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Zibitt M, Ange B, Wynter Z, Mundy C, Herrmann S, Stansfield BK. Hypothyroxinemia and weight velocity in preterm infants. J Pediatr Endocrinol Metab 2024; 37:236-242. [PMID: 38281180 DOI: 10.1515/jpem-2023-0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Hypothyroxinemia of prematurity (HOP) is characterized by low free thyroxine (FT4) associated with low or normal thyroid stimulating hormone (TSH). The objective of this study is to define FT4 and TSH values in very preterm infants (<32 weeks postmenstrual age, PMA) and correlate hypothyroxinemia and levothyroxine treatment with growth velocity at 28 days and 36 weeks PMA. METHODS Preterm neonates <32 weeks PMA admitted to the regional neonatal intensive care unit (NICU) at the Children's Hospital of Georgia (USA) between January 2010 and July 2022 were routinely screened for hypothyroxinemia. FT4 and TSH values were obtained on 589 eligible neonates between day of life (DOL) 4 and 14. Growth velocity (g/kg/day) from DOL 14 to DOL 28 and 36-weeks PMA were calculated for each neonate and potential explanatory variables (PMA, sex, and race) were incorporated into multivariate regression models to identify associations between HOP and growth velocity. RESULTS In 589 preterm infants, PMA at birth was strongly associated inversely with FT4 (R=0.5845) and modestly with TSH (R=0.2740). Both FT4 and gestational age, but not TSH or levothyroxine treatment, were associated with growth velocity at 28 days of life and at 36 weeks PMA. CONCLUSIONS We provide a large data set for identifying FT4 and TSH measurements and identify hypothyroxinemia of prematurity as a potential mediator of slow postnatal growth in very preterm infants.
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Affiliation(s)
- Meira Zibitt
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Brittany Ange
- Department of Surgery, Augusta University, Augusta, USA
- Department of Population Health Science, Augusta University, Augusta, GA, USA
| | - Zanna Wynter
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Cynthia Mundy
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Steve Herrmann
- Department of Pediatrics, Augusta University, Augusta, GA, USA
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Nolan B, Uy C, Stablein L, Bany-Mohammed F. Screening for Delayed Thyroid Stimulation Hormone Rise and Atypical Congenital Hypothyroidism in Infants Born Very Preterm and Infants with Very Low Birth Weight. J Pediatr 2024; 269:113974. [PMID: 38401790 DOI: 10.1016/j.jpeds.2024.113974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/24/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To determine among infants born very preterm (VPT) or with very low birth weight (VLBW) the incidence of alterations in thyroid function and associated comorbidities; the incidence of atypical congenital hypothyroidism (CH) requiring thyroxine therapy; and reference ranges for rescreening at 1 month of age. STUDY DESIGN A retrospective review of infants born VPT or with VLBW and admitted to UC Irvine Medical Center between January 1, 2012, and December 31, 2020. Repeat thyroid screening was obtained at 1 month of life (+10 days). Infants with thyroid-stimulating hormone (TSH) >5 μIU/mL or free thyroxine <0.8 ng/dL underwent follow-up testing and endocrinology consultation. Initial newborn screening (NBS) and repeat thyroid screening data were collected via chart review. Demographic data and short-term outcomes were abstracted from the California Perinatal Quality Care Collaborative database. RESULTS In total, 430 patients were included; 64 of 429 patients (14.9%) had TSH >5 μIU/mL and 20 of 421 patients (4.8%) had free thyroxine <0.8 ng/dL. Logistic regression analysis identified small for gestational age (P = .044), patent ductus arteriosus (P = .013), and late-onset sepsis (P = .026) as risk factors associated with delayed TSH rise. Atypical CH requiring treatment through neonatal intensive care unit discharge was diagnosed in 6 patients (incidence of 1.4%); none were identified by NBS. The 90th percentile TSH for infants with extremely low birth weight (<1000 g) was 7.2 μIU/mL, and the 95th percentile for those with birth weight of 1000-1500 g was 6.1 μIU/mL; using these cutoff values identified all infants diagnosed with atypical CH with 100% sensitivity and 90%-95% specificity. CONCLUSIONS Abnormal thyroid function is common in infants born preterm. Those infants, including some with atypical CH, are missed by NBS. We recommend repeat thyroid screening with TSH at 1 month of age in infants born VPT or infants with VLBW to identify CH that may require therapy.
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Affiliation(s)
- Bret Nolan
- Division of Neonatology, Department of Pediatrics, University of California Irvine, Orange, CA
| | - Cherry Uy
- Division of Neonatology, Department of Pediatrics, University of California Irvine, Orange, CA
| | - Lisa Stablein
- UC Irvine Medical Center High-Risk Infant Follow-up Program, Department of Pediatrics, University of California Irvine, Orange, CA
| | - Fayez Bany-Mohammed
- Division of Neonatology, Department of Pediatrics, University of California Irvine, Orange, CA.
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Chen S, Lu X, Yang B, Wu J, Huang H, Zou Y, Tang W, Xu P, Yang Y. Developmental Trends in Postnatal Thyroid Hormones and Thyroid Dysfunction in Preterm Infants Born at less than 34 weeks Gestation. Fetal Pediatr Pathol 2023:1-11. [PMID: 37053007 DOI: 10.1080/15513815.2023.2195520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To analyse the trends in thyroid function tests (TFT) in preterm infants, evaluate the frequency of thyroid dysfunction, and identify the factors that influence thyroid function. METHODS The TFT results and risk factors for thyroid dysfunction in preterm infants with gestational ages (GA) between 25 and 34 weeks were analysed. RESULTS In total, 535 infants were enrolled in this study. Thyroid hormone levels vary with gestational and postnatal age, and the total frequency of thyroid dysfunction is 50.3%. Thirty-one infants (5.8%) had delayed TSH elevation. Transient hypothyroxinaemia of prematurity remained significantly associated with both lower birth weight and GA. Congenital hypothyroidism was significantly associated with lower birth weight, 5 min Apgar score, and dopamine use. CONCLUSIONS Thyroid hormone levels in preterm infants are related to gestation and postnatal age, the frequency of thyroid dysfunction in premature infants is high, and is negatively correlated with GA and birth weight.
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Affiliation(s)
- Shaohong Chen
- Medical College of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Xiaoyan Lu
- Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Bicheng Yang
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Jieru Wu
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Hui Huang
- Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Wenyan Tang
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Ping Xu
- Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Yu Yang
- Medical College of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
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Campos-Martorell A, Montaner Ramon A, Narváez Barros K, Marin Soria JL, López Galera RM, Fernández DY, León MC. Thyroid Function in 509 Premature Newborns Below 31 Weeks of Gestational Age: Evaluation and Follow-up. J Clin Res Pediatr Endocrinol 2022; 14:453-462. [PMID: 35860376 PMCID: PMC9724057 DOI: 10.4274/jcrpe.galenos.2022.2022-2-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Preterm and low birth weight (LBW) neonates may present with thyroid dysfunction during a critical period for neurodevelopment. These alterations can be missed on routine congenital hypothyroidism (CH) screening which only measures thyroid stimulating hormone (TSH). The objective of this study was to evaluate a protocol for thyroid function screening (TFS) six years after national implementation. METHODS Serum TSH and free thyroxine (fT4) were measured during the second week of life in neonates below 31 weeks. Patients with abnormal TFS (fT4 <0.8 ng/dL and/or TSH >5 mU/L) were followed up with repeated tests until normal levels were reported. Patients who were still on levothyroxine (LT4) at three years of age were re-evaluated. RESULTS Five-hundred and nine neonates were included. Thyroid dysfunction was detected in 170 neonates (33%); CH n=20 (3.9%) including typical CH n=1; delayed TSH elevation CH n=19; hypothyroxinemia of prematurity (HOP) n=15 (2.9%); and transient hyperthyrotropinemia n=135 (26.5%). Twenty-one neonates (4.1%) were treated (20 for CH and 1 for HOP). At 3-year follow-up only three patients were diagnosed with permanent CH and still need treatment. LBW infants tended to have TSH levels higher than those with adequate weight. CONCLUSION This protocol was able to detect thyroid dysfunction in preterm neonates who were not identified by the current program based on TSH determination in whole-blood. This thyroid dysfunction seems to resolve spontaneously in a few months in the great majority of neonates, but in some cases LT4 could be needed. There is a critical need for specific guidelines regarding the follow-up and re-evaluation of transient CH in preterm neonates.
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Affiliation(s)
- Ariadna Campos-Martorell
- Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology, Barcelona, Spain,* Address for Correspondence: Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology, Barcelona, Spain E-mail:
| | | | | | - Jose Luis Marin Soria
- University of Barcelona, Spain School of Medicine, Neonatal Screening Program of Catalonia, Inborn Errors Metabolism Unit Biochemistry and Molecular Genetics Department Center for Biomedical Diagnosis (CDB) Hospital Clinic, Barcelona, Spain
| | - Rosa Maria López Galera
- University of Barcelona, Spain School of Medicine, Neonatal Screening Program of Catalonia, Inborn Errors Metabolism Unit Biochemistry and Molecular Genetics Department Center for Biomedical Diagnosis (CDB) Hospital Clinic, Barcelona, Spain
| | - Diego Yeste Fernández
- Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology; Vall d’Hebron Research Institute, Clinic of Paediatric Endocrinology, Barcelona, Spain
| | - María Clemente León
- Autonomous University of Barcelona, Vall d’Hebron University Hospital, Clinic of Pediatric Endocrinology; Vall d’Hebron Research Institute, Clinic of Paediatric Endocrinology, Barcelona, Spain
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Tang B, Ling Q, Yang Q, Li M, Shi W, Wu Q. How to survive a periviable birth baby with birth weight of 450g: A case report. Medicine (Baltimore) 2022; 101:e31356. [PMID: 36281089 PMCID: PMC9592289 DOI: 10.1097/md.0000000000031356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE An increasing number of periviable birth newborns (PVBs) have emerged with concurrent growing high-risk pregnancy. To date, postnatal management of PVBs remains one of the most challenging issues and limited studies have been reported. PATIENT CONCERNS A female baby born at 230/7 weeks of gestation with birth weight of 450g. DIAGNOSIS PVB baby, respiratory distress syndrome (RDS), ventilator associated pneumonia (VAP), intraventricular hemorrhage (IVH), metabolic bone disease of prematurity (MBDP), transient hypothyroxinemia of prematurity (THOP), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP). INTERVENTIONS Individualized treatment and intensive care, including neonatal resuscitation, effective respiratory and circulatory support, venous access and nutrition, prevention and treatment of infection, management of endocrine and metabolic problems, individualized nursing such as developmental supportive care, integrated oral motor interventions, skin care, family-integrated-care, etc were performed according to existing literature. OUTCOMES The baby was discharged home after 138 days of hospitalization with body weight of 2700 g, a full oral feed achieved, and without any requirement of respiratory support or oxygen supply. Now she is 38-month-old, with no significant long-term adverse sequelae. LESSONS Our case expands the experience and knowledges of individualized and intensive management of PVB babies in their early life days, which increase PVBs' survival and improves their prognosis.
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Affiliation(s)
- Binzhi Tang
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Qiying Ling
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Qian Yang
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Maojun Li
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Wei Shi
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Qing Wu
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Department of Pediatrics, Clinical College of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- *Correspondence: Qing Wu, Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No. 32 West Second Section First Ring Road, Chengdu 610072, Sichuan Province, China (e-mail: )
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Yoon SA, Chang YS, Yang M, Ahn SY, Sung SI, Cho HS, Park WS. Effect of levothyroxine supplementation in extremely low birth weight infants with transient hypothyroxinemia of prematurity. Sci Rep 2022; 12:9717. [PMID: 35690687 PMCID: PMC9188355 DOI: 10.1038/s41598-022-13927-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to determine the short- and/or long-term outcomes of levothyroxine replacement therapy in extremely low birth weight (ELBW) infants with transient hypothyroxinemia of prematurity (THOP). The medical records of 335 ELBW infants with THOP were reviewed retrospectively to identify whether levothyroxine treatment affects short- and/or long-term outcomes at a corrected age of 2 years. The infants were arbitrarily grouped based on thyroxine (T4) (free T4 [fT4]) levels into group 1 (n = 142), which included infants with T4 (fT4) levels < 2.5 (0.5) ng/dl, and group 2 (n = 193), which included those with T4 (fT4) levels ranging from ≥ 2.5 (0.5) ng/dl to < 4.5 (0.9) ng/dl. Levothyroxine replacement therapy was not associated with beneficial short- or long-term outcomes in ELBW infants with THOP. Short-term outcomes, such as mortality and composite morbidities, and long-term outcomes, such as failure to achieve catch-up height at a corrected age of 2 years, were significantly higher in group 1 than in group 2, regardless of levothyroxine treatment status. Levothyroxine replacement therapy is not associated with short-or long-term advantages in ELBW infants with THOP. This study suggests that the severity of THOP may be the major determinant of adverse outcomes in ELBW infants with THOP, rather than levothyroxine treatment.
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Affiliation(s)
- Shin Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 1 Sunhwan-ro 776, Seowon-gu, Cheongju, 28644, South Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Misun Yang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hee-Seung Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
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Postnatal Serum Total Thyroxine Level Associated with Short- and Long-Term Anthropometric Outcomes in Very Preterm Infants. Nutrients 2022; 14:nu14102056. [PMID: 35631197 PMCID: PMC9143878 DOI: 10.3390/nu14102056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Thyroxine (T4) importantly regulates the growth of newborns. Compared to fetuses with equivalent gestational ages, very preterm infants (VPIs) often experience relatively low thyroxinemia, with a normal thyroid-stimulating hormone (TSH) concentration < 10 μIU/mL. However, there is continued debate regarding postnatal thyroxine supplementation for VPIs with normal TSH and transitionally low thyroxinemia. Little research has explored the role of the postnatal total T4 (TT4) serum concentration on the growth of VPIs. In this study, we aim to clarify whether the postnatal thyroxine concentration is associated with the short- and long-term growth outcomes of VPIs. A total of 334 surviving VPIs in our previously reported cohort, born in the period August 2007−July 2016, were enrolled. The exposure variable was the postnatal TT4 concentration at 1 month old. The primary outcomes were body weight increments over 28 days after the screening and anthropometric outcomes at the corrected age of 24 months old. Infants with any hormonal replacement, severe brain injury, congenital anomaly, or cerebral palsy were excluded. In total, 290 (86.8%) VPIs were included for analysis. In the 28 days after thyroid function screening, the TT4 concentration was found to have a significant association with positive increments in body weight (mean increment: 25.7 g per 1 μg/dL; p < 0.001) and a positive body weight z-score (mean increment: 0.039 per 1 μg/dL; p = 0.037), determined by generalized estimating equation analysis. At the corrected age of 24 months old, a higher postnatal TT4 concentration was associated with a lower body mass index (mean coefficient: −0.136; 95% CI: −0.231 to −0.041, p = 0.005) and lower body mass index z-score (mean coefficient: −0.097; 95% CI: −0.170 to −0.024, p = 0.009). Infants with a TT4 concentration > 6.4 ug/dL had significantly lower odds of overweight status (odds ratio: 0.365; 95% CI: 0.177 to 0.754, p = 0.006). We conclude that the postnatal TT4 concentration is associated with a positive increment in body weight in the short term. At the same time, the postnatal TT4 concentration is associated with lower odds of overweight status after long-term follow-up.
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Montaner-Ramón A, Hernández-Pérez S, Campos-Martorell A, Ballesta-Anguiano M, Clemente-León M, Castillo-Salinas F. Thyroid function in < 32 weeks gestation preterm infants. An Pediatr (Barc) 2022; 96:130-137. [DOI: 10.1016/j.anpede.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 10/19/2022] Open
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Stawerska R, Nowak-Bednarek M, Talar T, Kolasa-Kicińska M, Łupińska A, Hilczer M, Gulczyńska E, Lewiński A. The prevalence of hypothyroxinemia in premature newborns. Front Endocrinol (Lausanne) 2022; 13:940152. [PMID: 36034431 PMCID: PMC9399394 DOI: 10.3389/fendo.2022.940152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
Congenital hypothyroidism diagnosed by TSH assessment in bloodspot screening may be overlooked in preterm newborns due to immaturity of the hypothalamus-pituitary-thyroid axis in them. The purpose of the study was to determine the prevalence and causes of hypothyroxinemia in preterm newborns, determined by TSH and FT4 serum concentration measurement, performed on the 3-5th day of life. We assessed TSH, FT4 and FT3 serum concentration on the 3-5th day of life in preterm children born at our centre within three consecutive years. We assessed the incidence of hypothyroxinemia, and its cause: primary hypothyroidism, secondary hypothyroidism or low FT4 syndrome - with normal TSH concentration, its dependence - among others - on gestational age (GA), birth body weight (BBW) and being SGA. A total of 525 preterm children were examined. FT4 concentration was decreased in 14.9% of preterm newborns. The most frequent cause of hypothyroxinemia was low FT4 syndrome (79.5%). More than 92% cases of hypothyroxinemia occurred in children born before the 32nd week and/or with BBW below 1500 g. Thus, every fourth child in these groups had a reduced FT4 concentration. Neonates with hypothyroxinemia were significantly lighter than those with normal FT4. In older and heavier neonates with hypothyroxinemia, serious congenital defects were observed. Neither IVH nor SGA nor twin pregnancies predispose children to hypothyroxinemia. Among newborns with untreated hypothyroxinemia in whom TSH and FT4 assessment was repeated within 2-5 weeks, a decreased FT4 concentration was confirmed in 56.1% of cases. As hypothyroxinemia affects 25% of newborns born before the 32nd week of gestation and those in whom BBW is less than 1500g, it seems that in this group of children the newborn screening should be extended to measure serum TSH and FT4 concentration between the 3-5th day of life. In older and heavier neonates, additional serum TSH and FT4 assessment should be limited to children with severe congenital abnormalities but not to all SGA or twins. Despite the fact that the most common form of preterm hypothyroxinemia is low FT4 syndrome, it should be emphasized that FT4 remains lowered on subsequent testing in more them 50% of cases.
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Affiliation(s)
- Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Paediatric Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Marzena Nowak-Bednarek
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Tomasz Talar
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Marzena Kolasa-Kicińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
| | - Anna Łupińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Paediatric Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Maciej Hilczer
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
| | - Ewa Gulczyńska
- Department of Neonatology, Intensive Therapy and Neonatal Pathology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial - Hospital Research Institute, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- *Correspondence: Andrzej Lewiński,
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Klosinska M, Kaczynska A, Ben-Skowronek I. Congenital Hypothyroidism in Preterm Newborns - The Challenges of Diagnostics and Treatment: A Review. Front Endocrinol (Lausanne) 2022; 13:860862. [PMID: 35370986 PMCID: PMC8972126 DOI: 10.3389/fendo.2022.860862] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/23/2022] [Indexed: 12/26/2022] Open
Abstract
Preterm newborns are forced to adapt to harsh extrauterine conditions and endure numerous adversities despite their incomplete growth and maturity. The inadequate thyroid hormones secretion as well as the impaired regulation of hypothalamus-pituitary-thyroid axis may lead to hypothyroxinemia. Two first weeks after birth are pivotal for brain neurons development, synaptogenesis and gliogenesis. The decreased level of thyroxine regardless of cause may lead to delayed mental development. Congenital hypothyroidism (CH) is a disorder highly prevalent in premature neonates and it originates from maternal factors, perinatal and labor complications, genetic abnormalities, thyroid malformations as well as side effects of medications and therapeutic actions. Because of that, the prevention is not fully attainable. CH manifests clinically in a few distinctive forms: primary, permanent or transient, and secondary. Their etiologies and implications bear little resemblance. Therefore, the exact diagnosis and differentiation between the subtypes of CH are crucial in order to plan an effective treatment. Hypothyroxinemia of prematurity indicates dynamic changes in thyroid hormone levels dependent on neonatal postmenstrual age, which directly affects patient's maintenance and wellbeing. The basis of a successful treatment relies on an early and accurate diagnosis. Neonatal screening is a recommended method of detecting CH in preterm newborns. The preferred approach involves testing serum TSH and fT4 concentrations and assessing their levels according to the cut-off values. The possible benefits also include the evaluation of CH subtype. Nevertheless, the reference range of thyroid hormones varies all around the world and impedes the introduction of universal testing recommendations. Unification of the methodology in neonatal screening would be advantageous for prevention and management of CH. Current guidelines recommend levothyroxine treatment of CH in preterm infants only when the diagnose is confirmed. Moreover, they underline the importance of the re-evaluation among preterm born infants due to the frequency of transient forms of hypothyroidism. However, results from multiple clinical trials are mixed and depend on the newborn's gestational age at birth. Some benefits of treatment are seen especially in the preterm infants born <29 weeks' gestation. The discrepancies among trials and guidelines create an urgent need to conduct more large sample size studies that could provide further analyses and consensus. This review summarizes the current state of knowledge on congenital hypothyroidism in preterm infants. We discuss screening and treatment options and demonstrate present challenges and controversies.
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Metabolic-endocrine disruption due to preterm birth impacts growth, body composition, and neonatal outcome. Pediatr Res 2022; 91:1350-1360. [PMID: 34040160 PMCID: PMC9197767 DOI: 10.1038/s41390-021-01566-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023]
Abstract
Despite optimized nutrition, preterm-born infants grow slowly and tend to over-accrete body fat. We hypothesize that the premature dissociation of the maternal-placental-fetal unit disrupts the maintenance of physiological endocrine function in the fetus, which has severe consequences for postnatal development. This review highlights the endocrine interactions of the maternal-placental-fetal unit and the early perinatal period in both preterm and term infants. We report on hormonal levels (including tissue, thyroid, adrenal, pancreatic, pituitary, and placental hormones) and nutritional supply and their impact on infant body composition. The data suggest that the premature dissociation of the maternal-placental-fetal unit leads to a clinical picture similar to panhypopituitarism. Further, we describe how the premature withdrawal of the maternal-placental unit, neonatal morbidities, and perinatal stress can cause differences in the levels of growth-promoting hormones, particularly insulin-like growth factors (IGF). In combination with the endocrine disruption that occurs following dissociation of the maternal-placental-fetal unit, the premature adaptation to the extrauterine environment leads to early and fast accretion of fat mass in an immature body. In addition, we report on interventional studies that have aimed to compensate for hormonal deficiencies in infants born preterm through IGF therapy, resulting in improved neonatal morbidity and growth. IMPACT: Preterm birth prematurely dissociates the maternal-placental-fetal unit and disrupts the metabolic-endocrine maintenance of the immature fetus with serious consequences for growth, body composition, and neonatal outcomes. The preterm metabolic-endocrine disruption induces symptoms resembling anterior pituitary failure (panhypopituitarism) with low levels of IGF-1, excessive postnatal fat mass accretion, poor longitudinal growth, and failure to thrive. Appropriate gestational age-adapted nutrition alone seems insufficient for the achievement of optimal growth of preterm infants. Preliminary results from interventional studies show promising effects of early IGF-1 supplementation on postnatal development and neonatal outcomes.
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Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome. Nutrients 2021; 13:nu13041055. [PMID: 33805038 PMCID: PMC8064055 DOI: 10.3390/nu13041055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
Primary congenital hypothyroidism is a disease associated with low serum thyroxine and elevated thyroid-stimulating hormone (TSH) levels. The processes of screening and treating congenital hypothyroidism, in order to prevent neurodevelopmental impairment (NDI) in newborns, have been well investigated. Unlike term infants, very preterm infants (VPIs) may experience low thyroxine with normal TSH levels (<10.0 μIU/mL) during long-stay hospitalization. In the current literature, thyroxine treatment has been evaluated only for TSH-elevated VPIs. However, the long-term impact of low thyroxine levels in certain VPIs with normal TSH levels deserves more research. Since July 2007, VPIs of this study unit received screenings at 1 month postnatal age (PNA) for serum TSH levels and total thyroxine (TT4), in addition to two national TSH screenings scheduled at 3–5 days PNA and at term equivalent age. This study aimed to establish the correlation between postnatal 1-month-old TT4 concentration and long-term NDI at 24 months corrected age among VPIs with serial normal TSH levels. VPIs born in August 2007–July 2016 were enrolled. Perinatal demography, hospitalization morbidities, and thyroid function profiles were analyzed, and we excluded those with congenital anomalies, brain injuries, elevated TSH levels, or a history of thyroxine treatments. In total, 334 VPIs were analyzed and 302 (90.4%) VPIs were followed-up. The postnatal TT4 concentration was not associated with NDI after multivariate adjustment (odd ratios 1.131, 95% confidence interval 0.969–1.32). To attribute the NDI of TSH-normal VPIs to a single postnatal TT4 concentration measurement may require more research.
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Montaner-Ramón A, Hernández-Pérez S, Campos-Martorell A, Ballesta-Anguiano M, Clemente-León M, Castillo-Salinas F. [Thyroid function in < 32 weeks gestation preterm infants]. An Pediatr (Barc) 2020; 96:S1695-4033(20)30485-9. [PMID: 33358353 DOI: 10.1016/j.anpedi.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Preterm newborns (PN) have a higher risk of thyroid dysfunction than term newborns (TN). This condition may go unnoticed in neonatal screening due to a late elevation of thyrotropin (TSH) in these patients. OBJECTIVE Evaluate thyroid function in the second week of life in PN of < 32 weeks gestation (WG), and to identify factors associated to its alteration. PATIENTS AND METHODS A retrospective study was performed in neonates of < 32 weeks gestation (WG), in whom thyroid function was determined. An analysis was performed on thyroxine (T4L) and TSH levels, as well as their association with perinatal and neonatal outcomes. RESULTS The study included a total of 358 patients with mean gestational age (GA) of 29.3 weeks, and mean birth weight (BW) 1127 grams. A linear correlation was found between T4L and BW (correlation coefficient (R) 0.356; p < 0.001) and GA (R = 0.442; p < 0.001). TSH values were associated with small for gestational age (SGA 5.3 mU/L [1.5-37]; non-SGA 2.89 mU/L [0.2-19.5]; p < 0.001), inotropic support (Yes 3.98 mU/L [0.6-22.9]; No 3.16 mU/L [0.2-37]; p = 0.019) and BW (R = -0.249; p < 0.001). Nine (2.5%) patients were treated with levothyroxine, of whom six were SGA. CONCLUSIONS Thyroid function analysis in the second week of life helps to identify asymptomatic newborns with risk of thyroid dysfunction. SGA newborns are at higher risk of thyroid function alterations.
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Affiliation(s)
- Alicia Montaner-Ramón
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España.
| | - Susana Hernández-Pérez
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | - Ariadna Campos-Martorell
- Unidad de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | | | - María Clemente-León
- Unidad de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | - Félix Castillo-Salinas
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
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Saeidinejat S, Ghaemi Belhouri N, Attarian F. Assessment of intelligence quotient score in children at the age of six with suspected congenital hypothyroidism: A retrospective cohort study. Med J Islam Repub Iran 2020; 34:117. [PMID: 33315974 PMCID: PMC7722976 DOI: 10.34171/mjiri.34.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical suspicion of Congenital Hypothyroidism (CH) is identified by abnormal results in the first test of Thyroid Stimulating Hormone (TSH) (5-9.9 mIU/L), and normal results in re-test (TSH<4 mIU/L). The CH has a contribution to physical and mental health. This study aimed to determine the Intelligence Quotient (IQ) score in children with suspected congenital hypothyroidism.
Methods: This research is a retrospective cohort study conducted in Mashhad, Iran. The IQ scores of 1976 children at the age of 6 were considered as an outcome variable. The history of CH screening for each newborn was assessed, then all suspected CH newborns that diagnosed healthy in re-test were considered as an exposed group, the effects of this situation on IQ score was assessed using logistic regression. All analysis was performed in STATA.
Results: The averages of IQ score (p<0.001), weight (p=0.024), and height (p<0.001) in the exposed group were lower than the unexposed group. The exposed group was related to those whose parental education was less or equal to 12 years (p<0.001). Similarly, the history of CH and maternal education for ≤12 years were detected as risk factors for having an IQ score of <90 in children.
Conclusion: Aside from the link between parental education and clinical suspicion of CH in neonates, our findings underline the possible strong effect of CH status and maternal education for ≤12 years on reducing IQ scores in the next years of child life.
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Affiliation(s)
- Shahin Saeidinejat
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nosrat Ghaemi Belhouri
- Department of Pediatric Endocrinology and Metabolism, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fahimhe Attarian
- Student Research Committee, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Chung HR. Screening and management of thyroid dysfunction in preterm infants. Ann Pediatr Endocrinol Metab 2019; 24:15-21. [PMID: 30943675 PMCID: PMC6449615 DOI: 10.6065/apem.2019.24.1.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022] Open
Abstract
Preterm infants can suffer various thyroid dysfunctions associated with developmental immaturity of the hypothalamic-pituitary-thyroid axis, postnatal illness, medications, or iodine supply. The incidence of thyroid dysfunction among preterm infants is higher than that among term infants and has been increasing with improvement in the survival of preterm infants. Hypothyroxinemia is frequently observed during the first week of life in extreme preterm neonates, and the incidence of delayed thyrotropin elevation is high at the age of 2-6 weeks. Although the necessity of routine rescreening remains controversial, recent guidelines on screening for congenital hypothyroidism have recommended rescreening of all preterm neonates. Thyroid hormone replacement is recommended for persistent thyrotropin elevation with or without hypothyroxinemia. Hypothyroxinemia without thyrotropin elevation does not require treatment, and some potential risks of levothyroxine supplementation have been reported. Although most thyroid dysfunctions are transient, careful follow-up after discontinuation of levothyroxine is considered so as to avoid missing persistent hypothyroidism.
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Affiliation(s)
- Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea,Address for correspondence: Hye Rim Chung, MD Department of Pediatrics, Seoul National Universit y Bundang Hospital, 82, Gumi-ro 173 Beongil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7289 Fax: +82-31-787-4054 E-mail:
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