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Tan LO, Tan MG, Poon WB. Lack of association between hypothyroxinemia of prematurity and transient thyroid abnormalities with adverse long term neurodevelopmental outcome in very low birth weight infants. PLoS One 2019; 14:e0222018. [PMID: 31513612 PMCID: PMC6742353 DOI: 10.1371/journal.pone.0222018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/20/2019] [Indexed: 01/25/2023] Open
Abstract
Introduction The association between hypothyroxinemia of prematurity with neurodevelopment was controversial. Objectives To compare 5 year neurodevelopmental outcomes of very low birth weight (VLBW) infants with hypothyroxinemia of prematurity against those without. Methods Retrospective cohort study in a single tertiary neonatal centre of VLBW infants born between the year 2008 to 2011. Comparisons were made between all abnormal and normal thyroid function controls using cord thyroid function tests, thyroid function tests during admission and pre-discharge thyroid function test done at term equivalent age. At 2 years corrected age, Bayley scales of infant and toddler development–third edition and Vineland II adaptive behaviour scales (VABS) were collected. At 5 years, Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), Bracken School Readiness Assessment, VABS and Beery Test of Visual-Motor Integration were collected. Results 110 subjects were studied at 2 years corrected age and 80 subjects at 5 years old. 29 infants had abnormal thyroid function test (10 infants with hypothyroxinemia of prematurity and 19 infants with transient thyroid abnormalities). There were no significant difference in the 2 years and 5 years developmental outcome between infants with and without hypothyroxinemia of prematurity (p-value>0.05); and between infants with and without transient thyroid abnormalities (p-value>0.05). There were no significant difference in neurological, visual and hearing impairment between infants with or without hypothyroxinemia of prematurity (p-value>0.05). Conclusions Hypothyroxinemia of prematurity or transient thyroid abnormalities in VLBW infants were not associated with poorer neurodevelopment and did not support the need for levothyroxine supplementation.
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Affiliation(s)
- Lay Ong Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Neonatal & Developmental Medicine, Singapore General Hospital, Singapore, Singapore
- * E-mail:
| | - Mary Grace Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Woei Bing Poon
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
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Ares S, Quero J, Diez J, Morreale de Escobar G. Neurodevelopment of preterm infants born at 28 to 36 weeks of gestational age: the role of hypothyroxinemia and long-term outcome at 4 years. J Pediatr Endocrinol Metab 2011; 24:897-902. [PMID: 22308839 DOI: 10.1515/jpem.2011.166] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
CONTEXT Hypothyroxinemia in premature neonates may affect long-term neurodevelopment. OBJECTIVE This study aimed to examine the effects of hypothyroxinemia of the newborn preterm infants born at 28-36 weeks of gestational age (GA) on the neurodevelopment at 4 years of age. PATIENTS Prospective observational cohort study conducted in Madrid, Spain. Forty-six preterm infants were included in the study. MAIN OUTCOME The effects of the exposure to neonatal hypothyroxinemia on mental development were examined. RESULTS Using regression analyses we found that neonatal T4 had a positive association with general cognitive index and Verbal index, and neonatal FT4 with general cognitive and Memory indexes at 4 years of age. CONCLUSIONS The exposure to hypothyroxinemia during the neonatal period of late preterm infants may play role in neurodevelopmental delays. Higher T4 level means a trend to higher indexes and low T4 level means a lower neurodevelopmental indexes at 4 years of age.
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Affiliation(s)
- Susana Ares
- Neonatology Unit, University Hospital La Paz, Madrid, Spain.
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Deming DD, Rabin CW, Hopper AO, Peverini RL, Vyhmeister NR, Nelson JC. Direct equilibrium dialysis compared with two non-dialysis free T4 methods in premature infants. J Pediatr 2007; 151:404-8. [PMID: 17889078 DOI: 10.1016/j.jpeds.2007.03.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 02/15/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the incidence of low free T4 values reported by a direct equilibrium dialysis method to their incidence reported by 2 non-dialysis methods. STUDY DESIGN Ninety-five infants, < or = 33 weeks gestational age at birth, admitted to Loma Linda University Children's Hospital before day 3 of life were studied. Infants were grouped by gestational age ranges: < or = 27, 28-30, and 31-33 weeks. Free T4 determinations were measured at 3, 7, and 14 days of life with 3 different free T4 methods. Gestational age-specific newborn reference ranges were available for the direct equilibrium dialysis method only. The only reference ranges available for the non-dialysis free T4 methods were not gestational age specific. Using available reference ranges we classified free T4 values as either low or not low. The incidence of low free T4 values was compared at 3, 7, and 14 days of life. RESULTS Low direct equilibrium dialysis free T4 values were substantially less frequent than non-dialysis free T4 values. CONCLUSION Substantial free T4 inconsistencies occur between dialysis and non-dialysis free T4 methods in preterm infants. It is unclear how much of this inconsistency is method dependent and how much is reference range dependent.
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Affiliation(s)
- Douglas D Deming
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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Abstract
Screening for thyroid hormone levels in the first week of life is extremely important to identify infants with CH. Worldwide neonatal screening programs have been successful in decreasing childhood mental retardation related to CH by early detection and treatment. To successfully screen for CH, nurses must understand how to draw blood that will yield valid results on the metabolic screening filter paper. It is also important for the nurse to understand that thyroid levels are normally decreased in preterm infants and that regular follow-up of those low thyroid levels is crucial because levels may return to normal and eventual treatment is necessary. Early follow-up testing and treatment are essential. A thyroid scan or ultrasonography is optional and decided on by evaluating the risk-benefit ratio.
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Sárközy G, Griesmaier E, He X, Kapelari K, Urbanek M, Simbruner G, Gressens P, Keller M. T3 replacement does not prevent excitotoxic cell death but reduces developmental neuronal apoptosis in newborn mice. Eur J Paediatr Neurol 2007; 11:129-35. [PMID: 17222575 DOI: 10.1016/j.ejpn.2006.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 11/26/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Periventricular leukomalacia (PVL) is a major cause of neurological handicap in pre-term infants. At present, there are no effective or causal therapies available. Thyroid hormones play an essential role in brain development and are reported to be decreased in pre-terms and following brain injury in adults. HYPOTHESIS Excitotoxic brain damage of newborn mice decreases thyroid hormone concentrations. Exogenous T3 administration restores thyroid hormone levels and reduces perinatal brain damage in an animal model of PVL. DESIGN AND METHOD To create white and gray matter (WM/GM) lesion mimicking several key aspects of PVL, we injected ibotenic acid (Ibo), a glutamate analog, into the right hemisphere (intracranially (i.c.)) of 5-day-old mice. T3 (10 microg/kg body weight (bw)) was injected intraperitoneally (i.p.) 1 h or repeatedly 1/24/48/72/96 h post-insult. We determined lesion size, number of apoptotic cells in WM/GM and serum T3/T4 concentration at 24 and 120 h after injury. Serum T3/T4 concentration was also determined before and 1 and 2h after T3 administration. RESULTS Excitotoxic brain damage did not alter serum T3/T4 concentrations within 120 h of injury. Serum T3 levels were distinctly elevated within 1 h of T3 injection; however, this elevation was relatively short-lived (half-life estimated to be less than 12 h). Neither single nor repetitive T3 treatment regimen reduced excitotoxic lesion size, but it did reduce apoptosis. CONCLUSIONS T3 replacement does not prevent excitotoxic cell death, but it does reduce developmental neuronal apoptosis, which could participate to the beneficial neuropsychological effects of hormone therapy. Further study is therefore warranted.
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Affiliation(s)
- Gergely Sárközy
- Department of Paediatrics IV, Neonatology, Neuropediatrics and Metabolic Diseases, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Austria
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Osborn DA, Hunt RW. Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2007; 2007:CD005948. [PMID: 17253571 PMCID: PMC9004229 DOI: 10.1002/14651858.cd005948.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Observational studies have shown an association between transiently low thyroid hormone levels in preterm infants in the first weeks of life (transient hypothyroxinaemia) and abnormal neurodevelopmental outcome. Thyroid hormone replacement might prevent this. OBJECTIVES To determine whether prophylactic thyroid hormones given to preterm infants without congenital hypothyroidism result in clinically important changes in neonatal and long term outcomes. SEARCH STRATEGY The standard search strategy of the Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 - March 2006), EMBASE, PREMEDLINE, and searches of abstracts of conference proceedings, citations of published articles and expert informants. SELECTION CRITERIA All trials using random or quasi-random patient allocation in which prophylactic thyroid hormone treatment was compared to control in premature infants. DATA COLLECTION AND ANALYSIS Assessment of trial quality, data extraction and synthesis of data, using relative risk (RR) and weighted mean difference (WMD), were performed using standard methods of the Cochrane Collaboration and its Neonatal Review Group. MAIN RESULTS Four studies enrolling 318 infants were included. All studies enrolled preterm infants on the basis of gestational age criteria. All studies commenced treatment in the first 48 hours, but used different regimens, dose and durations of treatment. All four studies used thyroxine (T4). Valerio 2004 incorporated one arm with an early short course of T3, then T4 for 6 weeks. Only two studies with neurodevelopmental follow-up were of good methodology (van Wassenaer 1997; Vanhole 1997). All studies were small with the largest (van Wassenaer 1997) enrolling 200 infants.No significant difference was found in neonatal morbidity, mortality or neurodevelopmental outcome in infants who received thyroid hormones compared to control. van Wassenaer 1997 reported no significant difference in abnormal mental development at 6, 12, 24 months (RR 0.67, 95% CI 0.28, 1.56) or five years (RR 0.66, 95% CI 0.22, 1.99) or cerebral palsy assessed at five years (RR 0.72, 95% CI 0.28, 1.84). Meta-analysis of two studies (van Wassenaer 1997, Vanhole 1997) found no significant difference in the Bayley MDI (WMD -1.14, 95% CI -5.46, 3.19) and PDI (WMD 0.22, 95% CI -4.80, 5.24) at 7 - 12 months. van Wassenaer 1997 reported no significant difference in the Bayley MDI (MD -3.50, 95% CI -11.21, 4.21) and PDI (MD 3.10, 95% CI -3.31, 9.51) at 24 months, IQ scores at 5 years (MD -2.10, 95% CI -7.91, 3.71) and children in special schooling at 10 years (RR 0.88, 95% CI 0.43, 1.83). Meta-analysis of all four trials found no significant difference in mortality to discharge (typical RR 0.76, 95% CI 0.46 to 1.24). van Wassenaer 1997 reported no significant difference in death or cerebral palsy at five years (RR 0.70, 95% CI 0.43 to 1.14). No significant differences were reported for neonatal morbidities, including the need for mechanical ventilation, duration of mechanical ventilation, air leak, CLD in survivors at 28 days or 36 weeks, intraventricular haemorrhage, severe intraventricular haemorrhage, periventricular leucomalacia, patent ductus arteriosus, sepsis, necrotising enterocolitis or retinopathy of prematurity. AUTHORS' CONCLUSIONS This review does not support the use of prophylactic thyroid hormones in preterm infants to reduce neonatal mortality, neonatal morbidity or improve neurodevelopmental outcomes. An adequately powered clinical trial of thyroid hormone supplementation with the goal of preventing the postnatal nadir of thyroid hormone levels seen in very preterm infants is required.
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Affiliation(s)
- D A Osborn
- Royal Prince Alfred Hospital, RPA Newborn Care, Missenden Road, Camperdown, New South Wales, Australia, 2050.
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Abstract
BACKGROUND Extremely premature infants are at risk of transient hypothyroxinaemia in the first weeks after birth. These low thyroid hormone levels are associated with an increased incidence of neonatal morbidity, mortality and longer term developmental impairments. Thyroid hormone therapy might prevent these problems. OBJECTIVES To determine the evidence for thyroid hormone therapy in preterm infants with transient hypothyroxinaemia (low thyroid hormone level, normal TSH) for improvement of neonatal outcomes and neurodevelopment. SEARCH STRATEGY Searches were performed of The Cochrane Central Register of Controlled (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 - March 2006), PREMEDLINE (March 2006), EMBASE (1980 - March 2006), previous reviews including cross references, abstracts and conference proceedings, supplemented by requests to expert informants. SELECTION CRITERIA Trials enrolling preterm infants with transient hypothyroxinaemia (low thyroid hormone level, normal TSH level) in the neonatal period, using random or quasi-random patient allocation to thyroid hormone therapy compared to control (placebo or no treatment). DATA COLLECTION AND ANALYSIS Independent assessment of trial quality and data extraction by each review author. Synthesis of data using relative risk (RR) and weighted mean difference (WMD) using standard methods of the Cochrane Collaboration and its Neonatal Review Group. MAIN RESULTS Only one study was eligible. Chowdhry (1984) enrolled 23 infants < 1250 g and 25 - 28 weeks gestation with transient hypothyroxinaemia (serum total T4 </=4 mug/dl and TSH </= 20 IU/L). Infants were randomised to thyroxine 10 mug/kg/day or placebo beginning on day 15 and continuing daily for seven weeks. Chowdhry (1984) reported no neonatal mortality and one infant death in each group prior to discharge. No significant difference was reported in CLD at 28 days or 36 weeks, patent ductus arteriosus, necrotising enterocolitis, retinopathy or prematurity, weight gain, growth in head circumference or length. No significant difference was reported for mean T4 levels between thyroxine and placebo treated infants on day 21, 35, 49, 63 and 77 after birth. Free T4 was not measured. Neurodevelopmental follow up was inadequate to draw any conclusions from. AUTHORS' CONCLUSIONS There is insufficient evidence to determine whether use of thyroid hormones for treatment of preterm infants with transient hypothyroxinaemia results in changes in neonatal morbidity and mortality, or reductions in neurodevelopmental impairments. Further research is required.
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Affiliation(s)
- D A Osborn
- Royal Prince Alfred Hospital, RPA Newborn Care, Missenden Road, Camperdown, New South Wales, Australia, 2050.
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Osborn DA, Hunt RW. Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd005948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Paul DA, Leef KH, Locke RG, Bartoshesky L, Walrath J, Stefano JL. Increasing illness severity in very low birth weight infants over a 9-year period. BMC Pediatr 2006; 6:2. [PMID: 16460568 PMCID: PMC1413532 DOI: 10.1186/1471-2431-6-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 02/06/2006] [Indexed: 11/29/2022] Open
Abstract
Background Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH. Methods Cohort study of 1414 VLBW infants cared for in a single level III neonatal intensive care unit in Delaware from 1993–2002. Infants were divided into consecutive 3-year cohorts. Illness severity was measured by two objective methods: the Score for Neonatal Acute Physiology (SNAP), based on data from the 1st day of life, and total thyroxine (T4), measured on the 5th day of life. Death before hospital discharge and severe intraventricular hemorrhage (IVH) were investigated in the study sample in relation to illness severity. The fetal death rate was also investigated. Statistical analyses included both univariate and multivariate analysis. Results Illness severity, as measured by SNAP and T4, increased steadily over the 9-year study period with an associated increase in severe IVH and the combined outcome of death and/or severe IVH. During the final 3 years of the study, the observed increase in illness severity accounted for 86% (95% CI 57–116%) of the variability in the increase in death and/or severe IVH. The fetal death rate dropped from 7.8/1000 (1993–1996) to 5.3/1000 (1999–2002, p = .01) over the course of the study. Conclusion These data demonstrate a progressive increase in illness in VLBW infants over time, associated with an increase in death and/or severe IVH. We speculate that the observed decrease in fetal death, and the increase in neonatal illness, mortality and/or severe IVH over time represent a shift of severely compromised patients that now survive the fetal time period and are presented for care in the neonatal unit.
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MESH Headings
- Birth Weight
- Cerebral Hemorrhage/classification
- Cerebral Hemorrhage/epidemiology
- Cohort Studies
- Delaware/epidemiology
- Female
- Fetal Death/epidemiology
- Gestational Age
- Humans
- Infant Mortality/trends
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/classification
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal
- Logistic Models
- Multivariate Analysis
- Pregnancy
- Prognosis
- Severity of Illness Index
- Survival Rate
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Affiliation(s)
- David A Paul
- Department of Pediatrics, Section of Neonatology, Christiana Care Health Services, Newark, DE, USA
- Department of Pediatrics, duPont Hospital for Children, Wilmington, DE, USA. Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kathleen H Leef
- Department of Pediatrics, Section of Neonatology, Christiana Care Health Services, Newark, DE, USA
| | - Robert G Locke
- Department of Pediatrics, Section of Neonatology, Christiana Care Health Services, Newark, DE, USA
- Department of Pediatrics, duPont Hospital for Children, Wilmington, DE, USA. Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Louis Bartoshesky
- Department of Pediatrics, duPont Hospital for Children, Wilmington, DE, USA. Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Judy Walrath
- Eugene duPont, Preventive Medicine and Rehabilitation Institute, Christiana Care Health Services, Newark, DE, USA
| | - John L Stefano
- Department of Pediatrics, Section of Neonatology, Christiana Care Health Services, Newark, DE, USA
- Department of Pediatrics, duPont Hospital for Children, Wilmington, DE, USA. Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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Rabin CW, Hopper AO, Job L, Peverini RL, Clark SJ, Deming DD, Nelson JC, Vyhmeister NR. Incidence of low free T4 values in premature infants as determined by direct equilibrium dialysis. J Perinatol 2004; 24:640-4. [PMID: 15306825 DOI: 10.1038/sj.jp.7211109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of transient reductions in serum free T(4) (FT(4)) in premature infants may be overestimated because certain FT(4) analytical methods underestimate FT(4) concentrations. Transient reductions of FT(4) measurements have been reported in the majority of premature newborn infants. Direct equilibrium dialysis (DED) does not underestimate FT(4) concentrations and is the best available technique to measure serum FT(4) in the premature infant. OBJECTIVE To evaluate the incidence of low FT(4) concentrations in premature infants using DED to measure FT(4). DESIGN/METHOD We measured FT(4) by DED in infants with birth weight <1500 g. Infants were excluded if the following conditions were present: congenital anomalies or maternal thyroid disorders. Free T(4) was measured at 14 days of life. Low FT(4) was defined using a statistical definition of FT(4) measurements <10.3 pmol/l (0.8 ng/dl). RESULTS Free T(4) was measured by DED in 114 infants. Low FT(4) levels were seen in nine infants (7.9%). CONCLUSION The incidence of low FT(4) was much lower than previously reported when FT(4) was measured using DED indicating that methodological issues are involved in the variability among estimates of the frequency of transient reduction in FT(4).
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Affiliation(s)
- Christopher W Rabin
- Department of Pediatrics, Coleman Pavilion Room 11121C, Loma Linda University School of Medicine, 11175 Campus Street, Coleman Pavilion, Suite 11121, Loma Linda, CA 92354, USA
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Kantor MJ, Leef KH, Bartoshesky L, Getchell J, Paul DA. Admission thyroid evaluation in very-low-birth-weight infants: association with death and severe intraventricular hemorrhage. Thyroid 2003; 13:965-9. [PMID: 14611706 DOI: 10.1089/105072503322511373] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine if thyroxine (T(4)) and thyrotropin (TSH) levels, measured at the time of admission to the neonatal intensive care unit, are associated with the outcomes of death and/or severe intraventricular hemorrhage (IVH). STUDY DESIGN Blood for total T(4) and TSH was obtained upon admission to the neonatal intensive care unit in infants with birthweights less than 1500 g. Infants were followed until hospital discharge. Statistical analysis included one-way analysis of variance, Pearson correlation, and logistic regression. Data are expressed as mean +/- standard deviation (SD). RESULTS One hundred twenty-two infants were enrolled. The mean gestational age of the study population was 27 +/- 2.8 weeks. Both T(4) (R = 0.25, p < 0.01) and TSH (R = 0.39, p < 0.01) at the time of admission correlated with gestational age. Infants who died and/or had severe IVH (n = 31) had lower T(4) (5.0 +/- 2.1 vs. 8.4 +/- 4.1 microg/dL, p < 0.01) and lower TSH (5.5 +/- 6.0 vs. 18.1 +/- 18.1 microIU/mL, p = 0.03) at the time of admission compared to infants who survived without severe IVH. After controlling for gestational age, low T(4) remained associated with an increased odds of death and/or severe IVH (odds ratio for every 1 microg/dL decrease in T(4): 1.4, 95% confidence interval 1.1-1.7). CONCLUSIONS Our data show that both low total T(4) and TSH, measured at the time of nursery admission, are associated with death and severe intraventricular hemorrhage. Our data suggest that it may be feasible to design a study of early T(4) supplementation to determine potential benefit in infants with the lowest T(4) values rather than treating based on associated factors such as gestational age.
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Affiliation(s)
- Michelle J Kantor
- Section of Neonatology, North Shore Medical Center, Miami, Florida, USA
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