Download PDF
Am J Perinatol 2019; 36(14): 1510-1513
DOI: 10.1055/s-0039-1678556
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Methemoglobinemia Associated with Late-Onset Neonatal Sepsis: A Single-Center Experience

Ingrid Anne Mandy Schierz
1   Neonatal Intensive Care Unit, AOUP “P. Giaccone,” Department of Sciences for Health Promotion and Mother and Child Care “G. D'Alessandro,” University of Palermo, Palermo, Italy
,
Giuseppa Pinello
1   Neonatal Intensive Care Unit, AOUP “P. Giaccone,” Department of Sciences for Health Promotion and Mother and Child Care “G. D'Alessandro,” University of Palermo, Palermo, Italy
,
Ettore Piro
1   Neonatal Intensive Care Unit, AOUP “P. Giaccone,” Department of Sciences for Health Promotion and Mother and Child Care “G. D'Alessandro,” University of Palermo, Palermo, Italy
,
Mario Giuffrè
1   Neonatal Intensive Care Unit, AOUP “P. Giaccone,” Department of Sciences for Health Promotion and Mother and Child Care “G. D'Alessandro,” University of Palermo, Palermo, Italy
,
Giovanni Corsello
1   Neonatal Intensive Care Unit, AOUP “P. Giaccone,” Department of Sciences for Health Promotion and Mother and Child Care “G. D'Alessandro,” University of Palermo, Palermo, Italy
› Author Affiliations Funding None.
Further Information

Publication History

23 October 2018

26 December 2018

Publication Date:
01 February 2019 (online)

    Permissions and Reprints

Abstract

Objective Methemoglobinemia (MetHb) is a rare congenital or acquired cause of infantile cyanosis. We examined the role of MetHb in a neonatal intensive care unit (NICU).

Study Design A retrospective observational study was conducted reviewing blood gas analyses of hospitalized newborns over a 2-year period. MetHb-positive patients (MetHb >1.8%) were matched with a control group for gestational age, weight, disease, and illness severity at admission. Maternal, neonatal, clinical, and laboratory parameters were collected and analyzed in both groups.

Results MetHb incidence was 6%. The mean MetHb in the case group was 7.2%, and the first positive samples were observed at a mean of 22 days of life, 6 days prior to clinical or culture-proven sepsis. We identified low maternal age (31 vs. 34 years; p = 0.038), sepsis (90 vs. 45%; p = 0.022), and protracted parenteral nutrition (46 vs. 23 days; p = 0.013) as risk factors for MetHb, and early minimal enteral feeding as protective factor (12th vs. 9th day; p = 0.038).

Conclusion MetHb has a high occurrence in NICU and can be a helpful prognostic indicator of an infectious process. Understanding and prompt identification of MetHb can allow pediatricians to implement a life-saving therapy.

Keywords

observational study - cyanosis - anemia - hypoxia - newborn
 

  • References

  • 1 Skold A, Cosco DL, Klein R. Methemoglobinemia: pathogenesis, diagnosis, and management. South Med J 2011; 104 (11) 757-761
    CrossrefPubMedGoogle Scholar
  • 2 Umbreit J. Methemoglobin--it's not just blue: a concise review. Am J Hematol 2007; 82 (02) 134-144
    CrossrefPubMedGoogle Scholar
  • 3 DomBourian M, Ezhuthachan A, Kohn A, Berman B, Sykes E. A 5-hour-old male neonate with cyanosis. Lab Med 2015; 46 (01) 60-63
    CrossrefPubMedGoogle Scholar
  • 4 Hanukoglu A, Danon PN. Endogenous methemoglobinemia associated with diarrheal disease in infancy. J Pediatr Gastroenterol Nutr 1996; 23 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 5 Mérieau E, Suc AL, Beau-Salinas F, Norbert K, Saliba E, Cantagrel S. Metoclopramide and neonatal methaemoglobinemia [in French]. Arch Pediatr 2005; 12 (04) 438-441
    CrossrefPubMedGoogle Scholar
  • 6 Lepe-Zúñiga JL, Aguilar-Gómez LE, Godínez-Téllez NC. Association of benzocaine and paracetamol with neonatal-acquired methemoglobinemia [in Spanish]. Bol Méd Hosp Infant México 2015; 72 (04) 271-275
    PubMedGoogle Scholar
  • 7 Vohra R, Huntington S, Koike J, Le K, Geller RJ. Pediatric exposures to topical benzocaine preparations reported to a statewide poison control system. West J Emerg Med 2017; 18 (05) 923-927
    CrossrefPubMedGoogle Scholar
  • 8 Kuiper-Prins E, Kerkhof GF, Reijnen CG, van Dijken PJA. A 12-day-old boy with methemoglobinemia after circumcision with local anesthesia (lidocaine/prilocaine). Drug Saf Case Rep 2016; 3 (01) 12
    CrossrefPubMedGoogle Scholar
  • 9 Shamriz O, Cohen-Glickman I, Reif S, Shteyer E. Methemoglobinemia induced by lidocaine-prilocaine cream. Isr Med Assoc J 2014; 16 (04) 250-254
    PubMedGoogle Scholar
  • 10 Greer FR, Shannon M. ; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Committee on Environmental Health. Infant methemoglobinemia: the role of dietary nitrate in food and water. Pediatrics 2005; 116 (03) 784-786
    CrossrefPubMedGoogle Scholar
  • 11 Krafte-Jacobs B, Brilli R, Szabó C, Denenberg A, Moore L, Salzman AL. Circulating methemoglobin and nitrite/nitrate concentrations as indicators of nitric oxide overproduction in critically ill children with septic shock. Crit Care Med 1997; 25 (09) 1588-1593
    CrossrefPubMedGoogle Scholar
  • 12 Ohashi K, Yukioka H, Hayashi M, Asada A. Elevated methemoglobin in patients with sepsis. Acta Anaesthesiol Scand 1998; 42 (06) 713-716
    CrossrefPubMedGoogle Scholar
  • 13 Davidson D, Barefield ES, Kattwinkel J. , et al; The I-NO/PPHN Study Group. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. Pediatrics 1998; 101 (3 Pt 1): 325-334
    CrossrefPubMedGoogle Scholar
  • 14 Société Francaise d'Anesthésies et de Rianimation. Ressources et utilitaires. Available at: https://sfar.org/scores2/snap22.php . Accessed September 30, 2018
    PubMedGoogle Scholar
  • 15 Hjelt K, Lund JT, Scherling B. , et al. Methaemoglobinaemia among neonates in a neonatal intensive care unit. Acta Paediatr 1995; 84 (04) 365-370
    CrossrefPubMedGoogle Scholar
  • 16 Miyazono Y, Hirono A, Miyamoto Y, Miwa S. Erythrocyte enzyme activities in cord blood of extremely low-birth-weight infants. Am J Hematol 1999; 62 (02) 88-92
    CrossrefPubMedGoogle Scholar
  • 17 Yadegarian A, Zipkin R, Qawasmi A. , et al. Index of suspicion. Pediatr Rev 2014; 35 (07) 311-317
    CrossrefPubMedGoogle Scholar
  • 18 Avery A, L'hirondel JL. Nitrate and methemoglobinemia. Environ Health Perspect 2003; 111 (03) A142-A143
    PubMedGoogle Scholar
  • 19 Mutlu M, Erduran E, Aslan Y. Acquired methemoglobinemia in infants. Turk J Haematol 2011; 28 (02) 131-134
    PubMedGoogle Scholar
  • 20 Gala HC, Madave A. An unusual case of neonatal methemoglobinemia. Indian Pediatr 2017; 54 (02) 163
    PubMedGoogle Scholar
  • 21 Burke KA, Lascelles J. Nitrate reductase system in Staphylococcus aureus wild type and mutants. J Bacteriol 1975; 123 (01) 308-316
    CrossrefPubMedGoogle Scholar