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Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children

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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.

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Figure 1

Abbreviations

G6PD:

Glucose-6-Phosphate Dehydrogenase

STB:

Total Serum Bilirubin STB

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Funding

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Authors and Affiliations

Authors

Contributions

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.

All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Alexis Chenouard.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

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.

Additional information

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

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