Safety of Ibuprofen in Children With <scp>G6PD</scp> Deficiency: A Systematic Review
Bibliographic record
Abstract
INTRODUCTION: Ibuprofen is included on websites and frequently referenced lists as medium risk for inducing hemolysis in children with glucose-6-phosphate dehydrogenase (G6PD) deficiency. This presents a challenge for otolaryngologists who perform tonsillectomy and other surgeries in children, as ibuprofen serves as an important alternative to opioids for perioperative pain control. We systematically review published literature and national medication databases to evaluate the risk of hemolytic anemia and related complications when ibuprofen is used in children with G6PD deficiency. METHODS: Systematic literature review using preferred reporting items for systematic reviews and meta-analyses methodology. National drug adverse reaction database inquiry. RESULTS: Our search yielded 774 results for review consideration. Of these, three studies were included in our final analysis (two retrospective case-series, and one nonrandomized prospective study). The prospective study showed no evidence of hemolysis from perioperative exposure to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) in children with G6PD deficiency at high risk. Two population studies in the Middle East suggested extremely low incidence of ibuprofen-related hemolysis (approximate 1/100,000 affected children per year). United States Food and Drug Administration (FDA), European Medicine Agency, and Health Canada adverse drug reaction databases reveled reported ibuprofen-related hematologic adverse reactions of approximate 1/100 million affected children per year. CONCLUSIONS: There is scant, low-quality evidence of hemolytic anemia caused by ibuprofen in children with G6PD deficiency. If an association does exist, it is extremely rare. Drug-induced hemolytic anemias are recognizable and reversible following discontinuation of the inciting medication. Given these low risks, ibuprofen should be considered an appropriate choice in the management of perioperative pain in children with G6PD deficiency. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1300-1305, 2022.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.008 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".