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BMC Pediatrics
Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | Sectio Ceasarea | Research article

Thyroid dysfunction in preterm infants born before 32 gestational weeks

Authors: Hye-Rim Kim, Young Hwa Jung, Chang Won Choi, Hye Rim Chung, Min-Jae Kang, Beyong Il Kim

Published in: BMC Pediatrics | Issue 1/2019

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Abstract

Background

Thyroid hormones are critical for growth and brain development during the newborn period and infancy. Because of delayed maturation of the hypothalamic-pituitary-thyroid axis in preterm infants, thyroid dysfunction is common, and thyroid stimulating hormone (TSH) elevation is often delayed in preterm infants. The objective of this study was to determine the incidence of thyroid dysfunction requiring levothyroxine treatment and to identify its risk factors in preterm infants.

Methods

A retrospective cohort study was performed on preterm infants who were born before 32 gestational weeks and admitted to a single tertiary academic center for more than 8 weeks between January 2008 and December 2014. In these infants, serial thyroid function tests (TFTs) measuring serum TSH and free thyroxine (fT4) were routinely performed at 1, 3, and 6 weeks of postnatal age.

Results

Of the 220 preterm infants enrolled, 180 infants underwent TFTs at 1, 3, and 6 weeks of postnatal age and were included in the study. Of the 180 infants, 35 infants (19.4%) were started on levothyroxine treatment based on the results of serial TFTs. Among the 35 infants who were treated with levothyroxine, 16 infants (45.7%) had normal results on the initial TFT. Three of these 16 infants continued to have normal results on the second TFT. Thyroid dysfunction requiring levothyroxine treatment was significantly associated with maternal pregnancy-induced hypertension (adjusted odds ratio 2.64, 95% confidence interval 1.02–6.81).

Conclusions

Thyroid dysfunction requiring levothyroxine treatment occurred in nearly one-fifth of preterm infants born before 32 gestational weeks. Nearly half of the preterm infants who were treated with levothyroxine had normal TSH and fT4 levels at 1 week of postnatal age. The findings of the present study suggest that serial TFTs is important to find preterm infants who require levothyroxine treatment.
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Literature
1.
Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010;5:17.CrossRef
2.
Van Wassenaer AG, Kok JH. Hypothyroxinaemia and thyroid function after preterm birth. Semin Neonatol. 2004;9:3–11.CrossRef
3.
Uhrmann S, Marks KH, Maisels MJ, Friedman Z, Murray F, Kulin HE, et al. Thyroid function in the preterm infant: a longitudinal assessment. J Pediatr. 1978;92:968–73.CrossRef
4.
Delahunty C, Falconer S, Hume R, Jackson L, Midgley P, Mirfield M, et al. Levels of neonatal thyroid hormone in preterm infants and neurodevelopmental outcome at 5 1/2 years: millennium cohort study. J Clin Endocrinol Metab. 2010;95:4898–908.CrossRef
5.
Dilli D, Eras Z, Andiran N, Dilmen U, Sakrucu ED. Neurodevelopmental evaluation of very low birth weight infants with transient hypothyroxinemia at corrected age of 18-24 months. Indian Pediatr. 2012;49:711–5.CrossRef
6.
LaFranchi SH. Newborn screening strategies for congenital hypothyroidism: an update. J Inherit Metab Dis. 2010;33(2):225–33.CrossRef
7.
Zung A, Bier Palmon R, Golan A, Troitzky M, Eventov-Friedman S, Marom R, et al. Risk factors for the development of delayed TSH elevation in neonatal intensive care unit newborns. J Clin Endocrinol Metab. 2017;102(8):3050–5.CrossRef
8.
Chung HR, Shin CH, Yang SW, Choi CW, Kim BI, Kim EK, et al. High incidence of thyroid dysfunction in preterm infants. J Korean Med Sci. 2009;24:627–31.CrossRef
9.
Scratch SE, Hunt RW, Thompson DK, Ahmadzai ZM, Doyle LW, Inder TE, et al. Free thyroxine levels after very preterm birth and neurodevelopmental outcomes at age 7 years. Pediatrics. 2014;133:e955–63.CrossRef
10.
Larson C, Hermos R, Delaney A, Daley D, Mitchell M. Risk factors associated with delayed thyrotropin elevations in congenital hypothyroidism. J Pediatr. 2003;143:587–91.CrossRef
11.
Vigone MC, Caiulo S, Di Frenna M, Ghiradello S, Corbetta C, Mosca F, et al. Evolution of thyroid function in preterm infants detected by screening for congenital hypothyroidism. J Pediatr. 2014;164(6):1296–302.CrossRef
12.
Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723–9.CrossRef
13.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.CrossRef
14.
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187(1):1–7.CrossRef
15.
The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123(7):991–9.CrossRef
16.
Murphy N, Hume R, van Toor H, Matthews TG, Ogston SA, Wu SY, et al. The hypothalamic-pituitary thyroid axis in preterm infants;changes in the first 24 hours of postnatal life. J Clin Endocrinol Metab. 2004;89:2824–31.CrossRef
17.
Tylek-Lemanska D, Kumorowicz-Kopiec M, Starzyk J. Screening for congenital hypothyroidism: the value of retesting after four weeks in neonates with low and very low birth weight. J Med Screen. 2005;12:166–9.CrossRef
18.
Lee JH, Kim SW, Jeon GW, Sin JB. Thyroid dysfunction in very low birth weight preterm infants. Korean J Pediatr. 2015;58:224–9.CrossRef
19.
Kaluarachchi DC, Colaizy TT, Pesce LM, Tansey M, Klein JM. Congenital hypothyroidism with delayed thyroid-stimulating hormone elevation in premature infants born at less than 30 weeks gestation. J Perinatol. 2017;37:277–82.CrossRef
20.
Rose SR, Brown RS, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, et al. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics. 2006;117:2290–303.CrossRef
21.
Mandel SJ, Hermos RJ, Larson CA, Prigozhin AB, Rojas DA, Mitchell ML. Atypical hypothyroidism and the very low birthweight infant. Thyroid. 2000;10:693–5.CrossRef
22.
Leger J, Olivieri A, Donaldson M, Torresani T, Krude H, Van Vilet G, et al. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014;99(2):363–84.CrossRef
23.
Fisher DA. Thyroid function and dysfunction in premature infants. Pediatr Endocrinol Rev. 2007;4:317–28.PubMed
24.
Zung A, Yehieli A, Blau A, Almashanu S. Characteristics of delayed TSH elevation in neonatal intensive care unit (NICU) newborns. J Pediatr. 2016;178:135–40.CrossRef
25.
Tehrani RF, Aghaee M, Asefzadeh S. The comparison of thyroid function tests in cord blood following cesarean section or vaginal delivery. Int J Endocrin Metab. 2003;1:22–6.
26.
McElduff A, McElduff P, Wiley V, Wilcken B. Neonatal thyrotropin as measured in a congenital hypothyroidism screening program: influence of the mode of delivery. J Clin Endocrinol Metab. 2005;90:6361–3.CrossRef
27.
Herbstman J, Apelberg BJ, Witter FR, Panny S, Goldman LR. Maternal, infant, and delivery factors associated with neonatal thyroid hormone status. Thyroid. 2008;18:67–76.CrossRef
28.
Chan LY, Chiu PY, Lau TK. Cord blood thyroid-stimulating hormone level in high-risk pregnancies. Eur J Obstet Gynecol Reprod Biol. 2003;108:142–5.CrossRef
29.
Ryckman KK, Spracklen CN, Dagle JM, Murray JC. Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone. J Pediatr Endocrinol Metab. 2014;27(9–10):929–38.PubMedPubMedCentral
30.
van Wassenaer AG, Kok JH. Trials with thyroid hormone in preterm infants: clinical and neurodevelopmental effects. Semin Perinatol. 2008;32:423–30.CrossRef
31.
Porterfield SP, Hendrich CE. The role of thyroid hormones in prenatal and neonatal neurological development - current perspectives. Endocr Rev. 1993;14:94–106.PubMed
32.
Leviton A, Paneth N, Reuss ML, Susser M, Allred EN, Dammann O, et al. Hypothyroxinemia of prematurity and the risk of cerebral white matter damage. J Pediatr. 1999;134(6):706–11.CrossRef
33.
Paul DA, Leef KH, Stefano JL, Bartoshesky L. Low serum thyroxine on initial newborn screening is associated with intraventricular hemorrhage and death in very low birth weight infants. Pediatrics. 1998;101:903–7.CrossRef
34.
Lim G, Lee YK, Han HS. Early discontinuation of thyroxine therapy is possible in most very low birth weight infants with hypothyroidism detected by screening. Acta Paediatr. 2014;103:e123–9.CrossRef
35.
Jung JM, Jin HY, Chung ML. Feasibility of an early discontinuation of thyroid hormone treatment in very low birth weight infants at risk for transient or permanent congenital hypothyroidism. Horm Res Paediatr. 2016;85:131–9.CrossRef
36.
Radetti G, Fanolla A, Pappalardo L, Gottardi E. Prematurity may be a risk factor for thyroid dysfunction in childhood. J Clin Endocrinol Metab. 2007;92:155–9.CrossRef
Metadata
Title
Thyroid dysfunction in preterm infants born before 32 gestational weeks
Authors
Hye-Rim Kim
Young Hwa Jung
Chang Won Choi
Hye Rim Chung
Min-Jae Kang
Beyong Il Kim
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1792-0

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