A Multi-Center Retrospective Database Evaluation of Pediatric Subjects Diagnosed With Methemoglobinemia

Neha Sinha; Brooke Lichak; Neal J Thomas; Conrad Krawiec

doi:10.1177/11795565241271678

A Multi-Center Retrospective Database Evaluation of Pediatric Subjects Diagnosed With Methemoglobinemia

Clin Med Insights Pediatr. 2024 Sep 19:18:11795565241271678. doi: 10.1177/11795565241271678. eCollection 2024.

Authors

Neha Sinha¹, Brooke Lichak², Neal J Thomas^{1

3}, Conrad Krawiec¹

Affiliations

¹ Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA, USA.
² Yale New Haven Children's Hospital, New Haven, CT, USA.
³ Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.

Abstract

Background: Methemoglobinemia requires early identification and treatment, but limited knowledge exists regarding the current therapeutic approach taken by clinicians as well as the outcomes that occur in children.

Objectives: To determine the current prevalence of this rare disease in the pediatric population, evaluate the impact of methemoglobin and functional hemoglobin levels, and assess how this disease is approached by clinicians. We hypothesize that methemoglobinemia prevalence is low and more methylene blue use would be observed in subjects with functional hemoglobin levels less than 7 g/dL.

Design: This was a retrospective observational cohort study utilizing deidentified TriNetX^® electronic health record (EHR) data.

Methods: Using a multicenter EHR database, we evaluated subjective characteristics, diagnostic, laboratory results, medication, and procedural codes.

Results: Ninety-eight children (mean age 5.3 ± 5.3 years) from 53 healthcare organizations were included. Methemoglobinemia prevalence was 0.0015% with an overall 30-day mortality of 6.1%. Subjects with methemoglobin percentages greater than 20% had a higher frequency of methylene blue administration (70.6% versus 24.7%, P = .0005). Critical care service requirements and methylene blue administration were similar in the subjects with functional hemoglobin less than 7 g/dL and more than 7 g/dL groups. Overall, 13 (13.2%) subjects underwent glucose-6-phosphate dehydrogenase deficiency (G6PD) testing.

Conclusion: In our study, we found methemoglobinemia prevalence in children is low, there is a low frequency of G6PD testing despite methylene blue hemolysis risk, and subjects appeared to be treated similarly despite a low functional hemoglobin. These findings highlight the continued critical nature of this disease and may highlight opportunities for education aimed at improving care in children diagnosed with methemoglobinemia, particularly related to G6PD testing.

Keywords: Hypoxia; critical care; methemoglobinemia; pediatrics.