Application of povidone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency

The effects of topical iodine containing antiseptics on thyroidal status and early neurodevelopment of preterm infants

OBJECTIVES

The goal of this study was to determine the quality of these disinfectants' effects on thyroid function and neurological scores in premature newborns aged 28 to 36 gestational weeks (GW).

METHODS

This cohort study was conducted from October 2020 to September 2021 among 28-36 GW preterm infants at the neonatal care unit of Jiangnan University Hospital. We divided this 12 month period into two consecutive 6 month periods. Composite iodine disinfectants and alcohol are used for skin and umbilical cord disinfection of preterm infants, respectively. Urinary iodine concentration (UIC), thyroid hormone levels, and neonatal behavioral and neurological assessment (NBNA) scores were determined in both groups.

RESULTS

A total of 126 patients were included in the study, 65 in the iodine exposed group and 61 in the alcohol group. The second UIC and the incidence of serum T4≤5 μg/dL and TSH≥10 mIU/L in the iodine exposed group were significantly higher than those in the alcohol group (p<0.05). The first NBNA score was lower in the iodine exposed group than in the alcohol group (p<0.05). However, whether it has clinical significance remains to be explored. There was a linear relationship between the two NBNA scores (iodine exposure group, R ²=0.344; alcohol group, R ²=0.227). No sepsis or other adverse outcomes occurred in the two groups of preterm infants after disinfection with different disinfectants.

CONCLUSIONS

Iodine-containing disinfectants seem to have the potential to cause an increased rate of thyroid dysfunction and a decreased neurological score and should be evaluated in further studies.

Prevalence of insufficient iodine intake in pregnancy worldwide: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES

Iodine deficiency in pregnant women is related to impaired foetal growth and development. The objective of this study was to estimate the prevalence of insufficient iodine intake in pregnant women from different regions of the world.

SUBJECTS/METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and Google Scholar grey literature were searched until 10 April 2021. Two reviewers independently conducted article selection, data extraction, and assessment of the risk of bias. Meta-analyses with random effects, subgroup analyses, and meta-regressions were performed.

RESULTS

In total, 4639 observational articles were found, with 61 eligible for inclusion. The population consisted of 163,021 pregnant women adults and adolescents, and the overall prevalence of insufficient iodine intake was 53% (95% confidence interval [CI]: 47-60; I² = 99.8%). Pregnant women who live in insufficient iodine status country had a higher prevalence (86%; 95% CI: 78-93; I² =97.0%) of inadequate iodine nutritional status than to those living in country considered sufficient (51%; 95% IC: 45-57; I² = 99.8%).

CONCLUSION

Despite the progress in iodine fortification policies and periodic monitoring of the iodine nutritional status of the population worldwide, salt iodination alone may not be sufficient to provide adequate iodine status to pregnant women. Thus, other actions may be necessary to improve the nutritional clinical care of pregnant group.

Combined use of thyroid stimulating hormone plus free thyroxine levels and gestational age at birth for the prediction of neonatal hypothyroidism and associated risk factors

The present study aimed to explore the effectiveness of the combined use of thyroid-stimulating hormone (TSH) and free thyroxine [(FT4); TSH+FT4] levels and gestational age at birth to predict neonatal hypothyroidism and to identify the risk factors associated with the disease. The clinical data of 686 neonates with suspected hypothyroidism (TSH >10 mIU/l) who were admitted to The First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. From these, 70 neonates with confirmed hypothyroidism were assigned to the patient group and another 70 neonates with normal thyroid function to the normal (control) group. Sex, gestational age at birth, Apgar score, birth weight, body length, head circumference and heart rate data were collected. TSH and FT4 levels were measured by electrochemiluminescence immunoassay, and the predictive value of combined use of TSH+FT4 and gestational age at birth on neonatal hypothyroidism was analyzed. The prespecified secondary outcomes were the risk factors for neonatal hypothyroidism determined using univariate and logistic regression analyses. TSH levels were significantly higher, whereas FT4 levels were lower in the patient group at 3 days of age compared with the control group (P<0.05). After 8-week treatment with thyroxine, these levels were not significantly different between the patient and control groups (P<0.05). The combined use of TSH+FT4 levels and gestational age at birth to predict neonatal hypothyroidism demonstrated a significantly improved sensitivity, specificity, accuracy, positive predictive value and negative predictive value (92.86, 97.26, 96.76, 81.25 and 99.07%, respectively) compared with the use of only TSH+FT4 levels (P<0.05). Logistic regression analysis revealed a low gestational age at birth, maternal thyroid dysfunction and low birth weight were risk factors for neonatal hypothyroidism (P<0.05). The combined use of TSH+FT4 levels and gestational age at birth resulted in an improved prediction of neonatal hypothyroidism and contributed to early therapeutic intervention. Thus, special intervention is necessary for pregnant women with thyroid dysfunction to reduce the incidence of neonatal hypothyroidism.

Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era

OBJECTIVES

Approaches to nasal and oral decontamination with povidone-iodine (PVP-I) have been published to reduce nosocomial spread of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). The safety of PVP-I topically applied to the nasal and oral cavity is addressed by a literature review. The specific efficacy of PVP-I against coronaviruses and its potential efficacy against SARS-CoV-2 is discussed.

METHODS

A review was performed utilizing PubMed and Cochrane Databases. All citations in protocols for nasal and oral PVP-I use regarding COVID-19 were independently reviewed.

RESULTS

Povidone-iodine has been safely administered for up to 5 months in the nasal cavity and 6 months in the oral cavity. Concentrations less than 2.5% in vitro do not reduce ciliary beat frequency or cause pathological changes in ciliated nasal epithelium, upper respiratory, or mucosal cells. Adverse events with oral use have not been reported in conscious adults or children. Allergy and contact sensitivity is rare. Chronic mucosal use up to 5% has not been shown to result in clinical thyroid disease. PVP-I is rapidly virucidal and inactivates coronaviruses, including SARS-CoV and Middle East Respiratory Syndrome (MERS).

CONCLUSIONS

Povidone-iodine can safely be used in the nose at concentrations up to 1.25% and in the mouth at concentrations up to 2.5% for up to 5 months. Povidone-iodine rapidly inactivates coronaviruses, including SARS and MERS, when applied for as little as 15 seconds. There is optimism that PVP-I can inactivate SARS-CoV-2, but in vitro efficacy has not yet been demonstrated.