UGT1A1*6 mutation associated with the occurrence and severity in infants with prolonged jaundice

Assessment of the clinical significance of a UGT1A1 gene variant in affecting phototherapy response and long-term outcomes in neonatal hyperbilirubinemia

OBJECTIVE

Phototherapy is the standard treatment, but its efficacy can vary among neonates, prompting interest in genetic factors, particularly UGT1A1 gene variants. This study aims to evaluate the clinical significance of the UGT1A1 gene variant in influencing phototherapy response and long-term outcomes in neonatal hyperbilirubinemia.

METHODS

This retrospective study included 104 neonates with neonatal hyperbilirubinemia, of whom 63 carried the normal UGT1A1 gene, and 41 had the homozygous UGT1A1 Gly71Arg variant. Genetic testing for the UGT1A1 gene Gly71Arg locus had been previously conducted as part of their clinical care using DNA extraction and sequencing. Parameters such as phototherapy duration, complications, and long-term outcomes were analyzed to assess the correlation between the UGT1A1 gene variant and clinical results. Furthermore, the impact of the UGT1A1 gene variant was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Neonates with the UGT1A1 gene variant showed prolonged phototherapy duration, extended time to bilirubin normalization, increased phototherapy complications, higher phototherapy intensity, and more excellent rehospitalization rates for hyperbilirubinemia. The presence of the UGT1A1 gene variant correlated with specific complications, including dehydration, hypoglycemia, and hyperbilirubinemia. Additionally, infants with the UGT1A1 gene variant had significantly higher rates of developmental delay, cerebral palsy, hearing impairment, neurodevelopmental disorders, and severe hyperbilirubinemia-related morbidities. Mean peak bilirubin levels were significantly higher in the variant compared with the normal group. ROC analysis demonstrated moderate to strong sensitivities and specificities with area under the curve (AUC) values ranging from 0.693 to 0.830.

CONCLUSION

We found that a UGT1A1 gene variant significantly affects phototherapy response and can impact long-term outcomes in neonatal hyperbilirubinemia, highlighting the potential of genetic testing for personalized risk assessment and management of hyperbilirubinemia in newborns.

Genetic variation features of neonatal hyperbilirubinemia caused by inherited diseases

BACKGROUND

Genetic factors play an important role in neonatal hyperbilirubinemia (NH) caused by genetic diseases.

AIM

To explore the characteristics of genetic mutations associated with NH and analyze the correlation with genetic diseases.

METHODS

This was a retrospective cohort study. One hundred and five newborn patients diagnosed with NH caused by genetic diseases were enrolled in this study between September 2020 and June 2023 at the Second Affiliated Hospital of Xiamen Medical College. A 24-gene panel was used for gene sequencing to analyze gene mutations in patients. The data were analyzed via Statistical Package for the Social Sciences 20.0 software.

RESULTS

Seventeen frequently mutated genes were found in the 105 patients. Uridine 5'-diphospho-glucuronosyltransferase 1A1 (UGT1A1) variants were identified among the 68 cases of neonatal Gilbert syndrome. In patients with sodium taurocholate cotransporting polypeptide deficiency, the primary mutation identified was Na+/taurocholate cotransporting polypeptide Ntcp (SLC10A1). Adenosine triphosphatase 7B (ATP7B) mutations primarily occur in patients with hepatolenticular degeneration (Wilson's disease). In addition, we found that UGT1A1 and glucose-6-phosphate dehydrogenase mutations were more common in the high-risk group than in the low-risk group, whereas mutations in SLC10A1, ATP7B, and heterozygous 851del4 mutation were more common in the low-risk group.

CONCLUSION

Genetic mutations are associated with NH and significantly increase the risk of disease in affected newborns.

Prolonged Jaundice in a Premature Breastfed Infant With Gilbert's Syndrome

INTRODUCTION

Neonatal jaundice and prematurity pose significant barriers to breastfeeding in the first days of life. There is limited literature exploring the relationship between prolonged jaundice in breastfed infants and Gilbert's (Meulengraght) syndrome. This case study describes the diagnostic and therapeutic challenges associated with Gilbert's syndrome in a late preterm breastfed infant born in Germany.

MAIN ISSUE

In this case report, an infant born to a primipara woman presented at 3 weeks postpartum to an International Board Certified Lactation Consultant. The initial assessment revealed a late preterm infant with inadequate weight gain and jaundice. The dyad received breastfeeding support and eventually achieved adequate weight gain; however, the infant's jaundice persisted.

MANAGEMENT

The consulting midwife suggested that the persistent jaundice was "breastmilk jaundice" and recommended temporarily interrupting breastfeeding. Due to a suspected family history of Gilbert's Syndrome, the dyad was referred, instead, to a pediatric gastroenterologist. Pathologic liver disease was excluded, and genetic testing confirmed Gilbert's Syndrome. At 6 months of age, the dyad was successfully breastfeeding and beginning complementary feeding.

CONCLUSION

Genetic testing for Gilbert's Syndrome should be considered for infants with prolonged jaundice and positive family history. Interruption or cessation of breastfeeding are not evidence-based recommendations, and current guidelines do not support these practices. Lactation professionals play a critical role in the management of breastfeeding for preterm infants with prolonged jaundice and should refer to specialists to rule out pathologic etiologies.