a high incidence of severe neonatal hyperbilirubinemia, some of whom suffer permanent neurological damage due to bilirubin neurotoxicity [2]. Furthermore, both carboxyhemoglobin and ETCOc studies have shown these newborns to have an inherently higher rate of hemolysis than G6PD-adequate controls. G6PD-deficiency could, therefore, explain some of the cases of increased hemolysis [3, 4].

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References

  1. Wells S, Balasubramanian R, Nguyen K, Schutzman DL. End-tidal carbon monoxide for routine monitoring of significant hemolysis in the management of newborn hyperbilirubinemia. J Perinatol. 2025.

  2. Kaplan M, Kassirer Y, Hammerman C. Controversies in our understanding of extreme hyperbilirubinemia in glucose-6-phosphate dehydrogenase-deficient neonates. Pediatr Res. 2024.

  3. 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;93:822–7.

    Article  CAS  PubMed  Google Scholar 

  4. Kaplan M, Herschel M, Hammerman C, Hoyer JD, Stevenson DK. Hyperbilirubinemia among African American, glucose-6-phosphate dehydrogenase-deficient neonates. Pediatrics. 2004;114:e213–19.

    Article  PubMed  Google Scholar 

  5. Kemper AR, Newman TB, Slaughter JL, Maisels MJ, Watchko JF, Downs SM, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022;150:e2022058859.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

    Michael Kaplan & Cathy Hammerman

  2. Faculty of Medicine of the Hebrew University, Jerusalem, Israel

    Michael Kaplan & Cathy Hammerman

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  1. Michael Kaplan
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  2. Cathy Hammerman
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Michael Kaplan, MB ChB, conceived, wrote, edited and finalized this Letter. Cathy Hammerman, MD, reviewed, edited and approved the Letter.

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Correspondence to Michael Kaplan.

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Ethics approval was not applicable to this manuscript which is a letter to the editor, relating to a previously published paper performed by other authors and in another institution and country. The authors of this letter to the editor did not perform a study, or include human or animial subjects, and did not perform randomization. There was therefore no need to approach an Institutional Review Board.

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Kaplan, M., Hammerman, C. Hemolysis and dat positivity. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02305-1

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