Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect often presenting with neonatal jaundice and/or hemolytic anemia. G6PD hemolytic events are linked with exposure to a pro-oxidant agent. We here report three cases of initial G6PD crises in breastfed children secondary to maternal consumption of a tonic drink which contains quinine. Quinine was found in breast milk of one of the mothers after she consumed tonic water.
Conclusion: The amount of quinine that is transmitted through breast milk appears to be sufficient to induce G6PD crises in breastfed children. We hence recommend that consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency.
What is Known: • G6PD hemolytic events are linked with exposure to a pro-oxidant agent. • Ingestion of fava beans by a mother who was breastfeeding has been reported to induce a neonatal G6PD crisis. |
What is New: • Maternal consumption of tonic drink which contains quinine appears to be sufficient to induce G6PD crises in breastfed children. • Maternal consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency. |
Abbreviations
- G6PD:
-
Glucose-6-Phosphate Dehydrogenase
- STB:
-
Total Serum Bilirubin STB
References
Beutler E (1959) The hemolytic effect of primaquine and related compounds: a review. Blood 14:103–139
Bhutani VK, Johnson L, Sivieri EM (1999) Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 103:6–14
Cappellini MD, Fiorelli G (2008) Glucose-6-phosphate dehydrogenase deficiency. Lancet 371:64–74
Johnson L, Bhutani VK, Karp K, Sivieri EM, Shapiro SM (2009) Clinical report from the pilot USA Kernicterus Registry (1992 to 2004). J Perinatol 29(Suppl 1):S25–S45
Kaplan M, Vreman HJ, Hammerman C, Schimmel MS, Abrahamov A, Stevenson DK (1998) Favism by proxy in nursing glucose-6-phosphate dehydrogenase-deficient neonates. J Perinatol 18:477–479
Lalloo DG, Shingadia D, Bell DJ, Beeching NJ, Whitty CJ, Chiodini PL (2016) UK malaria treatment guidelines 2016. J Inf Secur 72:635–649
Phillips RE, Looareesuwan S, White NJ, Silamut K, Kietinun S, Warrell DA (1986) Quinine pharmacokinetics and toxicity in pregnant and lactating women with falciparum malaria. Br J Clin Pharmacol 21:677–683
Watchko JF, Tiribelli C (2013) Bilirubin-induced neurologic damage—mechanisms and management approaches. N Engl J Med 369:2021–2030
White NJ (1985) Clinical pharmacokinetics of antimalarial drugs. Clin Pharmacokinet 10:187–215
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Dr. Bichali, Dr. Brault, Dr. Masserot, Dr. Boscher, Dr. Couec, Dr. Deslandes, Dr. Pissard, Dr. Leverger, Dr. Vauzelle, Dr. Elefant, Pr Rozé, Dr. Cortey and Dr. Chenouard contributed to the clinical treatment of the patients and the writing of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Communicated by Peter de Winter
Suggested reviewers
Maria Domenica Cappellini, University of Milan, Milan, Italy (maria.cappellini@unimi.it)
Vinod Bhutani, Stanford University School of Medicine, Stanford, California, United States (bhutani@stanford.edu)
Gilles Cambonie, Montpellier University Hospital, Montpellier, France (g-cambonie@chu-montpellier.fr)
Michael Sgro, University of Toronto, Toronto, Canada (sgrom@smh.toronto.on.ca)
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Bichali, S., Brault, D., Masserot, C. et al. Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children. Eur J Pediatr 176, 1415–1418 (2017). https://doi.org/10.1007/s00431-017-2998-5
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DOI: https://doi.org/10.1007/s00431-017-2998-5